Who is supposed to pay for it? The healthcare industry of western industrialised nations has financing problems: technology marches on and makes new, sophisticated treatments possible; at the same time, the population is ageing. Consequently, scientists and politicians demand fundamental reforms to be implemented in order to ensure that healthcare remains financeable in future. RUB philosopher Corinna Rubrech discusses in her PhD thesis the way a new healthcare system might look like that is fair not just with regard to economic considerations.
No arbitrary distribution
If the state is the central entity in charge of distributing limited resources, how is it supposed to determine whose demand for those resources is the most acute, i.e. which patient is to be prioritised over others? In order to answer these questions, designated criteria are necessary that ensure that the distribution does not happen randomly. Corinna Rubrech from the Chair of Applied Ethics discusses those criteria from the philosophical perspective and assesses various suggestions that are put forward by healthcare economists for the restructuring of the healthcare system.
One initial suggestion is to exclude those individuals who lead a high-risk lifestyle, for example by doing extreme sports or smoking. The philosophical theories that propagate a strong sense of personal responsibility emphasise that an individual should be accountable for the consequences of the diseases he or she brought upon himself or herself. However, this raises the question who decides if, for example, a patient suffers from cancer because he had been a heavy smoker for many years or because of a genetic predisposition due to which he had always been likely to get larynx cancer.
The criterion of age
Another criterion that is subject to controversial debate is age. Healthcare politicians are debating if old people should have the same claims on healthcare services as young people. Certain philosophical theories present plausible arguments in favour of old-age rationing. If confronted with the choice of providing highly expensive life-prolonging treatment to everybody, regardless of their age, or only to individuals under a certain age limit, it may make sense to prioritise younger people. They would thus be given the chance of likewise living to an old age. Such distribution seems particularly appropriate if resources are in short supply, for example, if only a few donor organs are available for transplantation.
Complete "RUBIN" article - postgraduates temping as science journalists
PhD students at the RUB have assisted the "RUBIN" editorial team by contributing articles to the current German and English editions. Corinna Rubrech is one of the three temporary science journalists. She is doing her PhD in the RUB Research School and presents her research subject in the RUB science magazine, targeting the general audience.