How does Hackler define rationing when it concerns healthcare products
and services?
Is Rationing of Health Care Ethically Defensible? 325
As the cost of healthcare delivery increases and healthcare reform makes
major changes in the business of health care, the issue of rationing will become
more important and increasingly difficult. In his consideration of this issue,
Hackler defined the concept of rationing and argued that it may be ethically
justified under certain conditions. He also discussed the ideal conditions for
rationing in the real world and provided cautions about who should make
decisions about this practice. Finally, he stressed that whereas rationing
of healthcare spending may be necessary and defensible, trading lives for
money is not.
QUESTIONS FOR DISCUSSION
1. How does Hackler define rationing when it concerns healthcare products
and services?
2. What is the impact of a market-driven economy on the rationing
arguments presented in this chapter?
3. How does a fragmented healthcare system negatively affect the ethical
and procedural decisions in a rationing plan?
4. How can having a foundation in Kantian ethics help to limit the potential
for making tragic choices in rationing health care?
5. Given the changes that are projected in the 21st century for America
(including the Patient Protection and Affordable Care Act [PPACA] and
the increasing numbers of elderly people), do you think rationing of
health care will be inevitable?
FOOD FOR THOUGHT
PPACA promises great changes in the healthcare system. Coupled with the
rapidly aging baby boomer generation, this change may lead to an increased
demand for services without an accompanying supply of providers. Do you
think that rationing as defined in this chapter will be part of the post-PPACA
future? How can you justify rationing in a universal healthcare environment?
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