Use of ethical criteria in medical decision making. Corneal transplantation
C. H. Kliger
Department of Ophthalmology, University of California-Los Angeles School of Medicine, USA.
OBJECTIVES: To determine for a defined procedure the prevalence of the use
of 15 criteria currently or historically relied on to select recipients of
scarce medical resources, and to compare this use with the determinations
of a report of the American Medical Association Council on Ethical and
Judicial Affairs identifying many of these criteria as ethically
appropriate or inappropriate for such use. DESIGN: Survey. PARTICIPANTS:
All US members of a national cornea society were sent survey instruments.
Approximately 63% (214/340) responded. MAIN OUTCOME MEASURES: Mean ratings
on a scale of 1 to 5 (not important to very important) for each of the
allocation criteria with regard to degree of influence on the decision to
perform a corneal transplantation. RESULTS: Ethically appropriate criteria
tended to receive high overall ratings, and inappropriate criteria, low
ratings. Three ethically inappropriate criteria received relatively high
ratings: previous use of resources, perceived obstacles to treatment, and
contribution of patient to disease. High percentages of respondents applied
ratings other than not important to all criteria deemed ethically
inappropriate. CONCLUSIONS: Certain ethically inappropriate criteria may
have been viewed as influencing graft survival and thus thought to have
ethically appropriate aspects, mitigating to some degree the aforementioned
three ratings. Nonetheless, the study supports the need for standard
setting and educational efforts about criteria for the allocation of
medical resources to ensure that ethically inappropriate criteria are
consciously excluded from decision making and to stimulate discussion and
raise consciousness regarding this important issue.
