ETHICAL DILEMMAS of raising needs versus limited resources

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ETHICAL DILEMMASof raising needs versus limited
resources

• Manfred Maier

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CONTENT

• reasons for raising needs
• aspects of resources
• ethical dilemmas
• principles of solutions

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LEARNING GOALS

• explain same developments which challenge our
  resources
• discuss some ethical dilemmas arising from
  biomedical / social developments

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RAISING NEEDS IN HEALTH CARE

• demographic developments
• increased life expectancy
• increased elderly population
• increase in chronic diseases
• new diseases
• increase in multi- morbid patients
• new epidemics
• reduction in birth rate
• increased risks due to leisure time activities

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(No Transcript)
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RAISING NEEDS

• biomedical developments
• technical developments (PET,)
• diagnostic / therapeutic improvements
• Increased requirement for resources
• new medications
• screening prevention health promotion
• palliative care
• guidelines
• quality improvement measures
• information technology
• individualized treatment (pharmacogenomics)

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LIMITED RESOURCES

• financial resources
• reimbursement system
• structural resources
• Health insurance, HC- systems, group practices,
  facilities
• personnel resources
• imbalance of health care professionals,
  generalists - specialists, health care teams
• not all goals can be reached at the same time

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• ECONOMIC RESOURCES
• Education Health Care
  Environment Safety
• Prevention Curative Medicine
  Rehabilitation nursing continued
  payment of
  wages
• accidents diagnostics medical
  inpatient sickness
• immunization therapy social
  advising handicapped
• health checks emergency care
  occupational psychosocial
• Patient oriented health care

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ETHICAL PRINCIPLES

• Primacy of patient welfare
• Patient autonomy
• Social justice

Hippocrates (460-380 bc)
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ETHICAL DILEMMAS

• demanding patients
• patients in need
• guideline requirements
• genetic diagnostics
• screening procedures prevention
  medicalization
• palliative care
• defensive medicine
• to many duties in GP /FM time limited
• public health care private insurance
• economic forces ethical principles
• overuse misuse underuse of resources
• inpatient outpatient interface

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SOLUTIONS

• setting of goals for health care
• setting priorities
• provision of health care where it is most
  efficient
• communication with the public and with the
  patient
• transparency in health care