Dr Jacqueline Glover: Clinicians' Obligations of Justice Regarding Costs of Care

Clinicians have obligations of justice when treating patients, which can lead to difficult decisions on how to ethically allocate limited resources to patients as a whole, said Jacqueline Glover, PhD, professor in the Department of Pediatrics and the Center for Bioethics and Humanities at the University of Colorado Denver.

Transcript (slightly modified)

When considering an ethical framework for healthcare, what is the physician role regarding costs?

We think about clinicians as professionals, as having role-specific obligations, and it’s never part of a doctor’s, for example, role to consider costs. We want our clinicians to be gatekeepers, but only gatekeepers that swing the door maximally open. They should only consider one patient at a time, and never cost.

I think that’s not true. I think healthcare professionals have obligations of justice, just like you and I have obligations of justice, uncontrolled spending by some puts at risk the availability of some other things, or the very same thing, to others. Clinicians have obligations of justice because we all do.

We also think that the only benefits are on the side of receiving the drug, and that’s not necessarily true. High-cost drugs, not only with the side effects of any drug, but high-cost drugs may not have good outcomes because they’re so expensive. Patients who can’t afford them may start the treatment later, may not take the drug, may not be as compliant, and they may stop taking the drug because of cost.

So, healthcare professionals have obligations to consider patients’ benefit, but also obligations of justice to consider their patients altogether. Human needs are limitless, but our ability to respond to those needs are limited. Our resources are limited, and so cost is an ethical concern, because we have to figure out how best to use our limited resources on behalf of patients and on behalf of all the patients together, what we call the common good.

If we thought of time instead of cost, we don’t expect our doctors to spend all of their time with us. We realize that physicians, nurses, pharmacists have obligations to other patients, so we recognize that with time allocation. It’s the same thing for allocation of cost.