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Editorial

Published online by Cambridge University Press:  02 May 2006

DORIS SCHROEDER
DORIS SCHROEDER
Affiliation:
Centre for Professional Ethics, University of Central Lancashire, United Kingdom
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Extract

Rationing and patient selection is inevitable in medical care, but in its most extreme form—when doctors and nurses decide about life and death—it is an almost unbearable burden for the profession. Eric Goemare, the Head of the South African Mission of Médicins Sans Frontières (MSF) and his staff faced three equally difficult selection issues when rolling out antiretroviral treatment to HIV/AIDS patients in South Africa. Initially, the treatment had to be rationed due to lack of financial resources. Today, rationing is mostly due to lack of human resources. But at the same time, patients are being deselected because of nonadherence to the treatment regime to avoid the creation of multi-drug-resistant strains of the HIV virus.

Type
HEALTH AND HUMAN RIGHTS
Information
Cambridge Quarterly of Healthcare Ethics , Volume 15 , Issue 3 , July 2006 , pp. 301
Copyright
© 2006 Cambridge University Press

Rationing and patient selection is inevitable in medical care, but in its most extreme form—when doctors and nurses decide about life and death—it is an almost unbearable burden for the profession. Eric Goemare, the Head of the South African Mission of Médicins Sans Frontières (MSF) and his staff faced three equally difficult selection issues when rolling out antiretroviral treatment to HIV/AIDS patients in South Africa. Initially, the treatment had to be rationed due to lack of financial resources. Today, rationing is mostly due to lack of human resources. But at the same time, patients are being deselected because of nonadherence to the treatment regime to avoid the creation of multi-drug-resistant strains of the HIV virus.

Renée Fox, a medical sociologist who is conducting a sociological study of MSF, analyzes the most difficult aspects of this patient selection process in a lucid first-hand account together with Eric Goemare. Their article, which includes highly poignant and well-observed case studies, demonstrates the seriousness of the problems encountered. Moreover, the persistent ethical questions raised by Renée and Eric are applicable in most medical settings: “best outcomes” versus “fair chances” selection, clinician's fidelity versus the social goals of medicine, or quantity of persons treated versus quality of treatment.

Ruth Macklin examines these issues with analytical brilliance, and Solomon Benatar's knowledgeable comments from the public health perspective are as important for this minisymposium as his insistence that the emergence and spread of infectious diseases cannot be stopped with philanthropy, but only by addressing the underlying global economic, political, and social forces that perpetuate serious poverty. To round up this extraordinary set of papers, Eric makes some very interesting, practical comments on Ruth's response.

I would like to thank Renée, Eric, Ruth, and Solly for contributing to this minisymposium to such good effect! As this dialogue between thinkers and practitioners from different disciplines on a topic of pressing urgency and importance was so fruitful, I would like to encourage other potential contributors to my column to consider a similar format.