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.

Beneficence↗

PubMed1994

Keratitis as a complication of bilateral, simultaneous radial keratotomy.

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Humans↗

PubMed1990

Efficacy of home health care in patients with peripheral vascular disease.

This investigation was designed to study the effects of home health care (HHC) on patients who have been hospitalized with peripheral vascular disease. For a patient to have HHC, the patient had to have a defined wound, educational needs, or both. Sixty patients, 30 with HHC and 30 without, were contacted approximately 30 days after their last hospital discharge. The 30 patients with HHC were deemed to be at increased risk because of multisystem disease with multiple medications, infirmity, early senility, and often complex wounds. In a prospective fashion, each patient was interviewed by either a registered nurse or medical student using a standardized data collection form. The following issues were assessed: incidence of postoperative complications, knowledge of the patient of his or her disease, compliance with medication (knowledge of, regular use), incidence of readmission, and unscheduled clinic or emergency department visits. Upon statistical analysis using the two-sample t-test and Pearson chi-square test, no significant differences were found between the two groups in terms of complications, compliance, or patient education. HHC, therefore, was found to be helpful to patients with peripheral vascular disease. In our study, the use of HHC made the risk of complications in a group of patients with defined teaching needs and wound care needs equal to that in a group with no such defined needs on discharge from the hospital.

Chi-Square Distribution↗