George Annas, JD, MPH, Health Law Dept., Boston University School of Public Health, 715 Albany St., Boston, MA 02118-2307, 617-638-4626, firstname.lastname@example.org and Michael Grodin, MD, Boston Medical Center, The Boston Center for Refugee Health and Human Rights, Dowling 7, 1 Boston Medical Center Place, Boston, MA 02118.
What ethical and human rights lessons can be learned by resource poor countries from the experience of the US in rationing health care and medicine? Rationing schemes for medicines have generally been based on medical selection criteria, usually itself based on likely medical benefit from the intervention; a random device, like a lottery, which is the fairest; ability to pay, the market model, which is the most prevalent; and some combination of the first three. Ethical principles require that whatever system is chosen be the fairest (equity). In addition, potential benefits can be accounted for by including both desire for treatment and the probability of benefit from it (for either individuals or groups). The most developed examples are selecting the next person to get a kidney or heart transplant, and determining the group priorities for flu vaccine during a vaccine shortage. Human rights considerations demand that whatever priority system is used it be nondiscriminatory, i.e. that it make no distinctions based on gender, race, religion, national origin or any other fixed characteristic of individuals. This presentation will conclude with a determination of if and how any of these principles should be applied to the distribution of ARVs in resource poor countries, or if other principles are more relevant in this setting.
Presenting author's disclosure statement:
Any relevant financial relationships? No
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA