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Research on “Big Ticket” Items: Ethical Implications for Equitable Access

Published online by Cambridge University Press:  01 January 2021

Robert M. Veatch
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“Big ticket” items in medicine pose a moral puzzle. We can call it the “Coby Howard puzzle,” after the boy whose need for an expensive bone marrow transplant forced Oregonians to reassess their policy of prohibiting this and other expensive “big ticket” procedures in favor of more low-tech, apparently cost-efficient interventions. The Oregon rationing debate was stimulated by the concern that expenditures on “big ticket” medical treatments for life-threatening disease were coming at the expense of low-tech, preventive “basic” care like immunizations, wellbaby clinics, and prenatal care.

Another recent example was the public controversy over expenditures of over $1,800 per day on a project to try to separate Siamese twins conjoined at the heart. The physicians, prior to the procedure, claimed there was a one percent chance of success. It was reported that 50,000 children in Philadelphia could be immunized at the cost of that innovative therapy. Cost-benefit analysis suggests that much greater good would be done in the long run if we ignored the expensive, long-shot, high-risk projects and focused on basic medical needs.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 22 , Issue 2 , Summer 1994 , pp. 148 - 151
Copyright
Copyright © American Society of Law, Medicine and Ethics 1994

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References

Klevit, Harvey D., Bates, Alan C., Castanares, Tina, Kirk, E. Paul, Sipes-Metzler, Piage R., Wopat, Richard, “Prioritization of Health Care Services: A Progress Report by the Oregon Health Services Commission,” Archives of Internal Medicine, 151 (1991): 912–16.Google Scholar
Veatch, Robert M., “Should Basic Care Get Priority? Doubts About Rationing the Oregon Way,” Kennedy Institute of Ethics Journal, 1, no. 3 (1991): 187–206.CrossRefGoogle Scholar
Saltus, Richard, “Who Lives, Who Dies—And Who Pays?,” The Washington Post Health, Aug. 31, 1993, p. 7.Google Scholar
Ibid.Google Scholar
Rawls, John, A Theory of Justice (Cambridge: Harvard University Press, 1971); and Veatch, Robert M., “Justice and the Right to Health Care: An Egalitarian Account,” in Bole, Thomas J. III, Bondeson, William B., eds., Rights to Health Care (Dordrecht: Kluwer Academic Publishers, 1991), pp. 83–102.Google Scholar
For a fuller discussion of the difference between the “moment-in-time” and “over-a-lifetime” perspectives, see Veatch, Robert M., “Distributive Justice and the Allocation of Technological Resources to the Elderly,” Life-Sustaining Technologies and the Elderly: Working Papers, Volume 3, Legal and Ethical Issues, Manpower and Training, and Classification Systems for Decisionmaking (Washington, D.C.: U.S. Congress, Office of Technology Assessment, 1987), pp. 87–189; and Veatch, Robert M., “How Age Should Matter: Justice as the Basis for Limiting Care to the Elderly,” in Winslow, Gerald R., Walters, James W., eds., Facing Limits: Ethics and Health Care for the Elderly (Boulder, Colorado: Westview Press, 1993), pp. 211-29.Google Scholar
Rawls, , op. cit., pp. 284–93.Google Scholar