Justice in the distribution of health resources

December 10, 2013

I teach a course titled “Ethical Decision-Making” at Midwestern University College of Pharmacy in Glendale, Arizona. Nonetheless, I confess I have struggled to understand how pharmacists can in any practical way assume responsibility for the eighth article of the Pharmacist Code of Ethics (http://www.pharmacist.com/code-ethics).

That one comes last, and it is sometimes easy merely to recite the words, without giving too much thought to what they mean for pharmacists in daily practice and life. The eighth article reads:

A pharmacist seeks justice in the distribution of health resources.When health resources are allocated, a pharmacist is fair and equitable,balancing the needs of patients and society.

It seems unlikely that it simply means we should allocate a drug that is temporarily in low supply among patients throughout the period of shortage. Does it mean, as seems more likely, that a patient with a minimum-wage job and no health insurance should have access to medications that are the same as - or at least similar to - those available to our other patients?

A different type of commodity

Healthcare is not like most other commodities. In most instances, medication and medical treatment are not luxuries. Patients do not use healthcare services because they want to, but because they must.

Healthcare, including the distribution of prescription drugs, is allocated based upon the ability to pay - or to get someone else to pay. If someone has no money, of course, welfare provides. If patients have a lot of money, meaning they earn livable wages, they have insurance.

We are now struggling with what to do with those in the middle - those who make too much money to receive welfare but not enough to be able to choose both food and drugs.

Providers in the middle

We are arguing in this country about the Affordable Care Act, passed by one political party and opposed by the other. Those who support the law are trying desperately to implement what even they agree is a less-than-perfect system of health insurance. Those opposed to the ACA appear to be desperately trying to destroy it before it has an opportunity to work.

Pharmacists and the healthcare community are also in the middle. Few pharmacists believe that patients who can be treated with the wonder drugs we oversee should have to go untreated or die because they are neither poor enough nor rich enough to receive them. Nor can we, as business operators, provide prescriptions without payment. To say, “Let charities provide” is a haphazard and inefficient answer.

The system of payment for healthcare services, meaning primarily insurance, in the United States has grown haphazardly, without an overall plan or goal. If an efficient system of paying for healthcare had been planned, it is unlikely that the companies we work for would have been put in charge of deciding which and how much insurance we need. Rather, using principles of the free market, we each would have been able to make those decisions for ourselves. Instead there evolved an employer-based system of socialized medicine in which the centralized planning is performed by the boss.

Professional responsibility

Whether we as pharmacists support the ACA as the best answer available or oppose it as the worst answer available, we should work together to solve the underlying problems. If the ACA isn’t the best answer, then it is incumbent upon us either to help to fix it or to work to implement an alternative that is better.

Perhaps government should not be a major part of the solution. If not, what should be?

If this eighth article of the pharmacists’ ethical code has meaning, it must lead us to agree that all patients need access to the essential prescription drugs required to treat their symptoms.

We as pharmacists should raise our voices, individually or collectively, demanding either to fix the problems with the ACA or to propose workable alternatives.