Painful justice: an ethical perspective on the allocation of trauma services in Australia.

Abstract

Australia faces general and particular problems in the just distribution of trauma services, such as a proliferation of expensive technologies, economic and geographic limitations on their provision, and inequities in allocation. The ethics of shalom in which people live in harmonious relationships with each other, the world and God provide a moral framework for the discussion of the allocation of health care. Ethics deal with people and their relationships, which entails examining the nature and consequences of an action or policy and the character of the persons and institutions involved. The goal of health care, including trauma services, is not to 'fight disease' or to improve the health of the community, but to return people to proper functioning as people-in-relationships, as far as this is practicable. In applying this to the equitable provision of trauma services in Australia, we should distinguish between sustenance rights and community-provided mercies. The former are basic services that we need in order to function meaningfully in the community, and to which we are entitled (eg., basic health care). The latter are other benefits that we as members of the community choose to provide for each other, but to which we are not entitled per se (eg., ICU, Tertiary Trauma Centres). We should do all we reasonably can to ensure that all people receive their healthcare sustenance rights, that healthcare mercies are equitably distributed, and that the person-orientation of health care is maintained in the face of 'technological imperatives'.