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Ahmeneh Ghavam from U of Chicago: first speaker in ethics of rationing in #PedsICU #CCC49
Ghavam : objectives and overview #CCC49 #PedsICU
Ghavam: how did we get here? #CCC49 #PedsICU by 2030 we’ll spend more than 20% of GDP on healthcare in the US
Ghavam: the “R” word, we do it whether we acknowledge it or not #CCC49 #PedsICU
Ghavam: different types of rationing #CCC49 #PedsICU need more macro allocation and explicit
Ghavam: rationing at the bedside #CCC49 #PedsICU bedside rationing is not perfect
Ghavam: is rationing ethical (it’s already being done by insurance) #CCC49 #PedsICU
Ghavam: it’s a balance #CCC49 #PedsICU four ethical principles: first, distributive justice
Ghavam: beneficence #CCC49 #PedsICU
Ghavam: non-maleficence #CCC49 #PedsICU
Ghavam: autonomy is violated by rationing #CCC49 #PedsICU
Ghavam: implications of rationing for children. Money saved could be applied to a lot of public good. But could have negative effects #CCC49 #PedsICU.
Ghavam: a sample case SMA type 1 #CCC49 #PedsICU significant management differences between US and commonwealth countries. US leans more towards high cost pathway.
Ghavam: example continued SMA patient #CCC49 #PedsICU rationing is already occurring by insurance companies.
Ghavam: across the pond. NHS experience #CCC49 #PedsICU
Ghavam: uninsured in the US remain #CCC49 #PedsICU
Ghavam: US with higher avoidable mortality, lower coverage, higher costs, higher infant mortality #CCC49 #PedsICU
Ghavam: summary #CCC49 #PedsICU maximize resources for more people.
Now to @hmushay for the con-side of rationing #CCC49 #PedsICU
Ushay: things that may influence his opinions (after stating that he couldn’t find an ethicist to help support his position.) no child should die in the US for lack of access to the #pedsICU #CCC49
Ushay: but the world we work in #CCC49 #PedsICU
Ushay: it’s a balance #CCC49 #PedsICU rationing decisions
Ushay: it differs from Triage. But we ration every day. #CCC49 #PedsICU examples of medications
Ushay: every day decisions in the #PedsICu #CCC49. Rationing already occurs
Ushay: photographs from India #CCC49 #PedsICU CICU vs intubated kids being hand bagged by families in the same hospital.
Ushay: society statements tend to argue against bedside rationing #CCC49 #PedsICU
Ushay: principles of ethics #CCC49 #PedsICU
Ushay: it’s an argument of justice. And in the US rationing would disproportionately affect impoverished minority and underserved populations. #CCC49 #PedsICU
Ushay: justice concerns. #CCC49 #PedsICU. Who speaks for children? Only the AAP
Ushay: the fiduciary relationship #CCC49 #PedsICU
Ushay: gatekeeping #CCC49 #PedsICU
Ushay: how do we decide? Good rules don’t exist. #CCC49 #PedsICU
Ushay: economic argument, yes healthcare is expensive, but child health is a tiny part of the spending. #CCC49 #PedsICU
Ushay: pediatric beds grew at faster rate, but almost exclusively in NICU beds, while PICU beds actually decreases #CCC49 #PedsICU
Ushay: only 1/3 of high cost patients, remained high cost patients of complex pediatric patients #CCC49 #PedsICU outpatient spending can decreases costs.
Ushay: utilization costs are not the major driver of costs. #CCC49 #PedsICU
Ushay: #CCC49 #PedsICU
Ushay: conclusions. #CCC49 #PedsICU family satisfaction with EOL care in the ICU is high
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