P.J. Maddox's response:

I am touched and encouraged by the numerous responses received on the resource allocation article. Awareness of the limitations our resources and the impact of resource allocation on varying social and individual levels is certainly a first step for all of us. Insight about the wide array of values and priorities possessed by decision-makers, consumers and policy-makers alike, as well as the awareness of the circumstances of a particular patient care situation make even our best attempts at rational decision-making frustrating and at times discouraging. Why do we so often seem to be in a situation that has no "good" choices? Why can’t we always come up with a "win-win" alternative? And, why does this bother us so much?

As Americans, we have come to expect great and almost unlimited responses from our health system and its providers. As nurses we are not accustomed to making decisions that don’t "feel good." And yet, in nature and in our society, resources are limited in their availability and sometimes accessibility. Often driven by values of wanting to help individuals and society, it seems repugnant to us to deal with resource allocation when it means saying "no" or "not that way." We share the most economically advantaged society and health system in the world. Part of good care is good stewardship of our resources. Because there are no easy formulas or value correct approaches that fit all situations, an open dialogue about the reality of our circumstances weighed against competing demands, benefits and differing values and goals are important decisional considerations.

A real and open dialogue about the complexity of decision-making and the ethical principles imbedded in them is critical. I hope that this OJIN edition continues to encourage discussion about the importance of explicit resource allocation decisions and serves to further the dialogue on the important dilemmas we face as administrators, health care professionals and socially responsible citizens. Thank you for sharing your thoughts!

Go to the article.
Letters by Michael P. Austin, Scott V. Hudson, Judy Fiene

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