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A study on the ethics of microallocation of scarce resources in health care
  1. P A C Fortes1,
  2. E L C P Zoboli2
  1. 1Faculty of Public Health, University of San Paulo, Brazil
  2. 2School of Nursing, University of San Paulo, Brazil
  1. Correspondence to:
 Dr P A de Carvalho Fortes, Faculty of Public Health, University of San Paulo, Av Dr Arnaldo 715, Cerqueira César, 01246–904, San Paulo, Brazil;


Objectives: This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism.

Methods: A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies (see appendix). In each of the eight cases the interviewee had to choose which of the two patients described, both of whom suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed.

Results: The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people’s disapproval of the alcoholic was stronger than that of the nicotine abuser.

  • Bioethics
  • health care rationing
  • selection of patients
  • institutional ethics

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