Making tough resource decisions. A process for considering both values and costs.

Effective resource management involves prospective decision making, including setting priorities. This enables healthcare facilities to provide services that are consistent with institutional commitments and, under some circumstances, to limit or deny services that are inconsistent with those commitments. The challenge is to apply explicit moral analysis to resource allocation efforts to ensure that facilities are treating patients consistently and fairly. Not only are allocation decisions unavoidable, they also can promote holistic, socially responsible medical practice. But current mechanisms, which are largely hidden from view and informal, can negatively affect important relationships with constituents. The just allocation of our precious healthcare resources rests on values that can either conflict with or complement one another. The core values in resource management include respect for persons, professional integrity, due process, informed consent, stewardship, and the common good. An interdisciplinary team of providers should oversee an ongoing review of resource management mechanisms. The group should meet regularly to look at how the mechanism works, what its goals are, what unit of care it evaluates, and what measurements are used to reach the goals. The measures might include severity of illness, effectiveness, cost, and social factors. Examining questions related to each of these areas can help the group determine whether an existing or proposed resource management mechanism is morally defensible.