Use of ethical criteria in medical decision making. Corneal transplantation.

OBJECTIVES

To determine for a defined procedure the prevalence of the use of 15 criteria currently or historically relied on to select recipients of scarce medical resources, and to compare this use with the determinations of a report of the American Medical Association Council on Ethical and Judicial Affairs identifying many of these criteria as ethically appropriate or inappropriate for such use.

DESIGN

Survey.

PARTICIPANTS

All US members of a national cornea society were sent survey instruments. Approximately 63% (214/340) responded.

MAIN OUTCOME MEASURES

Mean ratings on a scale of 1 to 5 (not important to very important) for each of the allocation criteria with regard to degree of influence on the decision to perform a corneal transplantation.

RESULTS

Ethically appropriate criteria tended to receive high overall ratings, and inappropriate criteria, low ratings. Three ethically inappropriate criteria received relatively high ratings: previous use of resources, perceived obstacles to treatment, and contribution of patient to disease. High percentages of respondents applied ratings other than not important to all criteria deemed ethically inappropriate.

CONCLUSIONS

Certain ethically inappropriate criteria may have been viewed as influencing graft survival and thus thought to have ethically appropriate aspects, mitigating to some degree the aforementioned three ratings. Nonetheless, the study supports the need for standard setting and educational efforts about criteria for the allocation of medical resources to ensure that ethically inappropriate criteria are consciously excluded from decision making and to stimulate discussion and raise consciousness regarding this important issue.