40. CASE: All Things Being Equal…

As a member of your health region Foundation Board, you know that there is going to be a rather intense, lengthy, and difficult discussion tonight. A high profile community member recently passed away and left $500,000 in her will to the Foundation. This was an unexpected donation and means that the Foundation is in a position to put the money towards an important project for the health region in addition to what was already planned. Many suggestions for the use of this money have been made, and in conversation with senior leadership, the Foundation Board has narrowed these options down to three for consideration:

  • The accreditation report from a few years ago strongly recommended equipment upgrades for both the Emergency Department and the Intensive Care Unit. While some upgrades have been made, there are still a number of important ones left to do. Knowing that accreditation is coming up again soon, there is increasing pressure to find the resources to complete these upgrades.
  • The health care teams on several inpatient units recently highlighted the need for equipment to accommodate persons who are obese. This equipment includes specialized beds, lifts, chairs, etc. and will require some renovation of doorways for the new equipment. Issues of patient and staff safety, as well as good patient care, have been identified as motivating this request. Given some local press on the difficulties experienced and the associated shame expressed by patients who are morbidly obese in the health region, a number of people have indicated that this is an issue that requires immediate attention.
  • A pledge to expand community palliative care services was made last year by the health region. With the aging population and difficulty for many in accessing hospital-based palliative care, this pledge was received with much anticipation. To date, however, it has been difficult to attract the needed staff. Additional funds could go towards incentive packages as well as to greatly improve the infrastructure for this type of service.
  • How would you advise your board to make such a decision?
  • What further information do you need to move ahead with the discussion?
  • What underlying values should be considered?
  • How will you justify and communicate the decision that you made?

Some Values and Ethics Issues to Consider

  • Resource allocation
  • Distributive justice
  • Priority setting

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