Ethics for the Pediatrician: Just Distribution of Health-care Resources and the Neonatal ICU

Abstract

1. Charles C. Camosy, PhD* 1. *Department of Theology, Fordham University, Bronx, NY. After completing this article, readers should be able to: 1. Explore some implications of the finite nature of human beings (as exemplified by sickness and mortality) and of resources, both for medicine in general and the neonatal intensive care unit (NICU) in particular. 2. Explain the refusal to discriminate on the basis of disability for even the sickest members of the NICU population. 3. Show how taking cost into consideration, at both macro and clinical levels, does not violate human dignity. 4. Respond to arguments that NICU care is among the most cost-effective in medicine. 5. Suggest future strategies for combating a culture of overtreatment in the NICU. The debate over health-care reform in the United States brought discussions of “comprehensive health benefits” and “cost containment measures” to the dinner tables of average Americans. However, the American Academy of Pediatrics (AAP) faced this issue in 1998: (1) “The American Academy of Pediatrics (AAP) advocates universal and insured financial access to quality health care for all newborns, infants, children, adolescents, young adults through age 21 years, and pregnant women … Such insurance should provide a comprehensive benefit package that should include, but not be limited to, pregnancy related services, preventive care services recommended by the AAP, acute and chronic care services, and emergency care services.” In this same statement, the AAP acknowledged that: “Cost containment is essential but must not impair the quality of care delivered. Physicians must play an important role in establishing principles of evidence-based medicine, validating the measurements used, and ensuring quality in any cost-containment process. Responsibility for controlling costs should be a combined responsibility of employers, families, clinicians, payers, and administrators of health …