From an Ethics of Rationing to an Ethics of Waste Avoidance

The New England Journal of Medicine has recently published an article entitled, "From an Ethics of Rationing to an Ethics of Waste Avoidance," by Howard Brody, M.D., Ph.D.  The article talks about how in medicine, people are focusing on the ethical dilemma of waste avoidance these days.  The facts that have recently overtaken this ethical discussion show that waste in U.S. health care, defined more broadly as spending on interventions that do not benefit patients, actually amounts to a much larger sum — at least 30% of the budget — and that this waste is a major driver of cost increases.  The two principal ethical arguments for waste avoidance are first, that we should not deprive any patient of useful medical services, even if they're expensive, so long as money is being wasted on useless interventions, and second, that useless tests and treatments cause harm. Treatments that won't help patients can cause complications. Diagnostic tests that won't help patients produce false positive results that in turn lead to more tests and complications. Primum non nocere becomes the strongest argument for eliminating nonbeneficial medicine.

This ethical decision is hard for physicians because they are supposed to do whatever they can to help out their patients, even though this might lead to waste.  If the doctor believes that the treatment might help the patient even if its a tiny percent, its hard for them to say no to it, especially since the patient will probably want the treatment also because they would like to get better.  I have no problem with this type of waste, but I do have a huge problem with doctors who order usless tests and treatments to increase their bank account.  Since waste is currently 30% of our health budget, maybe if we can get rid of the waste we could save enough money to permit both universal coverage and future cost control.