Having considered the most important responsibilities of present-day healthcare, we have to think about two statements. As said by a certain physician, "the chief duty of a practitioner is to continue permitting the victims of self-indulgence to exploit injurious joys of living like tobacco, liquor, gluttony and letting them live as long as it is possible." According to the WHO statement, "healthiness is the enjoyment of superb bodily, spiritual and social condition." This state is not just the absence of an illness or impairment. The quoted practitioner shows extreme modesty of requirements where he notices a physician as an operator in charge of an android whose sole duty is just to do that. Another attitude comes from extreme expectations, in conditions of common awareness and individual care for everyone's general fitness combined with the favourable state of the community with respect to individual good. The power of healthcare is based upon education and prophylaxis.
In what way should the healthcare funds be assigned, with respect to the general and particular needs? The case of Mr XYZ, the first citizen of the Aberration Republic who got a new heart is representative and indicative. The clinic paraphernalia were so scanty that his post-surgical treatment required changing the schedule of several other equally serious operations due to the fact that the only really germ-free area was the surgery room where the transplantation took place. Nevertheless, in such conditions it was impossible to find an alternative way out from that awkward dilemma.
With respect to someone's necessities, the question usually arises of who is the first to be treated. In the described case explained the patient's privileged position which was justified from the scientific point of view. Anyway, any time the means are limited, the basic question arises again of the right to choose whether to save or sacrifice an individual life considering the arguments for and against a given decision. If there are three directly endangered patients and a dose of efficient preparation for only one, the decision whom to choose requires extreme responsibility. If the perspective of the highest individual prosperity and maximum life span were considered, the junior patient would have to be selected, if the necessity of medication were the measure, the gravest case should be the priority, and for the cause of common good, the one with the best social record and the most politically correct should win the privilege of granted life. Out of the three criteria, the illness seriousness looks decisive, as regardless of the patient's age and individual social merits, the objective necessity of the physician's intervention is forced purely by the current circumstances and the relative efficiency has the soundest point of reference. In such cases, even the slightest sign of health recuperation gains additional magnitude and is proportionally the most favourable course of events. There must be a provision, though, that the priorities are clearly defined and the terms used mean the same to everybody. The only doubts of ethical nature would appear in case of equal seriousness of the illnesses and the dilemma of honest application of medicines would be there in its pure form.
The efficient medication is a very strong aspect of selection and the assignment of medicines is likely to be conditioned by the prospective achievement of desired results. In cases with low degree of complexity, like blood transfusion, the choice is determined by the criteria of the treatment possibility and adequacy. The scale of accomplishment is to be objective and proportional to the patient's benefit. There must also be a general system of evaluation, based upon the comparable statistics. This would allow an analysis on multiple levels and translation of the medical benefit to the other values to be compared to it in a highly organised social system. The next issue being considered applies to the expectations from someone whose treatment has proved successful. The other aspects concern what is going to be, and this specific one is concerned with what has already been. The physician can select someone who is going to continue working or someone who has children to be brought up, otherwise bound for orphanage, while someone unemployed and homeless is the least likely to be chosen. The choice is still less probable if a patient is a poor demented, aggressive creature with unsocial behaviour, that cannot control the bodily reactions and on top of everything suffers from an incurable disease that deserves constant care. A chronic alcoholic who suffers from self-induced cirrhosis certainly will not be offered a liver transplant, and the relatively recent example of late football champion George Best, who induced incurable cirrhosis after actually having his liver transplanted proves the futility of treatment in such cases. Demented individuals, though, need special forms of medical aid, adequate to their illnesses. There is also a big issue of addictions and prospects of their curability.
In the everlasting conflict the ethical principles that should be the priority at the assignment of medicines are often ignored, as the physicians follow their particular goals, i.e. determine the priority only of patients in their charge as a rule. In that way they always declare the patient's good as the main principle of what they usually do. The fanatics of equal opportunities cry for the ban of medicines that are not commonly accessible, so nobody would be aided in the conditions of their shortage. There are also missionaries of random choice, which a common sense commentator would like to call Russian roulette à rebours, or just waiting in line. The main concern is then avoiding manipulation and enforcing a just assignment of limited means. This imposes top secrecy of information and sounds as a new way of finding the differences in the degree of equality, i.e. which of the patients are more equal than others
There is no method of square assignment of inadequate resources and there is no such prospect at present. Everything ends up in projects and suggestions, shortly speaking, wishful thinking. Everything the inadequately financed national health systems can do is to appeal to the physicians to mind the ethical values and human rights. Everything depends on the preferred hierarchy of values, although several principles are unquestionable, including jurisprudence, respect for individual religious beliefs, and the most important principle of the patient's good, according to the rules of ethics and the Hippocrates' Oath.
