The ethics of health economic decisions examplified by the kidney substitution therapy

Abstract

In the nowadays popular interpretation of the notion of economy the utilitaristic idea of calculating the expected benefit plays a leading role. Changes in death rates and equalisation of consumption allow the calculation of a definite amount of money for human life. The methodological analysis however shows deficiencies causing doubts regarding the validity of these statements. Using the calculation of the expected benefit on patients suffering from end stage renal failure every kind of therapy, especially dialysis, is economically unprofitable. A physician stands between the economical profit oriented priority and the patient's interest which puts him into the position of an administrator. Interpreting the notion of economy as idea of the patient's priority as shown in the biblical parable of the wise administrator considers human costs which are economically uncalculable. A balance of these different priorities can only be achieved with regard to the content not sociotechnically. Therefore, according to John Rawls, health economical decisions have to be made regarding that differences in supply are only reasonable if the least receives the utmost advantage.