The recent issue raised by a group of oncologists who accuse Infarmed of rationing cancer patients' access to new cancer therapies has once again reiterated the importance of discussing in a clear, transparent and, above all fair, the criteria for setting health priorities.
On another occasion, I had the opportunity to develop, albeit briefly, this problem linked specifically to the idea of using age to prioritize access to medical care or not.
In fact, the National Ethics Council, in its Opinion 64 / CNECV / 2012 (Opinion on a Deliberation Model for Financing the Cost of Medicines), considered that there is an ethical basis for the National Health Service (NHS) to promote measures to contain costs by trying to ensure a "fair and balanced distribution of resources".
At the time, the word rationing generated, in my view completely disproportionately, an intense debate. Perhaps, for the first time, health professionals and politicians were shaken by this emerging paradigm shift; We won't be able to give everything to everyone and we will, however difficult, have to choose.
The evolution of drug prices, medical interventions and diagnostic methods has posed major challenges, both in terms of potential health gains and rising costs.
In addition to these issues, the fact that the Portuguese population is aging less healthy than most countries in the European area, and the fact that we increasingly have the active and young population with problems such as diabetes, obesity that will certainly result in significant increases in your health costs.
Assuming that we want everyone to live longer and that scientific and technological progress will continue to develop exponentially, it is indeed imperative to be creative in solutions; therefore, it is imperative today (1) to invest in effective prevention, using public health models to address some of the scourges that affect future old people who, as anticipated, will become ill even before they are old, and (2) as suggested by the CNECV in 2012, to involve health professionals, researchers and society in identifying problems associated with misuse of resources, including waste and, more challenging, in designing guidelines for delineating priorities and making choices that are fair and equitable.
Strangely, it is now, at a time, perhaps inappropriately termed post-crisis, that the scale of this problem and the debate on drug costs and prescription restrictions intensifies. We have lost seven years, but today, more than ever I think we find consensus on the need to propose a decision-making model based on the principle of justice that will ultimately safeguard the dignity of those who are treated and treated. In an ethically imperfect situation, where the possibility of giving the best of all is increasingly compromised, a model that, as suggested in the CNECV opinion, allows for the use of transparent and fair criteria for prioritizing resource allocation is unavoidable…
To think that priorities can be set and choices made without ethical criteria is in fact morally and ethically unacceptable.
* Ana Sofia Carvalho is Professor of the Bioethics Institute
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