THE MEANING OF URGENCY IN THE ALLOCATION OF SCARCE HEALTH-CARE RESOURCES - A COMPARISON BETWEEN RENAL-TRANSPLANTATION AND PSYCHOGERIATRIC NURSING-HOME CARE

In the juridical and ethical literature on patient selection criteria it is an unargued premise that those who are most urgently in need of treatment or care will be given priority. The aim of this study is to gain insight into the medical practice of waiting list problems and pa tient selection at the microlevel, especially with respect to urgency. Thus, the study intends to contribute to the medical ethical discussi on on patient selection for scarce resources. The results of qualitati ve research into the meaning and occurrence of urgency in two health c are services, renal transplantation and psychogeriatric nursing home c are, are discussed. In the first sector, patients are seldom considere d urgent. Criteria for urgency are technical dialysis problems or seve re psychological burden due to protracted dialysis treatment. In contr ast, psychogeriatric patients are often considered urgent, with the pr incipal criterion being too heavy a care load for informal carers. Bot h health care services show variation in assigning urgency codes. It a ppears that the exact meaning of urgency is not self-evident and that admission of urgent patients to nursing homes can be negotiated by pro fessionals or informal carers. This points to the necessity of a discu ssion within these services as to the actual content matter of urgency . Further. professionals involved in renal transplantation raise sever al moral and practical arguments against giving patients priority, eve n if they need treatment urgently. It shows that distributive justice cannot always be applied. Occasionally non-urgent patients are rated u rgent as they have been waiting very long due to specific allocation p rocedures. In these cases urgency is granted in an unexpected way that is ultimately in accordance with the notion of procedural justice. (C ) 1998 Elsevier Science Ireland Ltd. All rights reserved.