April 24, 2024

Should we rethink our rescue intuitions?

How do our rescue intuitions apply to clinical practice, questions an ethicist in this month’s edition of AJOB.

The rescue instinct is a principle deeply set in our psyche – when we encounter someone whose life is at immediate risk we feel an obligation to rescue them. No normal person would stand by as a child drowns in a pool, for example.

But how analogous is this situation to various vexed situations in clinical practice? And what do we do when we have only limited healthcare resources to allocate?

A new article in the American Journal of Bioethics argues that we are often led astray by the ‘rescue instinct’, and that our allocation of healthcare resources needs to be revised in light of other equally important considerations. 

Nancy S. Jecker of the University of Washington School of Medicine believes we are often misled by our rescue intuitions.

Jecker premises her article ‘Rethinking Rescue Medicine’ on a social observation:

“Although society invests in rescuing needy patients, it also rejects giving full priority to rescue, because the opportunity cost of doing so would be too great.”

The question she poses is ‘How much is too much?’ How many resources should we allocate to rescue care as opposed to, for example, preventative measures?

Jecker takes aim at the U.S. Congress’s decision to ‘rescue’ patients with end-stage renal disease (ESRD) by funding all care for individuals with this condition:

“According to the U.S. Renal Data System Annual Data Report, the total costs of ESRD in 2011 was $45.5 billion, and it represented 18% of total Medicare expenditures (U.S. Renal Data System 2013). The deeper problem is that this uneasiness about enforcing limits has been not just irrational, but unjust. It has deterred us from allocating health care fairly.”

She also targets doctors guilty of overtreating patients (which she defines as “[performing procedures that] do not have a reasonable chance of helping the patient”).

Jeker wonders what if any ethical justification there is for prioritizing rescue over preventative care. On her account, we have a psychological bias towards the real lives involved rescue over the hypothetical lives envisioned when devising preventive care schemes.

Jecker advocates greater focus on ‘upstream factors’ such as social conditions that put people at greater risk of developing a life threatening disease. 

It is hard to see how this new paradigm could play out in practice: Preventative measures are important, but we also feel a countervailing moral imperative to attend to those in ‘real’ risk. Perhaps this imperative is too strong to dismiss. 

Should we rethink our rescue intuitions?
Xavier Symons
Creative commons
allocation of resources
rescue medicine