Because of this, the existing map is leading to increasingly unethical public policy results. Medical ethics needs to be revised if it is to provide meaningful guides to future health policy. We need a new ethics map. Most health care is paid for with pooled funds, either taxpayer or insurance, and you cannot distribute pooled funds by focusing on one patient at a time. Pooled funds must maximize the health of the pool.
Cost is always a consideration.
Most medical ethics, however, assume that resources are unlimited and that the sole issue is the interest of the individual patient. Such a view, highlighting individual needs and ignoring costs, violates the first rule of publicpolicy, which is to maximize the general good using limited funds. Constructing a public budget is a process of trade-offs and priority setting, and it would be public policy malpractice to ignore costs. It took John Kitzhaber, a physician-politician, to point out to a disbelieving nation that as an office holder he was responsible both for those covered and for those not covered, and he had to consider not only Coby Howard's need for a transplant, but also the state's duty to all of the medically indigent. It made more ethical sense to him as a public policymaker to cover all the medically indigent and ration what was subsidized, not who was subsidized.