However, a physician does not fail in his duty when he does not provide a treatment that is unavailable to him. The third case also raises no ethical problem. Although hospital budgets always have been and always will be limited, neither administrators nor physicians are responsible for this. Hospital administrators have to work within the budgets they are given. That one hospital provides a service while another does not is not an indication that the first hospital is acting irresponsibly or unethically.
Hospitals serve catchment areas.
Different catchment areas have different needs, depending on the demographics and the health profiles of their client populations. A responsible hospital administration will use its limited funds in the most cost-effective way possible to meet the needs of its client population. When resources are limited, only the services that address the major health problems of the client population in the most cost-effective way can be provided. This means that, on occasion, certain services will not be available in a particular location. However, even though the service might be provided by another hospital in another area, the hospital administration has not acted unethically by making a different choice.