Introduction

Medical resources are inevitably limited, and decisions will always have to be made between the various ways in which such resources might be used. The amount of money spent on healthcare varies both between countries and within countries over time. Different healthcare systems exist – some more efficient than others. Nevertheless, despite this variation, decisions will always have to be made about the priorities of healthcare spending. This is a profoundly moral matter and raises a wide range of ethical questions: What counts as a just distribution of healthcare resources? How ought we to decide between the provision of different treatments and the treatment of different patients? Given limited resources, which treatments don't we offer? What criteria ought to be used for rationing treatments?

We begin this chapter with an everyday sort of case, about long-term care of the very old. The demographic ‘crisis’ throughout Europe means that resource questions about the care of older people will become increasingly important, although the elderly are not our sole concern in this chapter. The case of Mr K also highlights conflict over resources between health and social services, between chronic and acute services, and between families and service providers, with clinicians caught in the middle. In this case the individual and the social collide. We shall use the case of Mr K as a starting point in trying to work out what guidance can be offered to clinicians and other healthcare professionals over such wider issues of resource allocation.