P.J. Maddox's article, "Administrative Ethics and the Allocation of Scarce Resources," gave me a lot to think about. As a pediatric home care nurse, I have been providing nursing care to children and their families in their homes for last five years. Many of my clients have been receiving years of daily care by registered and licensed nurses, with no foreseeable end to this care. I have served privately insured, Medicaid, and charity clients, and have made every attempt to provide the same high quality care without regard to social or economic class. However, I also feel the burden of increases in taxes and health insurance premiums, due to the rising costs of health care provided to a growing population who live longer with illness, some of whom are my clients. I frequently face internal ethical dilemmas of distributive justice when I consider how much of my family resources, i.e., my income, should I sacrifice for the good of others. My ability to financially provide for my family is limited. Having to bear greater costs associated with rising taxes and insurance premiums to provide care for others reduces the resources available to my family. How much justice is just? I, like many others, prefer to believe that we live in an egalitarian society, at least in concept. But the facts are that we live in a world where, in terms of access to resources, it will always be better to be rich. Thus my dilemma. Where is the balance between the needs of my family and the needs of others?
I appreciate the views and discussion presented in P. J. Maddox's article. They provide me with additional tools for exploring my own values in relation to ethical dilemmas and for making the best decisions possible, since there is usually no one right answer. Thank you for this opportunity to participate in this forum.
Scott V. Hudson
MAN Graduate Student
The University of Texas at Austin School of Nursing