 Waitlists
Michael A. Gillette, Ph.D.
|
This document and
the ideas presented herein are the intellectual
property of Bioethical Services of Virginia, Inc.
and may be used and reproduced only with proper
citation. |
The
Ethical Management of Waitlists
Some
Questions to Ask
1.
What is the
specific function of the organization within the continuum
of care? Who is the primary constituency?
2.
Does the
organization have a special obligation as a “safety net”
provider that would increase a duty to provide services to
those who cannot access services elsewhere?
·
The indigent
·
Recipients of
specific services that are not replicated elsewhere
·
Clients who
have been turned away from other providers
·
Clients who
cannot access other available providers
3.
To what
degree does ability to benefit from services matter?
·
Can services
be withheld when they are not likely to create a
therapeutic effect? Lost Causes?
·
Can clients
be turned away when their non-compliance eliminates any
meaningful hope of efficacy?
·
Can clients
be turned away when they request services that the
organization is not qualified to provide?
4.
To what
degree do answers to the above questions create “threshold
properties”, or are continual comparative judgments
legitimate?
5.
Should people
who have been waiting longer have priority over those with
greater needs?
6.
Should
previous clients have greater access given a prior
commitment from the organization?
7.
Can the
organization offer sub-optimal services to those on the
waiting list provided that these services do not violate
minimum standards of care?
8.
Could we ever
withdraw services from existing clients, or reduce their
services to sub-optimal levels, in order to serve other
new clients who have greater needs?
9.
Can a
hard-line constituency factor be applied effectively?
Evenly?
10.
Is there an
appropriate opportunity to introduce a random element of
choice?
11.
Should
culpability ever impact access (voluntary risks to health,
forfeiture of rights)?
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