Introduction

Rationing acute healthcare to support patients below 65 years has different ethical problems that are firmly anchored on concepts of justice, respect for the patients autonomy, beneficence, and non-malfeasance. The shift of rising demands from the ageing population and prevalence of chronic illnesses means that healthcare resources are likely to become even scarcer in the future; thus, distribution must be fair among the age groups (Scheunemann & White, 2023). Justice means that resource distribution is fair and the benefits are directed to the users who will most advantage from it. Population supporters assert that youngsters are likely to live longer, and therefore their abilities to contribute to society make them the right candidates for receiving the resource (Glans et al., 2020).

This point of view is closely related to utilitarian principle, according to which the greatest amount of health of most people should be saved. Ethical issues come to the fore when discussing self-governance, or autonomy. This view is highly dependent on the utility principle claiming that majority of peoples health has to be maximally saved. Ethical issues come into question when thinking about self-governance or self- governance.

However, ethical dilemmas arise when considering autonomy. While respecting individual choices is crucial, rationing can limit options for older patients who also have valuable life experiences and rights to care . Furthermore, non-maleficence emphasizes the obligation to avoid harm; denying necessary treatments to any demographic can lead to significant negative impact when that specific medicine is the only cure for the given health condition, while rationing acute healthcare resources for those under 65 may optimize societal benefits, it raises complex ethical questions about fairness, individual rights, and the moral implications of prioritizing one group over another. Addressing these challenges requires transparent discussions and ethical frameworks that consider the needs of all patients (Almesned et al., 2023).

Bioethical Principles

Bioethicists frequently utilize the four fundamental principles of healthcare ethics to assess the advantages and challenges associated with medical procedures. For a medical practice to be deemed "ethical," it should ideally uphold all four principles: autonomy, justice, beneficence, and non-maleficence.

Autonomy

The right of individuals to make informed decisions about their healthcare is gaining recognition globally. Patients are now encouraged to voice their preferences regarding treatment options for chronic conditions like diabetes and heart disease, discussing the pros and cons of each choice .The autonomy of the patients are being respected . This emphasizes the importance of informed consent, as patients need sufficient information to make effective decisions. For example, cancer patients often compare traditional treatments with alternatives such as chemotherapy, necessitating thorough discussions with healthcare providers . However, challenges persist in achieving a patient-centered approach due to policy restrictions and power dynamics that may limit patients' decision-making authority Communication and Leadership in Healthcare Quality Governance: Findings from Comparative Case Studies of Eight Public Hospitals in Australia | Emerald Insight, 2019 . These challenges are especially relevant during public health crises, where it is crucial to balance fair treatment with individual civil liberties (Scheunemann & White, 2023). Addressing these issues is essential for enabling all patients to exercise their autonomy effectively. Improving communication between patients and providers and adopting supportive policies can foster an environment conducive to patient-centered care (Hauge et al., 2023). Ultimately, empowering patients in their treatment decisions is vital for enhancing health equity and overall outcomes.

Beneficence

Beneficence requires healthcare providers to act in the best interest of their patients, advocating for their needs and promoting informed understanding of recovery prospects. It caters the intend to achieve the best possible outcome for patient. This includes effective pain management and ensuring proper transport for injured individuals. For example, a 30-year-old with severe injuries may have a better prognosis than a 50-year-old, highlighting the focus on patient welfare (Hauge et al., 2023). However, using age as a primary criterion for resource allocation can overlook individual health conditions and social factors, potentially directing care towards younger patients with less severe issues. This raises concerns about equity and efficiency in healthcare delivery (Almesned et al., 2023). While prioritizing younger patients aligns with beneficence, it also presents ethical challenges that must be addressed to ensure fair and reasonable healthcare services for all (Scheunemann & White, 2023).

Non-maleficence

Non-maleficence, a fundamental principle of medical ethics, mandates that healthcare providers must avoid causing harm to patients (Considine et al., 2020). This is achieved through several essential practices. They ensure that unnecessary harm to the patient is avoided . Healthcare professionals evaluate the risks and benefits of interventions to prevent unnecessary harm (Considine et al., 2020). Examples include discontinuing harmful medications, prescribing drugs with fewer side effects, and withholding treatments that lack proven efficacy. Additionally, protocols are established to minimize medical errors and ensure qualified personnel perform procedures, thereby reducing adverse outcomes (Communication and Leadership in Healthcare Quality Governance: Findings from Comparative Case Studies of Eight Public Hospitals in Australia | Emerald Insight, 2019)
Informed consent processes empower patients to make choices based on a clear understanding of risks, further protecting their well-being (Hauge et al., 2023). However, age-based rationing can pose challenges by potentially denying necessary treatments to older adults who still have significant quality of life. This raises ethical concerns about whether such policies genuinely avoid harm while maximizing overall benefits (Considine et al., 2020)

Justice

Justice in healthcare refers to the fair distribution of resources based on need and merit. The primary focus should be on providing equitable care regarding the needs and the availability of the resources. Advocating for rationing acute care for those under 65 raises questions about whether this approach truly aligns with principles of justice. For example: similar cases are treated via same approaches, Patients receive equitable care regarding their needs and available resources, as healthcare systems aim to ensure equal distribution of resources. According to (Mekonnen et al., 2021), justice in healthcare necessitates that resources be allocated in a manner that is equitable, ensuring that all individuals have access to necessary treatments regardless of age (Mekonnen et al., 2021)

While some may argue that younger individuals have more potential years of life ahead, this perspective can be problematic. For example In critical situations, such as a hospital with limited resources, a young patient may receive priority over an older patient with similar needs. Devaluing the lives and experiences of older adults who also contribute meaningfully to society (McCallum, 2023). A more equitable approach would consider individual circumstances rather than making blanket assumptions based on age. This perspective challenges the notion that younger patients should receive preferential treatment solely based on their age.

Other Ethical Concepts

In addition to the primary bioethical principles discussed above, other concepts such as human dignity and professional codes of conduct play vital roles in shaping ethical healthcare practices. Human dignity requires that all individuals be treated with respect and consideration regardless of their age or health status. Professional codes emphasize the importance of providing equitable care while upholding ethical standards.

Ethical Theories

When it comes to healthcare several ethical theories can be useful in analyzing actions and decisions that are going to be made within the health care setting so that the right thing and logically sound care to the patient can be availed. The focus of utilitarian philosophy is on the most beneficial state attainable by majority of individuals: an approach applied to ration resources in situations such as a pandemic. For instance arranging treatments to benefit those patients who are expected to get well soon can improve general health returns. However, social implications should take into account the secondary effects and overall quality of life for all individuals involved (Fox et al., 2020)

Conversely, deontological thinking revolves around fundamental principles and moral duties, such as obtaining patient consent and maintaining confidentiality. These practices serve to protect patients' rights and uphold ethical standards in healthcare. For example, physicians have a professional responsibility to honor a patients contained self-governance by making sure the patient fully understands the treatment choices open to them (Beauchamp & Childress, 2019).
Virtue ethics determines the right thing to do based on the character of the actors: The nurse or doctor in this case and the virtues include, care (Conroy et al., 2020) .Likewise, ethics-of-care focuses on the connection between the patient and the provider and making sure that the second can comprehend all the particularities regarding the first one (Dykgraaf et al., 2021). That is why integrating these ethical theories helps healthcare providers address difficult moral questions and provide much fairer and humane care to patients.

Conclusion

In conclusion, the ethical complexities surrounding the allocation of healthcare resources, particularly acute care for patients under 65, highlight the need for a nuanced approach that incorporates various ethical theories. Utilitarianism emphasizes achieving the greatest good for the majority, while deontological principles stress the importance of adhering to duties such as informed consent and confidentiality. Virtue ethics encourages healthcare professionals to embody compassion and integrity in their practice, and ethics-of-care underscores the necessity of meaningful patient-provider dialogue. By integrating these perspectives, healthcare systems can strive for equitable resource distribution that respects individual rights and maximizes overall health outcomes. Ultimately, ongoing discussions among stakeholders are essential to navigate these ethical dilemmas, ensuring that all patients receive fair and just treatment within an increasingly complex healthcare landscape.

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