What are the most important factors in producing ethical decisions in health care?

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Many different factors are involved in ethical decision making in health care. The first major issue is that one must take into account all the people who may be affected by decisions. First, one has the good of the individual patient. Next, if one has limited resources, for example, transplant organs or extremely expensive drugs, one must weigh relative merits, e.g. if person X gets the kidney, person Y does not, or expensive resources devoted to prolonging life for a few weeks for an end-stage cancer patient are resources not being devoted to prenatal care (no society, alas, has infinite money, doctors, hospitals, etc.). Next, one must consider both the wishes of individuals vs. social benefit, in the cases, e.g. where someone refuses to be vaccinated, or flies with tuberculosis, or doesn't take anti-psychotic medication and holds the potential to commit violent acts while delusional.

Another issue is the problem of patients wishing for ineffective or problematic care. For example, in the United States, advertising often leads people to ask for drugs that are expensive, ineffective, and possibly even dangerous for themselves or society as a whole (e.g. over-prescription of antibiotics leading to antibiotic resistant bacteria). Often people will find reports of barely tested experimental drugs that are extremely expensive. If insurance companies pay for these, that raises premiums for everyone. To what degree should decisions be made by doctors, patients, insurance companies, or governments?

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