Ethical considerations in resource allocation in a cochlear implant program.
OBJECTIVE
To review processes of resource allocation and the ethical considerations relevant to the fair allocation of a limited number of cochlear implants to increasing numbers of potential recipients.


METHODS
Review of relevant considerations.


METHODS
Tertiary referral hospital.


METHODS
Editorial discussion of the ethical issues of resource allocation.


METHODS
Heterogeneity of audiometric thresholds, self-reported disability of hearing loss, age of the potential cochlear implant recipient, cost-effectiveness, access to resources, compliance with follow-up, social support available to the recipient, social consequences of hearing impairment, and other recipient-related factors.


RESULTS
In a publicly funded health care system, there will always be a need for decision-making processes for allocation of finite fiscal resources. All candidates for cochlear implantation deserve fair consideration. However, they are a heterogeneous group in terms of needs and expected outcomes consisting of traditional and marginal candidates, with a wide range of benefit from acoustic amplification.


CONCLUSIONS
We argue that implant programs should thoughtfully prioritize treatment on the basis of need and potential benefit. We reject queuing on the basis of "first-come, first-served" or on the basis of perceived social worth.
Westerberg
Brian D
BD
Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada. BWesterberg@providencehealth.bc.ca
Pijl
Sipke
S
McDonald
Michael
M
D000328:Adult; D001955:British Columbia; D019929:Cochlear Implantation / Q000941:ethics*; D003362:Cost-Benefit Analysis / Q000941:ethics; D003638:Deafness / Q000534:rehabilitation*; D004992:Ethics, Medical; D005260:Female; D005380:Financing, Government / Q000941:ethics; D015276:Health Care Rationing / Q000941:ethics; D006301:Health Services Needs and Demand / Q000941:ethics; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000941:ethics*; D018579:Patient Selection / Q000941:ethics; D011379:Prognosis; D012017:Referral and Consultation / Q000941:ethics; D040841:Resource Allocation / Q000941:ethics*; D016896:Treatment Outcome; D014850:Waiting Lists