This study investigates how lifestyle factors affect laypeople’s allocation of a scarce medical resource and explores cross-cultural differences in ethical decision-making between the UK, France and Switzerland. A total of 193 participants completed an online questionnaire in which they had to rate the profiles of 16 hypothetical patients in terms of priority for access to kidney dialysis. Each profile was a unique combination of the following lifestyle factors: smoking behaviour, alcohol consumption, weight and amount of physical activity. As predicted, it was found that non-smokers were favoured over smokers, moderate drinkers over heavy drinkers, normal weight patients over obese patients and frequent exercisers over infrequent exercisers. However, contrary to our predictions, no cross-cultural differences were evident. The potential impact of these findings with respect to the formulation of guidelines for allocating scarce medical resources is discussed.
NHS (2019) Organ Donation and Transplantation. https://www.nhsbt.nhs.uk/what-we-do/transplantation-services/organ-donation-and-transplantation
United Network for Organ Sharing (2018) UNOS Data at a Glance [Data File]. https://unos.org/data
Persad, G., Wertheimer, A. and Emanuel, E.J. (2009) Principles for Allocation of Scarce Medical Interventions. The Lancet, 373, 423-431. https://doi.org/10.1016/S0140-6736(09)60137-9
Freund, A. (1971) Organ Transplant: Ethical and Legal Problems. In: Gortowitz, S., Macklin, R., Janton, A., O’Connor, J. and Sherwin, S., Eds., Moral Problems in Medicine, Prentice Hall, Englewood Cliffs, 276-281.
Mill, J.S. (1863) Utilitarianism. Parker, Son and Bourn, London.
Rawls, J. (1971) A Theory of Justice. Oxford University Press, Oxford.
Reeves, R. (2000) Fair Treatment: Public Conceptions of Distributive Justice in Health Care. Unpublished Doctoral Dissertation, Oxford University, Cambridge.
Boyd, K.M. and Potter, B.T. (1986) Priorities in the Allocation of Scarce Resources. Journal of Medical Ethics, 12, 197-200. https://doi.org/10.1136/jme.12.4.197
Giacomini, M.K., Cook, D.J., Streiner, D.L. and Anand, S.S. (2000) Using Practice Guidelines to Allocate Medical Technologies. International Journal of Technology Assessment in Health Care, 16, 987-1002. https://doi.org/10.1017/S026646230010306X
Hope, T., Hicks, N., Reynolds, D.J.M., Crisp, R. and Griffiths, S. (1998) Rationing and the Health Authority. British Medical Journal, 317, 1067-1069. https://doi.org/10.1136/bmj.317.7165.1067
Parsons, V. and Lock, P. (1980) Triage and the Patient with Renal Failure. Journal of Medical Ethics, 6, 173-176. https://doi.org/10.1136/jme.6.4.173
Hurst, S.A., Hull, S.C., DuVal, G. and Danis, M. (2005) How Physicians Face Ethical Difficulties: A Qualitative Analysis. Journal of Medical Ethics, 31, 7-14. https://doi.org/10.1136/bmj.317.7165.1067
Stafinski, T., Menon, D., Marshall, D. and Caulfield, T. (2011) Societal Values in the Allocation of Healthcare Resources. The Patient: Patient-Centered Outcomes Research, 4, 207-225. https://doi.org/10.2165/11588880-000000000-00000
Ubel, P.A. and Loewenstein, G. (1995) The Efficacy and Equity of Retransplantation: An Experimental Survey of Public Attitudes. Health Policy, 34, 145-151. https://doi.org/10.1016/0168-8510(95)00714-4
Murphy-Berman, V.A., Berman, J.J. and Campbell, E. (1998) Factors Affecting Health-Care Allocation Decisions: A Case of Aversive Racism? Journal of Applied Social Psychology, 28, 2239-2253. https://doi.org/10.1111/j.1559-1816.1998.tb01369.x
Russell, L.B., Siege, J.E., Daniels, N., Gold, M.R., Luce, B.R. and Mandelblatt, J.S. (1996) Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations. In: Gold, M.R., Siegel, J.E., Russell, L.B. and Weinstein, M.C., Eds., Cost-Effectiveness in Health and Medicine, Oxford University Press, New York, 3-24.
NICE: National Institute for Clinical Excellence (2010) HMSO, London.
Roberts, T., Bryan, S., Heginbotham, C. and McCallum, A. (1999) Public Involvement in Health Care Priority Setting: An Economic Perspective. Health Expectations, 2, 235-244. https://doi.org/10.1046/j.1369-6513.1999.00061.x
Ratcliffe, J. (2000) Public Preferences for the Allocation of Donor Liver Grafts for Transplantation. Health Economics, 9, 137-148. https://doi.org/10.1002/(SICI)1099-1050(200003)9:2 3.0.CO;2-1
Schwappach, D.L. (2003) Does It Matter Who You Are or What You Gain? An Experimental Study of Preferences for Resource Allocation. Health Economics, 12, 255-267. https://doi.org/10.1002/hec.713
Furnham, A., Ariffin, A. and McClelland, A. (2007) Factors Affecting Allocation of Scarce Medical Resources across Life-Threatening Medical Conditions. Journal of Applied Social Psychology, 37, 2903-2921. https://doi.org/10.1111/j.1559-1816.2007.00287.x
Furnham, A., Loganathan, N. and McClelland, A. (2010) Allocating Scarce Medical Resources to the Overweight. Journal of Clinical Ethics, 21, 346-356.
Furnham, A., Meader, N. and McClelland, A. (1998) Factors Affecting Nonmedical Participants’ Allocation of Scarce Medical Resources. Journal of Social Behavior and Personality, 13, 735-746.
Furnham, A., Petrides, K.V. and Callahan, I. (2011) Prioritizing Patients for Surgery: Factors Affecting Allocation of Medical Resources for Kidney Transplantation, IVF, and Rhinoplasty. Journal of Applied Social Psychology, 41, 588-608. https://doi.org/10.1111/j.1559-1816.2011.00728.x
Furnham, A., Simmons, K. and McClelland, A. (2000) Decisions Concerning the Allocation of Scarce Medical Resources. Journal of Social Behavior and Personality, 15, 185-201. https://doi.org/10.2224/sbp.2002.30.2.185
Furnham, A., Thomson, K. and McClelland, A. (2002) The Allocation of Scarce Medical Resources across Medical Conditions. Psychology and Psychotherapy: Theory, Research and Practice, 75, 189-203. https://doi.org/10.1348/147608302169643
Selvaraj, D., McClelland, A. and Furnham, A. (2017) Allocating Scarce Medical Resources: Using Social Usefulness as a Criterion. Ethics & Behavior, 29, 274-286. https://doi.org/10.1080/10508422.2017.1404909
Wiseman, D. (2006) Medical Resource Allocation as a Function of Selected Patient Characteristics. Journal of Applied Social Psychology, 36, 683-689. https://doi.org/10.1111/j.0021-9029.2006.00024.x
Wiseman, D. (2007) Patient Characteristics That Impact Healthcare Resource Allocation Choices: Relative Impact of Mental Illness, Age, and Parental Status. Journal of Applied Social Psychology, 37, 2072-2085. https://doi.org/10.1111/j.1559-1816.2007.00251.x
WHO (2018) Noncommunicable Diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Madsen, M. (2016) Third of Areas Rationing Surgery for Obese and Smokers, Surgeons Report. http://www.pulsetoday.co.uk/news/commissioning/commissioning-topics/secondary-care/third -of-areas-rationing-surgery-for-obese-and-smokers-surgeons-report/20031685.fullarticle
Siegel Bernard, S. (2015) Giving Out Private Data for Discount in Insurance. New York Times. https://www.nytimes.com/2015/04/08/your-money/giving-out-private-data-for-discount -in-insurance.html
Furnham, A.F., Hassomal, A. and McClelland, A. (2002) A Cross-Cultural Investigation of the Factors and Biases Involved in the Allocation of Scarce Medical Resources. Journal of Health Psychology, 7, 381-391. https://doi.org/10.1177/1359105302007004327
Gajre, M., McClelland, A. and Furnham, A. (2017) Allocating a Scarce Mental Health Treatment to the Underweight and Overweight. Journal of Mental Health, 27, 490-495. https://doi.org/10.1080/09638237.2017.1370636
WHO (2015) WHO Report on the Global Tobacco Epidemic 2015. https://www.afro.who.int/sites/default/files/2017-06/executive%20summary.pdf
WHO (2014) Global Status Report on Alcohol and Health. https://www.who.int/substance_abuse/publications/alcohol_2014/en
Kazancioglu, R. (2013) Risk Factors for Chronic Kidney Disease: An Update. Kidney International Supplements, 3, 368-371. https://doi.org/10.1038/kisup.2013.79
Major, B., Hunger, J.M., Bunyan, D.P. and Miller, C.T. (2014) The Ironic Effects of Weight Stigma. Journal of Experimental Social Psychology, 51, 74-80. https://doi.org/10.1016/j.jesp.2013.11.009
Schvey, N.A., Puhl, R.M. and Brownell, K.D. (2011) The Impact of Weight Stigma on Caloric Consumption. Obesity, 19, 1957-1962. https://doi.org/10.1038/oby.2011.204
Tomiyama, A.J. (2014) Weight Stigma Is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model. Appetite, 82, 8-15. https://doi.org/10.1016/j.appet.2014.06.108
Barry, C.L., Gollust, S.E., McGinty, E.E. and Niederdeppe, J. (2014) Effects of Messages from a Media Campaign to Increase Public Awareness of Childhood Obesity. Obesity, 22, 466-473. https://doi.org/10.1002/oby.20570
WHO (2002) Report on Tobacco Taxation in the United Kingdom. https://www.who.int/tobacco/training/success_stories/en/best_practices_united_kingdom _taxation.pdf
Steptoe, A., Wardle, J., Cui, W., Baban, A., Glass, K., Pelzer, K., Vinck, J., et al. (2002) An International Comparison of Tobacco Smoking, Beliefs and Risk Awareness in University Students from 23 Countries. Addiction, 97, 1561-1571. https://doi.org/10.1046/j.1360-0443.2002.00269.x
Hurst, S.A., Reiter-Theil, S., Slowther, A.M., Pegoraro, R., Forde, R. and Danis, M. (2008) Should Ethics Consultants Help Clinicians Face Scarcity in Their Practice? Journal of Medical Ethics, 34, 241-246. https://doi.org/10.1136/jme.2006.019828
Moscovici, S. and Zavalloni, M. (1969) The Group as a Polarizer of Attitudes. Journal of Personality and Social Psychology, 12, 125-135. https://doi.org/10.1037/h0027568
Corley, M.C., Westerberg, N., Elswick Jr., R.K., Connell, D., Neil, J., Sneed, G. and Witcher, V. (1998) Rationing Organs Using Psychosocial and Lifestyle Criteria. Research in Nursing & Health, 21, 327-337. https://doi.org/10.1002/(SICI)1098-240X(199808)21:4 3.0.CO;2-H
Steinbrook, R. (2006) Imposing Personal Responsibility for Health. New England Journal of Medicine, 355, 753-756. https://doi.org/10.1056/NEJMp068141
Inglis, V., Ball, K. and Crawford, D. (2005) Why Do Women of Low Socioeconomic Status Have Poorer Dietary Behaviours than Women of Higher Socioeconomic Status? A Qualitative Exploration. Appetite, 45, 334-343. https://doi.org/10.1016/j.appet.2005.05.003