Ethical dilemmas and decision-making processes in healthcare rationing within resource-scarce environments: a critical analysis

Abstract

Ethical dilemmas arise in healthcare rationing when the allocation of limited resources for care and the making of difficult decisions are involved. Similar situations occur in resource-scarce environments such as public hospitals in Goa, India. In this context, allocating clinical care resources is hindered by poor infrastructure, including a lack of consistent clinical protocols and unclear ethical guidance for healthcare practitioners in cases of potentially resource-rationing decisions. A Textual-Analytic Mixed Method (TAMM) containing secondary data from books, academic texts, policy documents, and news media. The oxygen crisis at Goa Medical College was a sobering reminder of the need to develop ethical frameworks and prepare for contingencies. Health practitioners implementing informal clinical processes based on urgency rather than formal triage criteria inevitably allow for bias and moral distress. To combat these situations, health practitioners need more formal ethical training, formal triage policies, possibly multidisciplinary review boards, and decentralized supply systems. If health practitioners are relying on institutional ethics to guide them in decision-making, the institution and the conditions of care must also be strong and ethical. Only then will health practitioners be accountable for fair decisions, and people will understand the difficulty of that accountability for care-oriented decision-making during crises when resources are limited.