This is my response to Dr. Maddox's article, Administrative Ethics and the Allocation of Scarce Resources. I work for a Texas state hospital where funding for mental health services is woefully inadequate. New generation antipsychotic medications have recently become available to treat mental illness and are more effective and have fewer side effects than older medications. Typical medication costs have increased from $.07 a day for treatment with a drug like Haldol to $6.00 - $12.00 a day for treatment with one of the new generation medications.
Psychiatrists at Texas state hospitals are faced with an ethical dilemma as to whether or not to initiate treatment with a new generation antipsychotic medication knowing that the community mental health center to which the patient will be discharged has a limited budget for the new medications. Dr. Maddox speaks of merit as the "best criterion" upon which to base a decision regarding location of scarce resources. What I repeatedly see in the Texas mental health system is that individual merit, need, contribution, and ability to pay are often indistinguishable. Instead, the most frequent differentiating criterion is patient effort and the decision to treat is often based on a patient's history of medication compliance.
Judy Fiene, RN, BSN
Graduate Student UT Austin School of Nursing
Director of Quality Management, Austin State Hospital