Equity in limit situations: access to treatment for people with hemophilia

Abstract

Hemophilia is a rare hematological condition and its treatment is the target of therapeutic innovation. In the meeting between patient needs, clinician conducts and guidance from the health manager, a conflict arises: is the protocol a therapeutic minimum or maximum? Clinical decisions under discussion with the allocation of resources lead to the discussion about equity in such limit situations. The method of the present study is a comprehensive bioethical analysis of 14 legal decisions about the access to hemophilia treatment. Decisions to guarantee access to treatments presuppose ethical link with the patient; the clinic retains a dimension of equity by allowing the treatment to be unique and the doses provided for in the protocol are suggestions and not limits. From an ethical point of view, these are
expressions of justice, precaution and consideration of a patient’s interests.