Ethics of resource allocation to congenital heart surgery in variable-resource contexts

The vast majority of the estimated 1.1-1.7 million infants born every year with congenital heart disease (CHD) requiring intervention live in places where this treatment is not readily available. The longterm solution is to train cardiologists and surgeons and develop cardiac care centers, but there has been some debate about whether or not this is the right thing to do in low resource environments. Consideration of this dilemma using different ethical systems helps to outline where and when it is appropriate to dedicate scarce resources to what may seem a costly endeavor. Beginning with the principlist approach to bioethics (which focuses on the four principles of beneficence, non -maleficence, respect for persons, and justice) gives an initial framework of the problem: program establishment can be encouraged only when conditions are adequate for the proposed level of care, and must be done with a plan to provide the care in an equitable manner. Through the lens of public health ethics, the focus turns to distributive justice and utility: expenditures should be allocated in a manner that benefits the population as a whole. Consequentialist ethics, incorporating evidence from cost effectiveness analysis, leads to the conclusion that providing congenital heart surgery is a good use of resources in many emerging economies.