Reflection: How do you think decision-makers balance the ethical principles of non-maleficence and distributive justice with economic principles such as scarcity and opportunity cost when allocating

In South Africa, where resources for healthcare are limited and many people face significant health challenges, decision-makers must carefully balance ethical principles with economic realities. The principle of non-maleficence, which means "do no harm," requires that health policies and resource allocation avoid causing harm to individuals, particularly vulnerable populations. At the same time, distributive justice calls for a fair distribution of resources, ensuring that those who need care the most, such as low-income groups and those with chronic conditions, receive adequate attention.

However, economic principles like scarcity (having limited resource) and opportunity cost (choosing one option over another) complicate this balance. With scarce resources, decision-makers often face tough choices, such as whether to invest in preventative measures or in treatments for those already sick. Allocating resources to one group can mean fewer resources for another, raising concerns about fairness and the potential harm to certain communities.

In such a setting, decision-makers often have to make trade-offs. For example, they might prioritize interventions that have the most significant impact on public health, such as treating high-prevalence diseases like HIV and TB, while also considering the long-term costs and benefits. In balancing these ethical and economic factors, decision-makers aim to minimise harm, ensure fairness, and make the most efficient use of limited resources. The challenge is to find solutions that align ethical principles with the need for effective, cost-conscious healthcare in a country facing both economic constraints and health inequities.