Consider the following situation:

Total US health care expenditures have been capped and are controlled by a health services commission. Because of tight budgetary constraints, the commission must decide whether to fund a comprehensive mammography screening program or a more limited mammography program and, instead, finance a high-cost chemotherapy program for patients with metastatic breast cancer treatments whose effectiveness has not been proven, but which might help certain subgroups of women). Under the first option, several thousand cases of early-stage breast cancer could be treated with curative surgery each year, but women currently suffering from advanced-stage breast cancer would receive no benefit. Consider the following questions (of course, you need not answer all):
How do we go about the task of deciding how to allocate funding?
How do we reconcile the fact that any choice would necessarily benefit one group and not the other?
How do we reconcile the ethical considerations against the fact that resources are finite?
Might there be an approach in which the dilemma is reframed so that it is not either/or? If so, be specific about how this can be achieved.

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