Ethics, equity, and human dignity in access to health services: the case of cochlear implants in children and adolescents.

Compare the number of implants performed in the last 12 years for children and adolescents up to 18 years in different regions of mainland Portugal. Study the trend of total implants over the years as well as the percentage held in early ages. Verify to what extent this practice is in line with the values of fairness and justice that underpin European health systems. A retrospective study of cochlear implantation was conducted using a hospital database containing all the episodes with cochlear implant procedures in public hospitals that occurred in Portugal between 2000 and 2012. An analysis by age, year, and region of the implants were performed. The Northern and Central regions, the nearest big center specializing in cochlear implants in Portugal, are those with the largest number of implants: 2.0 and 2.4 per 10,000 children, respectively. The regions of Alentejo and Algarve, which are more rural and remote regions of the center, record the smallest number of implants, 1.1 and 1.5 per 10,000 children, respectively. Over the years, there seems to be an increase of implants implemented in children under 18, most notably from a significant reduction in 2011 and 2012. However, an increase in children implanted before 24 months has been observed from the same zero children at this age in the early years studied to 0.46 per 10,000 inhabitants in 2012. The right to adequate health care must be in accordance with the full respect of fundamental human rights. Economic, social, and educational conditions must also be guaranteed in this process of auditory rehabilitation. Societies must develop a system of ethical health priorities, so that even in situations of financial crisis, the most disadvantaged sectors are not the most penalized ones by the inevitable economic constraints that are implemented.