Physicians at the bedside: practitioners' thoughts and actions regarding bedside allocation of resources

In the past, the study of the allocation of scarce medical resources centered around high-technology forms of health care such as the artificial heart, haemodialysis, etcetera. A major controversy considered in this study concerns the use of non-biomedical criteria (i.e., whether the social worth or financial status of a particular patient should dictate preferential medical treatment over another patient in times of shortage) in the allocation decision-making process. This article suggests that the study of allocation need not only focus on the dramatic realm of the high-tech, but should also concern itself with less dramatic everyday situations. Decisions concerning treatment based upon social worth and financial status are made almost daily by most practitioners; a thorough awareness of this phenomenon is prerequisite to the proper practice of medicine. Interviews with physicians disclose that most of these everyday allocation decisions are made tacitly, with non-biomedical criteria playing a role even in decisions that appear to have been prompted only by benign (even-guided) intentions.