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A framework for rationing by clinical judgment.

Samia A Hurst¹, Marion Danis

¹Institute for Biomedical Ethics, University of Geneva Medical School, Switzerland.

Kennedy Institute of Ethics Journal

|January 24, 2008

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Rationing by clinical judgment can be acceptable if practiced fairly. This involves clear processes and justice considerations, especially during resource shortages, to ensure equitable patient care.

Area of Science:

Medical Ethics
Health Economics
Public Health Policy

Background:

Rationing by clinical judgment is a controversial but sometimes necessary practice in healthcare.
The acceptability of rationing hinges on its implementation and perceived fairness.

Purpose of the Study:

To define rationing by clinical judgment in various resource scarcity scenarios.
To propose a framework for fair bedside rationing based on procedural justice.

Main Methods:

Defining rationing in three contexts: acute shortage, limited resources, and cost-benefit analysis.
Applying a six-requisite analytical framework grounded in procedural justice.

Main Results:

Identified three distinct scenarios for rationing by clinical judgment.

Related Experiment Videos

Outlined six minimal requisites for fair bedside rationing: closed system, general justice, individual respect, consistent process, explicitness, and review.

Conclusions:

Fair bedside rationing requires adherence to specific procedural justice principles.
Monitoring the applicability and appropriateness of rationing processes is crucial for ethical healthcare delivery.