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Recognizing bedside rationing: clear cases and tough calls

P A Ubel1, S Goold

  • 1Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.

Annals of Internal Medicine
|January 1, 1997
PubMed
Summary
This summary is machine-generated.

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Physicians must identify three conditions to recognize bedside rationing: withholding beneficial care for financial reasons, acting against patient interests, and controlling service access. This framework aids in understanding ethical healthcare resource allocation.

Area of Science:

  • Medical Ethics
  • Health Economics
  • Clinical Practice

Background:

  • Physicians face increasing pressure to control healthcare costs.
  • This pressure raises questions about the propriety of rationing healthcare at the bedside.
  • There is a divided opinion on whether bedside rationing is ever acceptable.

Observation:

  • This paper defines three essential conditions for an action to be classified as bedside rationing.
  • Condition 1: Withholding, withdrawing, or not recommending a service that the physician believes is in the patient's best medical interest.
  • Condition 2: The primary motivation for the action is to benefit parties other than the patient, such as the physician, organization, or society.
  • Condition 3: The physician has control over the availability or use of the service.
Keywords:
Analytical ApproachHealth Care and Public HealthProfessional Patient Relationship

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Findings:

  • These three conditions provide a clear framework for identifying bedside rationing.
  • Case studies illustrate the practical application and significance of these conditions.
  • The framework helps physicians recognize when they are engaging in rationing.

Implications:

  • Physicians can use this framework to identify instances of bedside rationing in their practice.
  • Medical leaders, ethicists, and policymakers can use this framework to guide discussions on the ethics of healthcare rationing.
  • This work contributes to a clearer understanding of ethical considerations in resource allocation within healthcare settings.