title: Physicians, thou shalt ration: the necessary role of bedside rationing in controlling healthcare costs.
abstract: Physicians are often asked to be "gatekeepers," determining their patients' access to medical therapies and technologies. At the same time, most physicians have been taught that they should act as patient advocates, pursuing patients' best interests regardless of cost. This paper reviews moral arguments ethicists have made for and against "bedside rationing." It argues that healthcare rationing is appropriate in order to help control healthcare costs, and that rationing decisions made at the bedside by physicians must be part of the rationing system. A system that attempts to control costs by mandating an elaborate set of rules would be burdensome, and many physicians would find ways
authors.affiliation: Veterans Affairs Health Services Research and Development, Michigan Program for Improving Healthcare Decisions, Division of General Internal Medicine, University of Michigan, Michigan, Detriot, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D003657:Decision Making / Q000941:ethics; D026690:Ethics, Clinical; D005246:Feedback; D020793:Gatekeeping / Q000191:economics / Q000941:ethics*; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics* / Q000379:methods; D006297:Health Services Accessibility / Q000191:economics / Q000941:ethics; D006801:Humans; D009014:Morals; D009922:Oregon; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D014481:United States; D014600:Utilization Review