title: Ethical principles and the rationing of health care: a qualitative study in general practice.
abstract: BACKGROUND
  Researching sensitive topics, such as the rationing of treatments and denial of care, raises a number of ethical and methodological problems.
  
  
  OBJECTIVE
  To describe the methods and findings from a number of focus group discussions that examined how GPs apply ethical principles when allocating scarce resources.
  
  
  METHODS
  A small-scale qualitative study involving purposive sampling, semi-structured interviews and focus groups.
  
  
  METHODS
  Twenty-four GPs from two contrasting areas of London: one relatively affluent and one relatively deprived.
  
  
  METHODS
  Initial interviews asked GPs to identify key resource allocation issues. The interviews were transcribed and themes were identified. A number of case studies, each illustrative of an ethical issue related to rationing, were written up in the form of vignettes. In focus group discussions, GPs were given a number of these vignettes to debate.
  
  
  RESULTS
  With respect to the ethical basis for decision making, the findings from this part of the study emphasised the role of social and psychological factors, the influence of the quality of the relationship between GPs and patients and confusion among GPs about their role in decision making.
  
  
  CONCLUSIONS
  The use of vignettes developed from prior interviews with GPs creates a non-threatening environment to discuss sensitive or controversial issues. The acceptance by GPs of general moral principles does not entail clarity of coherence of the application of these principles in practice.
authors.affiliation: Research fellow, Community Health Sciences, St. George's Hospital Medical School, University of London. l.berney@hscs.sgul.ac.uk
authors.forename: Lee
authors.initials: L
authors.lastname: Berney
authors.forename: Moira
authors.initials: M
authors.lastname: Kelly
authors.forename: Len
authors.initials: L
authors.lastname: Doyal
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
authors.forename: Chris
authors.initials: C
authors.lastname: Griffiths
authors.forename: Ian Rees
authors.initials: IR
authors.lastname: Jones
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D004992:Ethics, Medical; D005194:Family Practice / Q000941:ethics*; D005260:Female; D017144:Focus Groups; D015276:Health Care Rationing / Q000941:ethics*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D036301:Qualitative Research