Prevalence and determinants of physician bedside rationing: data from Europe.
BACKGROUND
Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent and character of bedside rationing.


METHODS
We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to identify the variables associated with reported rationing.


RESULTS
Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16), perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23).


CONCLUSIONS
Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability. The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance of discussions regarding how to ration care in the most ethically justifiable manner.
Hurst
Samia A
SA
Bioethics Institute, University of Geneva Medical School, Geneva, Switzerland.
Slowther
Anne-Marie
AM
Forde
Reidun
R
Pegoraro
Renzo
R
Reiter-Theil
Stella
S
Perrier
Arnaud
A
Garrett-Mayer
Elizabeth
E
Danis
Marion
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015276:Health Care Rationing / Q000941:ethics / Q000379:methods* / Q000639:trends*; D006306:Health Surveys; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009664:Norway; D010820:Physicians / Q000191:economics / Q000941:ethics / Q000639:trends*; D010821:Physicians, Family / Q000191:economics / Q000941:ethics / Q000639:trends; D015995:Prevalence; D040841:Resource Allocation / Q000191:economics / Q000941:ethics / Q000639:trends; D013557:Switzerland; D006113:United Kingdom