title: A framework for rationing by clinical judgment.
abstract: Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness.
authors.affiliation: Institute for Biomedical Ethics, University of Geneva Medical School, Switzerland.
authors.forename: Samia A
authors.initials: SA
authors.lastname: Hurst
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
mesh_terms: D001803:Blood Transfusion / Q000941:ethics; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D026690:Ethics, Clinical; D004992:Ethics, Medical; D015276:Health Care Rationing / Q000941:ethics* / Q000379:methods*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007362:Intensive Care Units / Q000941:ethics / Q000600:supply & distribution; D026684:Personal Autonomy; D012935:Social Justice; D014218:Triage / Q000941:ethics; D014611:Vaccination / Q000941:ethics; D000078329:Workforce
chemical_list: D007252:Influenza Vaccines