title: Who Should Ration?
abstract: A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color. In the absence of systemwide reform in which the resources saved from one patient or group of patients are reallocated for the benefit of others, prudence is urged in the application of "bedside rationing."
authors.affiliation: Professor of pediatrics (oncology) and medicine at Duke University Medical Center and Duke University School of Medicine in Durham, North Carolina, and a member scholar in the Trent Center for Bioethics, Humanities & History of Medicine and chair of Duke Hospital's ethics committee.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Rosoff
mesh_terms: D003363:Cost Control; D003657:Decision Making / Q000941:ethics*; D004992:Ethics, Medical; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics*; D006295:Health Resources; D006297:Health Services Accessibility / Q000191:economics / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics; D010818:Practice Patterns, Physicians'; D011287:Prejudice; D016079:Refusal to Treat / Q000941:ethics; D012935:Social Justice; D012941:Social Responsibility