“Bedside Rationing”: Is It Ethical? Would It be Effective?

There has been much discussion in recent years about “bedside rationing”. These discussions really involve the issue of what is the ethical role of the physician. Is it to provide the best treatment to the patient with only the patient's beneficence in mind or is it also to consider the societal implications of medical care and to withhold certain treatments to specific patients because of costs or scarcity, thus perhaps providing beneficence to society in general? After all, one may argue, that it is society who has given physicians their special privileges and therefore physicians should also be responsible to society.

In an excellent journal review of the issue of bedside rationing, Renee Witlen writing in Virtual Mentor first considers the views of P.Ubel, R,Arnold "The unbearable rightness of bedside rationing: physician duties in a climate of cost containment".( Arch Intern Med. 1995;155:1837-1842). She then presents opposing views. Here is an excerpt from the beginning of the Virtual Mentor article. I would strongly advise my visitors to click on the link above to read the entire piece.

In their 1995 article, 'The Unbearable Rightness of Bedside Rationing: Physician Duties in a Climate of Cost Containment,' Drs Peter Ubel and Robert Arnold assert that physicians should engage in bedside rationing in order to contain rising health care costs. They define bedside rationing as 'physicians"actions to withhold beneficial care from patients that physicians were free to offer them" and confine their discussion to rationing done "either without patients being aware of the rationing or, less often, with patients being aware but being given no choice". Many physicians and ethicists have rejected this role for physicians in the belief that physicians must advocate for the individual patient, even acting, if necessary, against the "apparent interests of society as a whole". Ubel and Arnold contend that if bedside rationing is conducted correctly, it is morally acceptable and, in conjunction with rationing decisions at higher levels of health care organizations, constitutes the only viable way to contain health care costs in the short and medium term.

Do you think that bedside rationing is fair and would be effective only in countries that have national health plans, where there is a more uniform allocation of healthcare resources as compared to our USA private/governmental forms of healthcare delivery? Let me know what you think. ..Maurice.