RT Article
T1 ADMINISTRATIVE GATEKEEPING – A THIRD WAY BETWEEN UNRESTRICTED PATIENT ADVOCACY AND BEDSIDE RATIONING
JF Bioethics
VO 23
IS 5
SP 311
OP 320
A1 Lauridsen, Sigurd
LA English
YR 2009
UL https://ixtheo.de/Record/1781881839
AB The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term ‘administrative gatekeeping’, makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.
K1 Bedside Rationing
K1 Professional Ethics
K1 Resource Allocation
K1 Social Justice
K1 Health Care Rationing
DO 10.1111/j.1467-8519.2008.00652.x