A framework for rationing by clinical judgment

Kennedy Institute of Ethics Journal
Samia A Hurst, Marion Danis

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.

Citations

Jul 25, 2013·Journal of General Internal Medicine·Marion DanisElizabeth McGlynn
May 30, 2014·Journal of General Internal Medicine·Amber K SabbatiniSusan D Goold
Sep 4, 2007·BMC Health Services Research·Samia A HurstMarion Danis
Sep 24, 2008·BMC Health Services Research·Sigurd M R LauridsenPeter Rossel
Sep 29, 2011·The Oncologist·Jennifer C KesselheimSteven Joffe
Dec 8, 2011·The American Journal of Bioethics : AJOB·Samia A Hurst
Jan 10, 2012·The American Journal of Bioethics : AJOB·Philip M Rosoff
Mar 16, 2012·The American Journal of Bioethics : AJOB·Nicolas Tavaglione, Samia A Hurst
Jan 7, 2016·The American Journal of Bioethics : AJOB·Leonard Fleck
Oct 30, 2010·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Philip J CrispinTherese M Crispin
Jan 7, 2011·Journal of Public Health Policy·Samia A HurstAlex Mauron
Jan 10, 2012·The American Journal of Bioethics : AJOB·Rebecca BamfordBryan M Weisbrod
Jan 10, 2012·The American Journal of Bioethics : AJOB·Samia A Hurst
Oct 12, 2011·Current Opinion in Critical Care·Scott D Halpern
Jul 30, 2019·The Journal of Medicine and Philosophy·Philip M Rosoff
Mar 18, 2021·BMC Health Services Research·Ursula W de RuijterJohan Legemaate
Jul 30, 2021·BMJ Global Health·Kristine Husøy OnarheimIngrid Miljeteig

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