Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing

Bioethics
Sigurd Lauridsen

Abstract

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.

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Citations

Jan 9, 2013·Multidisciplinary Respiratory Medicine·Silvia Rossi Ferrario, George Cremona
Dec 3, 2013·Journal of Medical Ethics·Kristin Voigt
Feb 26, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Catherine R ButlerDaniel Y Lam
Oct 7, 2011·Nursing Ethics·Alice GaudineLinda Thorne
Jul 26, 2012·Cambridge Quarterly of Healthcare Ethics : CQ : the International Journal of Healthcare Ethics Committees·Stella Reiter-Theil
Jul 2, 2017·International Journal for Equity in Health·Jin Xu, Anne Mills
Mar 18, 2021·BMC Health Services Research·Ursula W de RuijterJohan Legemaate

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