Informed Consent to Rationing Decisions
Hall, Mark A.
Milbank Quarterly. 1993; 71(4): 645-668.
To ration health care spending among competing medical and societal uses raises profound legal and ethical dilemmas. Previous discussions analyze whether rationing is permissible in any form, whether patients, physicians, or insurers (government and private) should be the primary rationing decision maker, the proper criteria for rationing, and the effect of cost containment on malpractice liability. Neglected in most of this legal-ethical discussion is the foundational doctrine of informed consent. There is little systematic analysis of how the physician's obligation to discuss the course of treatment and tailor it to individual patient desires is affected by public or private insurance that calls for the denial of marginally beneficial care because of costs. The issue is a compelling one regardless of whether, and to what extent, physicians are forced to make rationing decisions by rules or are induced to do so by educational, professional, or financial incentives. In all events, the messenger who delivers the bad news is under a fiduciary obligation of candor, which the law of informed consent is designed to enforce.
Alternatives; Autonomy; Containment; Contracts; Costs and Benefits; Consent; Disclosure; Economics; Government; Health; Health Care; Health Insurance; Incentives; Informed Consent; Insurance; Law; Legal Liability; Legal Rights; Liability; Malpractice; Managed Care Programs; Motivation; Managed Care; Organizations; Patient Care; Patient Participation; Patients; Physicians; Presumed Consent; Resource Allocation; Rights; Standards; Withholding Treatment;
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