The Problems With Rule-Based Rationing
Hall, Mark A.
Journal of Medicine and Philosophy. 1994 Aug; 19(4): 315-332.
Centralized, democratic rules are often asserted as a superior basis for rationing than individualized physician discretion. This article counters this prevailing wisdom by exploring the deficiencies of rule-based rationing. Rules are too imprecise to accurately reflect all the nuances of physical and mental impairment and the complexity of medical science, particularly considering the widely varying personal values that different patients attach to medical risk and benefit. Rule-based rationing also suffers from the biasing effects of interest group pressure on political processes and the tendency to absolve physicians from any moral responsibility for the rationing decisions they implement. Internalizing cost constraints is a more socially and professionally acceptable means of rationing and, in any event, it is inevitable since even a preponderance of rule-based rationing will leave considerable areas of discretion for physician judgment in the implementation and interpretation of the rules. As a consequence, despite the flaws of bedside rationing, it is foolhardy to dispense with it entirely in favor of an exclusively rule-based system.
Administrators; Biomedical Technologies; Costs and Benefits; Cultural Pluralism; Decision Making; Democracy; Diagnosis; Discrimination; Economics; Government; Government Regulation; Guidelines; Health; Health Care; Health Care Delivery; Health Insurance; Incentives; Industry; Insurance; Life; Managed Care Programs; Methods; Managed Care; Patient Care; Patients; Physicians; Political Activity; Practice Guidelines; Public Participation; Public Policy; Quality of Life; Regulation; Resource Allocation; Risk; Risks and Benefits; Science; Selection for Treatment; Social Discrimination; Socioeconomic Factors; Standards; Values;
Showing items related by title, author, creator and subject.
Hall, Mark A. (1994-08)
A No-Brainer: Criticisms of Brain-Based Standards of Death Review of BEYOND BRAIN DEATH: THE CASE AGAINST BRAIN BASED CRITERIA for HUMAN DEATH, Edited by Michael Potts, Paul A. Byrne, and Richard G. Nilges; BRAIN DEATH: PHILOSOPHICAL CONCEPTS and PROBLEMS, by Tom Russell Campbell, Courtney S. (2001-10)
MAKING MEDICAL SPENDING DECISIONS: THE LAW, ETHICS, and ECONOMICS of RATIONING MECHANISMS, by Mark A. Hall Snyder, Jack W. (1998-03)