Who Should Manage Care? the Case for Patients
Veatch, Robert M.
Kennedy Institute of Ethics Journal. 1997 Dec; 7(4): 391-401.
After establishing that it is essential that health care be rationed in some fashion, the paper examines the arguments for and against clinicians as gatekeepers. It first argues that bedside clinicians do not have the information needed to make allocation decisions. Then it claims that physicians at the bedside can be expected to make the wrong choice for two reasons: their commitment to the Hippocratic ethic forces them to pursue the patient's best interest (even when resources will produce only very marginal benefit and could do much more good elsewhere) and their values will lead them to calculate the net value of treatments incorrectly. Alternative decision makers are considered. It is argued that both groups of physicians and administrators will also make allocations incorrectly and that leaving the allocation decisions to patients themselves is the best approach. Mechanisms for fair and efficient rationing by patients at the societal and individual level are examined.
Accountability; Administrators; Beneficence; Conflict of Interest; Costs and Benefits; Decision Making; Economics; Gatekeeping; Goals; Health; Health Care; Health Promotion; Institutional Policies; Justice; Life; Medicine; Managed Care; Obligations to Society; Patient Advocacy; Patients; Physician's Role; Physicians; Prolongation of Life; Public Policy; Quality of Health Care; Quality of Life; Resource Allocation; Scarcity; Treatment Outcome; Utilitarianism; Value of Life; Values;