Physicians are often asked to be gatekeepers, determining their patients' access to medical therapies and technologies. At the same time, most physicians have been taught that they should act as patient advocates, pursuing patients' best interests regardless of cost. This paper reviews moral arguments ethicists have made for and against bedside rationing. It argues that health care rationing is appropriate in order to help control health care costs, and that rationing decisions made at the bedside by physicians must be part of the rationing system. A system that attempts to control costs by mandating an elaborate set of rules would be burdensome, and many physicians would find ways around the rules anyway.Physicians are deeply conflicted about their roles in cost-containment. Some of the conflict has to do with discomfort over the concept of rationing, but they are also in conflict about much deeper issues. The author argues that patients can do with less than the best treatment and physicians must come to terms with this. Finally, health care systems need to signal physicians that it is acceptable for them to offer less to their patients in order to serve the greater good.

Related Topics: Healthcare rationing

Keywords: decision making ethics, clinical ethics, feedback, gatekeeping economics, gatekeeping ethics, health care rationing economics, health care rationing ethics, health care rationing methods, health services accessibility economics, health services accessibil

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