Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physicianpatient relationship ("bedside rationing") is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physicianpatient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of his argument yet build on his genuine insights. In our analysis, Wyller's critique of bedside rationing is instructive both for harbouring some very common misconceptions that must be exposed and refuted, but also for offering important words of caution. In particular, bedside rationing must be performed in ways that do not harm the physician-patient relationship. Read irenically, Wyller's critique is a reminder of what must not be lost in our painful endeavour to update the ethics of medicine to encompass the unavoidability of rationing.
An ambitious plan to collect, curate, and make accessible information on genetic variations affecting human health is beginning to be realized.It has been 60 years since the first variation causing inherited disease was defined at the protein level. Currently, at least one such mutation is known to have occurred in 3000 of the 20,000 recognized human genes. In the next few years, the number of genes in which disease-causing mutations are recognized will increase dramatically. Despite good intentions, efforts to develop and build databases have failed to keep up with this pace.Thus, clinicians and diagnostic laboratories must waste their time trawling through many publications and databases to determine whether a mutation found in a patient has been previously characterized. Availability of previous characterizations of all mutations and their effects would allow them to base their diagnoses and prognoses on evidence rather than guesswork and conjecture. For inherited diseases, rapid access to curated information on all mutations in all genes from all populations is needed. Note that those who gain most by the availability of up-to-date gene variant data are usually downloading information only and are failing to add their findings to further improve the quality of the data collected. Changing this attitude and collecting all data seem to be mammoth tasks, but they are essential.
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