The bedside rationing paradigm and the shortcomings of modernist ethics

Abstract

Many bioethicists promote and defend the 'bedside rationing paradigm'; a pertinent example is the recent publication by Morten Magelssen and colleagues, in which they attack my previous criticism in the field. The present response focuses on what I consider to be the main side-effects of the 'bedside rationing paradigm': the ignorance towards intentions and societal roles, the crumbling of political practice, and the fiduciary loss in the physician-patient relationship. Further, I claim that these side effects are related to certain underlying presumptions, such as the conception of fairness as equivalent with distributive justice and the belief in the presence of universally valid, context-independent moral principles. These presumptions are characteristics of modernist ethics; thus, the 'bedside rationing paradigm' illustrates some fundamental shortcomings of this moral theory. I argue that an ethics of virtue is better suited to the practice of medicine as well as to the rationing dilemmas.

‘If he dies with the papers of his brother, his brother will be considered dead’. Moral understandings of health professionals about the use of deception to overcome restrictions in access to healthcare

“…Wyller 21,24 warns of the negative effects of bedside rationing on fiduciary. The notion of a formatted discourse illustrates that health professionals are aware that undocumented migrants can adjust to restrictions in healthcare access by adaptive practices.…”

“…In the last few years, there has been a considerable debate on ethical bedside rationing. [21][22][23][24] This debate focuses on policies imposing a given resourceallocation in a context of scarcity of healthcare resources. 21 With regard to the question whether rationing by health professionals is acceptable and/or unavoidable, Magelssen et al 22 advocate that bedside rationing in healthcare is unavoidable and that it is reasonable for health professionals to portion out healthcare resources and decline certain health services to patients, based on bioethical theories providing guidance on how to ration ethically in particular cases.…”

“…Opponents however argue against the possibility of health professionals offering some of their patients less than optimal healthcare services, claiming that rationing harms the physicianpatient relation by prioritizing the interests of a third party. Whereas rationing is defended on macro-utilitarian grounds, deontological approaches stress a primary obligation of health professionals to the patient in front of them, 21,24 claiming that the 'ethos of the profession' entails the implicit need to challenge underfunding or restraints that are perceived as arbitrary. 23 Therefore, Loughlin 23 advocates for a strategic attitude of 'critical citizenry' when a system prevents health professionals 'from giving people the care they deserve'.…”

“…23 Therefore, Loughlin 23 advocates for a strategic attitude of 'critical citizenry' when a system prevents health professionals 'from giving people the care they deserve'. For Wyller 24 'rationing is the hallmark of politics' and the need for bedside rationing by health professionals should be limited and confined to the political practice as far as possible.…”

Prioritering, styring og likebehandling: Utfordringer i norsk helsetjeneste

“…Det er grunn til å ta denne bekymringen på alvor. I en norsk kontekst er professor i barnesykdommer Vegard Bruun Bratholm Wyller blant dem som har fremsatt denne bekymringen med størst kraft og i størst detalj (Wyller, 2014(Wyller, , 2017. Hans kritikk er spesielt interessant fordi den artikulerer og utdyper intuisjoner som trolig er utbredt blant klinikere.…”