Variations in physician practice and covert rationing

Feinglass, Joseph

doi:10.1007/bf00539764

Cited by 4 publications

(1 citation statement)

References 31 publications

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“…A broader perspective on the present crisis is also gained by underscoring the fact that we already ration health care in many informal ways 3,19–28 . Various groups are denied beneficial care through interest group pressures, market forces, and implicit or explicit manipulations by various individuals.…”

Section: Enlarging Our Perspectivementioning

confidence: 99%

Ethical Constraints on Rationing Medical Care by Age

Jecker

Pearlman

1989

J American Geriatrics Society

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In a statement published in this issue, the Public Policy Committee of the American Geriatrics Society endorses the view that chronological age should not be a criterion for exclusion of individuals from medical care. This article aims to amplify the Committee's position by placing it within a broader context and identifying its justification in ethical argument. The paper is divided into three parts. The first part clarifies the difference between allocation (the distribution of funds between categories) and rationing (the distribution of funds within a single category). It is argued that given the current allocation of funds to medical care, some form of rationing is unavoidable. As others have noted, rationing is already occurring in an informal and piecemeal fashion. However, ethically sound rationing requires publicly debated and defensible policies. The second section of the paper reviews a number of arguments advanced in favor of rationing medical care on the basis of age. Objections to these arguments are carefully set out. The final part of the paper details and defends a series of positive arguments establishing special duties to the elderly. The paper concludes that to the extent that scarcity forces rationing, older persons should not be excluded because they are old.

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Section: Enlarging Our Perspectivementioning

confidence: 99%

Ethical Constraints on Rationing Medical Care by Age

Jecker

Pearlman

1989

J American Geriatrics Society

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Integrating medical ethics with normative theory: Patient advocacy and social responsibility

Jecker

1990

Theor Med Bioeth

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It is often assumed that the chief responsibility medical professionals bear is patient care and advocacy. The meeting of other duties, such as ensuring a more just distribution of medical resources and promoting the public good, is not considered a legitimate basis for curtailing or slackening beneficial patient services. It is argued that this assumption is often made without sufficient attention to foundational principles of professional ethics; that once core principles are laid bare this assumption is revealed as largely unwarranted; and, finally, that these observations at the level of moral theory should be reflected, in various ways, in medical practice. Specifically, this essay clarifies a tension that exists between different kinds of moral principles and explores the possibility of dissipating that tension by shoring up foundational principles. The paper begins by setting out three alternative models of how best to balance patient advocacy responsibilities with broader social responsibilities. It then turns to critically assess these models and argue that one has several advantages over the others.

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The futures of physicians: Agency and autonomy reconsidered

Salmon

White

Feinglass

1990

Theoretical Medicine

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The corporatization of U.S. health care has directed cost containment efforts toward scrutinizing the clinical decisions of physicians. This stimulated a variety of new utilization management interventions, particularly in hospital and managed care settings. Recent changes in fee-for-service medicine and physicians' traditional agency relationships with patients, purchasers, and insurers are examined here. New information systems monitoring of physician ordering behavior has already begun to impact on physician autonomy and the relationship of physicians to provider organizations in both for-profit and 'not-for-profit' sectors. As managed care practice settings proliferate, serious ethical questions will be raised about agency relationships with patients. This article examines health system dynamics altering the historical agency relationship between the physician and patient and eroding the tradiational autonomy of the medical profession in the United States. The corporatization of medicine and the accompanying information systems monitoring of physician productivity is seen to account of such change, now posing serious ethical dilemmas.

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Variations in physician practice and covert rationing

Cited by 4 publications

References 31 publications

Ethical Constraints on Rationing Medical Care by Age

Ethical Constraints on Rationing Medical Care by Age

Integrating medical ethics with normative theory: Patient advocacy and social responsibility

The futures of physicians: Agency and autonomy reconsidered

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