TY - JOUR
T1 - Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing
AU - Lauridsen, Sigurd
N1 - Keywords: Conflict (Psychology); Cost-Benefit Analysis; Decision Making; Ethical Analysis; Gatekeeping; Health Care Rationing; Health Services Accessibility; Healthcare Disparities; Humans; Moral Obligations; Patient Advocacy; Philosophy, Medical; Physician's Role; Physician-Patient Relations; Politics; Quality-Adjusted Life Years; Social Justice; Trust
PY - 2009
Y1 - 2009
N2 - The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.
AB - The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.
U2 - 10.1111/j.1467-8519.2008.00652.x
DO - 10.1111/j.1467-8519.2008.00652.x
M3 - Journal article
C2 - 18410460
SN - 0269-9702
VL - 23
SP - 311
EP - 320
JO - Bioethics
JF - Bioethics
IS - 5
ER -