George J Agich
Extract
Rationing is an inevitable consequence of practicing medicine under conditions of scarcity of resources. Unfortunately, appeals to professional autonomy have muddled the issues associated with limited resource availability in medicine by alleging conflicts that are irresolvable in principle between rationing under prospective payment systems and medical ethics. Such appeals do little to address the real problems involved or to help clarify the important ethical and public policy issues that surround this ineliminable fact of life. Careful analysis of rationing and professional autonomy, however, leads to the conclusion that rationing is a problem for medical ethics at least in the sense that it forces important and difficult questions to the surface regarding the proper nature and structure of medical practice. Some of these questions are precisely the ones at which prospective payment initiatives are aimed.
Agich GJ. Rationing and professional autonomy. J Law Med Ethics. 1989;18(1-2):77-84.