Rationing conscience

Dominic Wilkinson

Journal of Medical Ethics
Journal of Medical Ethics

Decisions about allocation of limited healthcare resources are frequently controversial. These decisions are usually based on careful analysis of medical, scientific and health economic evidence. Yet, decisions are also necessarily based on value judgements. There may be differing views among health professionals about how to allocate resources or how to evaluate existing evidence. In specific cases, professionals may have strong personal views (contrary to professional or societal norms) that treatment should or should not be provided. Could these disagreements rise to the level of a conscientious objection? If so, should conscientious objections to existing allocation decisions be accommodated? In the first part of this paper, I assess whether resource allocation could be a matter of conscience. I analyse conceptual and normative models of conscientious objection and argue that rationing could be a matter for conscience. I distinguish between negative and positive forms: conscientious non-treatment and conscientious treatment. In the second part of the paper, I identify distinctive challenges for conscientious objections to resource allocation. Such objections are almost always inappropriate.

Wilkinson D.  Rationing conscience.  J Med Ethics doi:10.1136/medethics-2016-103795

Rationing and professional autonomy

George J Agich

The Journal of Law, Medicine & Ethics
The Journal of Law, Medicine & Ethics

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.