Fair Resource Allocation and Rationing at the Bedside

Marion Danis is Head of the Section on Ethics and Health Policy in the Department of Bioethics in the Clinical Center of the National Institutes of Health and Chief of the Bioethics Consultation Service at the Clinical Center. Her research focuses predominantly on improving the health of disadvantaged populations and on strategies for public engagement in priority setting. She is also serves as a general internist in a primary care clinic Montgomery County, Maryland. Samia A. Hurst is professor of Bioethics and ethics consultant at Geneva University's medical school in Switzerland, chief editor of the Swiss bioethics journal Bioethica Forum, and a member of Switzerland's National Ethics Advisory Commission on Biomedical Ethics. Her research focuses on fairness in clinical practice, and the protection of vulnerable persons. Leonard Fleck, Ph.D. is a Professor of Philosophy and Medical Ethics in the Center for Ethics and Humanities in the Life Sciences, College of Human Medicine, Michigan State University. His areas of research include social and political philosophy, theories of health care justice, health care rationing, democratic deliberation, ethical and policy issues related to genetics. Reidun Førde is an MD and a previous Chair of the Council for Medical Ethics , Norwegian Medical Association. She was member of the second governmental commission on health priority making in Norway, and is also a member of the recently appointed third priority commission. She was also member of the first National Health Priority Council. Her research is on clinical ethics, end of life issues and resource allocation issues. Anne Slowther is Associate Professor of Clinical Ethics at Warwick Medical School, UK, an ethics consultant at the University Hospital Coventry and Warwickshire NHS Trust, and a family physician. She is chair of the UK Clinical Ethics Network and a member of the Governing Body of the Institute of Medical Ethics. Her research interests are in ethical decision making in clinical practice and evaluation of clinical ethics support.

Introduction ; Marion Danis, Reidun Forde, Leonard M. Fleck, Samia A. Hurst, Anne Slowther ; Part I. A European Survey of Bedside Rationing ; Chapter 1. The Values at the Bedside Study: Bedside rationing by physicians ; Samia A. Hurst, Anne Slowther, Reidun Forde, and Marion Danis ; Chapter 2. The interaction of bedside rationing and the fairness of healthcare systems: Physicians' views ; Samia A. Hurst, Reidun Forde, Anne Slowther, and Marion Danis ; Part II The Societal Context ; Chapter 3. The Swiss Context. ; Samia A. Hurst ; Chapter 4. The UK Context. ; Anne Slowther ; Chapter 5. The Norwegian Context. ; Reidun Forde ; Chapter 6. The Italian Context ; Renzo Pegoraro and Alessandra Bernardi ; Part III Analysis of Bedside Rationing ; Chapter 7. How Do Economic Incentive Schemes Influence Rationing Decisions by Primary Care Physicians? ; Tommy Allen, Matt Sutton, and Richard Cookson ; Chapter 8. The legal context of bedside rationing. ; Keith Syrett ; Chapter 9. Bedside Rationing or Rational Planning: In Search of Perspective on Medical Benefit and Safety ; Michael Barilan ; Chapter 10. Just Caring: The Ethics Challenges of Bedside Rationing ; Leonard M. Fleck ; Chapter 11. Overdiagnosis and Overtreatment: Implications for Bedside Rationing ; Howard Brody ; Chapter 12. How can bedside rationing be justified despite coexisting inefficiency? The need for "benchmarks of efficiency" ; Daniel Strech and Marion Danis ; Chapter 13. The Collective Action Problem ; Bob Goodin ; Chapter 14. Statistical vs. Identifiable Lives: Why Not to Use the R Word. ; Paul Menzel ; Chapter 15. Give to The Doctor What is Due to The Doctor! Why 'Fair Rationing at The Bedside' is Impossible ; Vegard Bruun Wyller ; Part IV. Strategies for Promoting Fair Bedside Rationing ; Chapter 16. Priority Setting in Hospital Care: Implementing National Legislation and Guidelines in a Hospital Trust ; Odd Soreide, Stener Kvinnsland, and Torhild Heggestad ; Chapter 17. Rationing by Clinical Judgment ; Samia A. Hurst and Marion Danis ; Chapter 18. Fairness and Transparency in Bedside Micro-allocation: Improving the Ethical Competence of Clinical Staff ; Jan Schurmann, Barbara Meyer-Zehnder, Marcel Mertz, Heidi Albisser Schleger, Mathias Schlogl, Reto Kressig, Hans Pargger, and Stella Reiter-Theil ; Chapter 19. Fair Resource Allocation in Clinical Care for Socially Disadvantaged Groups and Health Disparity Populations: Issues and Strategies ; Irene Dankwa-Mullan, Paula Goodwin, and Matthew Wynia ; Chapter 20. Bedside Rationing After Health Care Reform in the United States: The Emergence of Accountable Care Organizations ; Steven D. Pearson ; Chapter 21. Priority Setting Through Clinical Practice Guidelines: Lessons Learned ; Ole Norheim ; Chapter 22. Physicians as Bellwethers. ; Susan Dorr Goold ; Chapter 23. Moving Away from Silent Trepidation: Changing the Discussion of Rationing and Resource Allocation ; Marion Danis, Greer Donley and Reidun Forde ; Chapter 24. Priority Setting As a Clinical Skill: How Do We Educate Physicians? ; Anne Slowther and Benjamin P Bennett ; Afterword