Materials

Issue 179: Ruhnau, Clemens: Ethische Orientierung für ärztliches Rationieren beim einzelnen Patienten. . July 2008

Setting limits in health care systems seems to be inevitable. This results in quite diverse ethical challenges for physicians and for the physician-patient relationship, depending on the level where rationing decisions are determined and on the form of this determination. From an ethical point of view, rule-based rationing seems to be less problematic: Physicians simply play by explicitly formulated rules determining what patient, according to which indication, receives which service or not. But when physicians (have to) decide by themselves – without such rules – whether to ration care with regard to concrete patients or not, serious ethical questions emerge. Under what conditions and with respect to which criteria can those decisions be judged as ethically acceptable?
To answer this question, since 2000, three quite different concepts have been elaborated by Peter A.Ubel and Samia Hurst/Marion Danis (referring to the US-American context) and Georg Marckmann (referring to the German context). To promote further debates, Clemens Ruhnau systematically compares these proposals with regard to their presuppositions and intentions as well as to the criteria, conditions, restraints and forms of procedures that the authors claim for bedside rationing to be ethically acceptable. The strong and weak points of these concepts and their (political) feasibility come to light, as well as the whole spectrum of complicated ethical questions involved in this form of rationin