Bedside rationing by physicians: the case against.

Society should not accept the inevitability of rationing medical resources, at least not in the short term. Because of the high degree of waste and duplication that characterize the Canadian and, even more, the American healthcare system, the invitation to focus on rationing procedures known to be useful is likely to divert attention from the need to eliminate waste. If and when extensive rationing becomes necessary, however, Ubel's proposal that we adopt bedside rationing by physicians ought nevertheless to be rejected because it is ethically objectionable. Such a scheme would violate the bond of trust between doctor and patient, leading to arbitrary and discriminatory decisions. Since most physicians lack both the time and the expertise to perform cost-benefit calculations properly, Ubel's scheme would be inefficient as well as unethical. There is a better alternative.