The truth is beginning to leak out: not only are our national resources less than infinite, but even in the United States in 1992 we have a medical care system that is already involved in rationing, sometimes overtly and sometimes covertly. While fiscal redistribution could alleviate part of the problem—whether by less spending on health care administration, unnecessary procedures, military hardware, or cashmere sweaters for household pets — many now believe it unlikely that we will be able to provide unrestricted, high-technology care on (patient, physician, and lawyer) demand for everyone in every circumstance forever. If this is in fact true, then it is only reasonable, although frightening, to deal with this honestly and upfront. Can rationing be made rational?
Singer and Lowy, in this issue, suggest that one ethically compelling approach to rationing is to have the individual patient's preferences solely guide the agenda. The underlying assumption is that