Rationing, Patient Preferences, and Cost of Care at the End of Life

Peter A. Singer, MD, MPH, FRCPC; Frederick H. Lowy, MD, FRCPC
Arch Intern Med. 1992;152(3):478-480. doi:10.1001/archinte.1992.00400150012003.
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Rationing:  the word strikes terror into patients, physicians, and politicians alike. Patients fear that they will be denied access to needed medical services. Physicians worry that they will be the agents of rationing, placed into a conflict-of-interest situation between the commitment to their patients' best interest and third-party interests to reduce costs. Politicians are wary of being wedged between spiraling societal health spending and public expectations for high-quality health care.The dictionary defines rationing as follows: "to distribute or divide... commodities in short supply... in an equitable manner or so as to achieve a particular object..." and "to use sparingly."1 The term refers both to the situation of resource scarcity and the process used to distribute the scarce resource. Resources may be scarce because of natural limits (the scarcity of donor organs for transplantation) or because of fiscal decisions (the scarcity of cardiac surgery). Since society faces a number of


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