Angell M
Kennedy Inst Ethics J. 1993 Sep;3(3):279-86. doi: 10.1353/ken.0.0253.
American doctors in the 1990s are being asked to serve as "double agents," weighing competing allegiances to patients' medical needs against the monetary costs to society. This situation is a reaction to rapid cost increases for medical services, themselves the result of the haphazard development since the 1920s of an inherently inflationary, open-ended system for funding and delivering health care. The answer to an inefficient system, however, is not to stint on care, but rather to restructure the system to remove the inflationary pressures. As long as we are spending enormous resources on an inherently inefficient and inflationary system we cannot justify asking doctors to withhold beneficial care to save money for third-party payers. Doing so serves a largely political agenda and endangers the patient-centered ethic that is central to medicine.
20世纪90年代的美国医生被要求充当“双重代理人”，权衡对患者医疗需求的相互冲突的忠诚与社会的金钱成本。这种情况是对医疗服务成本迅速上涨的一种反应，而医疗服务成本上涨本身是自20世纪20年代以来一个本质上具有通胀性、无限制的医疗保健资金筹集和提供系统随意发展的结果。然而，对于一个低效的系统，答案不是减少护理，而是重组系统以消除通胀压力。只要我们在一个本质上低效且具有通胀性的系统上花费大量资源，我们就无法为要求医生为了第三方支付者省钱而拒绝提供有益护理的做法找到正当理由。这样做主要是为了实现政治议程，危及以患者为中心的医学核心伦理。
