Strech Daniel, Synofzik Matthis, Marckmann Georg
Institut für Ethik und Geschichte der Medizin, Eberhard-Karls Universität, Schleichstrasse 8, 72076 Tübingen, Germany.
J Med Philos. 2008 Feb;33(1):80-99. doi: 10.1093/jmp/jhm007.
Although rationing of scarce health-care resources is inevitable in clinical practice, there is still limited and scattered information about how physicians perceive and execute this bedside rationing (BSR) and how it can be performed in an ethically fair way. This review gives a systematic overview on physicians' perspectives on influences, strategies, and consequences of health-care rationing. Relevant references as identified by systematically screening major electronic databases and manuscript references were synthesized by thematic analysis. Retrieved studies focused on themes that fell under three major headings: (i) conditions and influences of BSR, (ii) strategies of BSR, and (iii) consequences of BSR. The range of themes indicates that physicians' rationing behavior is highly variable, strongly influenced by context-related factors, and consists mainly of implicit rationing strategies. Torn between patient advocacy and the obligation to contain costs, physicians experience various role conflicts. The development of explicit rationing strategies seems necessary to avoid arbitrary BSR and allow a fair allocation of health-care resources.
尽管在临床实践中对稀缺医疗资源进行配给是不可避免的，但关于医生如何看待和实施这种床边配给（BSR）以及如何以符合伦理道德的公平方式进行配给的信息仍然有限且分散。本综述系统地概述了医生对医疗资源配给的影响、策略和后果的看法。通过对主要电子数据库和手稿参考文献进行系统筛选所确定的相关参考文献，采用主题分析法进行了综合。检索到的研究集中在以下三个主要标题下的主题：（i）床边配给的条件和影响，（ii）床边配给的策略，以及（iii）床边配给的后果。主题范围表明，医生的配给行为高度可变，受与背景相关的因素强烈影响，并且主要由隐性配给策略组成。在患者权益倡导和控制成本的义务之间左右为难，医生经历着各种角色冲突。制定明确的配给策略似乎有必要，以避免任意的床边配给，并实现医疗资源的公平分配。
