Rosoff Philip M
Professor of pediatrics (oncology) and medicine at Duke University Medical Center and Duke University School of Medicine in Durham, North Carolina, and a member scholar in the Trent Center for Bioethics, Humanities & History of Medicine and chair of Duke Hospital's ethics committee.
AMA J Ethics. 2017 Feb 1;19(2):164-173. doi: 10.1001/journalofethics.2017.19.2.ecas4-1702.
A principal component of physician decision making is judging what interventions are clinically appropriate. Due to the inexorable and steady increase of health care costs in the US, physicians are constantly being urged to exercise judicious financial stewardship with due regard for the financial implications of what they prescribe. When applied on a case-by-case basis, this otherwise reasonable approach can lead to either inadvertent or overt and arbitrary restriction of interventions for some patients rather than others on the basis of clinically irrelevant characteristics such as ethnicity, gender, age, or skin color. In the absence of systemwide reform in which the resources saved from one patient or group of patients are reallocated for the benefit of others, prudence is urged in the application of "bedside rationing."
医生决策的一个主要组成部分是判断哪些干预措施在临床上是合适的。由于美国医疗保健成本持续且稳步上升，医生们不断被敦促要审慎地进行财务管理，充分考虑他们所开处方的财务影响。当逐案应用时，这种原本合理的方法可能会导致基于种族、性别、年龄或肤色等与临床无关的特征，对某些患者而非其他患者进行无意的、公开的或任意的干预限制。在没有全系统改革（即把从一个患者或一组患者节省下来的资源重新分配用于造福其他患者）的情况下，在应用“床边配给”时应谨慎行事。
