Tilburt Jon C, Sulmasy Daniel P
College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Philos Ethics Humanit Med. 2017 Aug 29;12(1):5. doi: 10.1186/s13010-017-0048-6.
Important discussions about limiting care based on professional judgment often devolve into heated debates over the place of physicians in bedside rationing. Politics, loaded rhetoric, and ideological caricature from both sides of the rationing debate obscure precise points of disagreement and consensus, and hinder critical dialogue around the obligations and boundaries of professional practice. We propose a way forward by reframing the rationing conversation, distinguishing between the scale of the decision (macro vs. micro) and its context (ordinary allocation vs. extraordinary re-allocation) avoiding the word "rationing." We propose to shift the terminology, using specific, descriptive words to defuse conflict and re-focus the debate towards substantive issues. These distinctions can clarify the real ethical differences at stake and facilitate a more constructive conversation about the clinical and social responsibilities of physicians to use resources ethically at the bedside and their role in allocating medical resources at a societal level.
基于专业判断限制医疗护理的重要讨论，常常演变成关于医生在床边资源分配中角色的激烈辩论。资源分配辩论双方的政治因素、情绪化言辞和意识形态化的描述，掩盖了分歧与共识的精确要点，阻碍了围绕专业实践的义务和界限展开的关键对话。我们提出一条前进的道路，通过重新构建资源分配的讨论框架，区分决策的规模（宏观与微观）及其背景（常规分配与非常规重新分配），避免使用“资源分配”一词。我们提议转变术语，使用具体的描述性词汇来化解冲突，并将辩论重新聚焦于实质性问题。这些区分能够厘清真正利害攸关的伦理差异，促进就医生在床边合理使用资源的临床和社会责任以及他们在社会层面分配医疗资源的作用展开更具建设性的对话。
