Ubel P A, Goold S
Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
Ann Intern Med. 1997 Jan 1;126(1):74-80. doi: 10.7326/0003-4819-126-1-199701010-00010.
Under increasing pressure to contain medical costs, physicians find themselves wondering whether it is ever proper to ration health care at the bedside. Opinion about this is divided, but one thing is clear; Whether physicians should ration at the bedside or not, they ought to be able to recognize when they are doing so. This paper describes three conditions that must be met for a physician's action to quality as bedside rationing. The physician must 1) withhold, withdraw, or fail to recommend a service that, in the physician's best clinical judgment, is in the patient's best medical interests; 2) act primarily to promote the financial interests of someone other than the patient (including an organization, society at large, and the physician himself or herself); and 3) have control over the use of the beneficial service. This paper presents a series of cases that illustrate and elaborate on the importance of these three conditions. Physicians can use these conditions to identify instances of bedside rationing; leaders of the medical profession, ethicists, and policymakers can use them as a starting point for discussions about when, if ever, physicians should ration at the bedside.
在控制医疗成本的压力不断增加的情况下，医生们开始思考在床边进行医疗资源分配是否恰当。对此观点不一，但有一点是明确的：无论医生是否应该在床边进行资源分配，他们都应该能够意识到自己何时在这样做。本文描述了医生的行为要称得上床边资源分配必须满足的三个条件。医生必须：1）拒绝提供、停止提供或不推荐一项在医生最佳临床判断中符合患者最佳医疗利益的服务；2）主要为促进患者以外的其他人（包括组织、整个社会以及医生本人）的经济利益而行动；3）对有益服务的使用具有控制权。本文列举了一系列案例来说明并详细阐述这三个条件的重要性。医生可以利用这些条件来识别床边资源分配的情况；医学专业的领导者、伦理学家和政策制定者可以将它们作为讨论医生何时（如果有）应该在床边进行资源分配的起点。
