By Jon C. Tilburt and Christine Cassel
JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368.
The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.
Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,” have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work. The specialty societies and the Choosing Wisely collaborative outline commonsense principles for avoiding unnecessary, wasteful care.
Recent calls for waste avoidance and parsimonious care are not just a clever way to help physicians ration health care. Despite the intuitive similarity between themes in rationing and waste avoidance, the ethical rationales underlying the two differ considerably.
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