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Medical Ethics and the Stewardship of Health Care Resources

“Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely…”
-ACP Ethics Manual, Sixth Edition

Conflicting Duties?

The physician’s primary duty, first and foremost, is to the individual patient. She or he must advocate for the patient-- in a health care system that grows more and more complex by the year-- based on the best interests of the patient. But the physician also should use health care resources responsibly and efficiently. Are these duties in conflict? The ACP Ethics Manual and ethics case studies from the ACP Ethics, Professionalism and Human Rights Committee explore these issues and provide help in sorting them out.

Is it Rationing?

The ACP Ethics Manual tells us that “parsimonious” care “utilizes the most efficient means to effectively diagnose a condition and treat a patient” and also respects the need for appropriate and equitable use of resources. And the primary basis for these physician judgments? Evidence-based medicine.

Parsimonious medicine care is not rationing. The goal of medical parsimony is to provide the care necessary for the patient's good-- not to reduce resource use-- although it may have the welcome side effect of preserving resources. It is this difference in intent and action that helps provide a foundation for the ethical distinction between parsimonious medicine and rationing.

Exploring Stewardship

In exploring these issues further, the ACP staff developed ethics case studies through an award from the ABIM Foundation’s Putting the Charter into Practice project.

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