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
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.
In exploring these issues further, the ACP Center for Ethics and Professionalism developed ethics case studies through an award from the ABIM Foundation’s Putting the Charter into Practice project.
Watch a video report of the ACP’s work on the Putting the Charter into Practice project presented by Dr. David Fleming, 2013-2014 President-Elect of the College.
One case study, Stewardship of Health Care Resources: Responding to a Patient’s Request for Antibiotics, addresses a physician’s response to a patient who requests antibiotics for a viral infection.
The analysis changes in a situation of true scarcity and emergency. A second case study developed through the grant project, Stewardship of Health Care Resources: Allocating Mechanical Ventilators During Pandemic Influenza, explores the physician’s ethical obligations in the allocation of life-sustaining health care resources during a medical emergency.
Additional ethics case studies, including Who Should Get What? Mammography and the Stewardship of Health Care Resources are also available.
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