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The Physician's Role in Resource Allocation

John La Puma, MD; Christine K. Cassel, MD; Holly Humphrey, MD

Arch Intern Med. 1988;148(8):1809-1811.

Abstract
• Medical decisions are increasingly shaped by financial considerations. Biomedical ethicists have encouraged the practicing physician to remain the agent of the individual patient, sometimes pitting physicians against health care institutions. The limitation of medical resources has given rise to the need for a clear conceptual basis for allocating scarce resources. The role of resource gatekeeper may be used to the indigent patient's disadvantage when the principles of triage are used incorrectly in situations of relative scarcity. To allocate limited resources fairly under changing policy and economic conditions, health care institutions should ensure that systematic processes, such as those of ethics consultants and committees, are readily available to help resolve problematic cases and policies. Physicians with clinical judgment and a primary commitment to patient care must assume active roles in these processes in order to build an ethically sound framework for clinical decision making in times of relatively scarce resources.

(Arch Intern Med 1988;148:1809-1811)

Author Affiliations
From the Section of Clinical Ethics, Lutheran General Hospital, Park Ridge, Ill (Dr La Puma), and the Department of Medicine, Section of General Internal Medicine, Center for Clinical Medical Ethics, University of Chicago Hospitals (Drs La Puma, Cassel, and Humphrey).

Footnotes
Accepted for publication March 29, 1988.

Reprint requests to Section of Clinical Ethics, Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068 (Dr La Puma).

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