Abstract
BACKGROUND: Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent and character of bedside rationing.
DESIGN, SETTING, AND PARTICIPANTS: We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to identify the variables associated with reported rationing.
RESULTS: Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16), perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23).
CONCLUSION: Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability. The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance of discussions regarding how to ration care in the most ethically justifiable manner.
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The views expressed here are the authors’ own and do not reflect the position of the National Institutes of Health, of the Public Health Service, or of the Department of Health and Human Services.
Conflict of interest statement for authors: none
This work was funded by the Department of Clinical Bioethics at the National Institutes of Health, and was conducted while S.A.H. was a fellow at this Department. S.A.H. was funded in part by the University Hospitals of Geneva, by the Oltramare Foundation, and by the Centre Lémanique d’Ethique. The views expressed here are the authors’ own, and not necessarily those of the University Hospitals of Geneva, the Oltramare Foundation, or the Centre Lémanique d’Ethique.
The funding sources were not involved in the study design, the collection, analysis, or interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.
S.A.H. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Hurst, S.A., Slowther, AM., Forde, R. et al. Prevalence and determinants of physician bedside rationing. J Gen Intern Med 21, 1138–1143 (2006). https://doi.org/10.1111/j.1525-1497.2006.00551.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00551.x