RATIONING HEALTH-CARE AT THE BEDSIDE

The collapse of national health care reform has left unresolved how best to limit rising casts and allocate limited resources within medicine. The rise of health maintenance organizations and other cost-conscious providers underscores the inevitability of health care rationing. Professor Hall argues that while scholars and practitioners debate the fine points of various rationing criteria, they ignore the more fundamental question of who should be empowered to make rationing decisions. In this Article, Professor Hall calls for lifting the ethical taboo against physician bedside rationing He argues that the prohibition is justified neither by actual practice nor by broad ethical principles. Physician rationing need not inject cost considerations into dramatic life-or-death medical decisionmaking, since most rationing entails marginal decisions in day-to-day practice. With this in mind, Professor Hall demonstrates, using economics, role morality, and the Ulysses paradigm, that neither the beneficence nor the autonomy principle of medical ethics dictates a blanket prohibition on physician rationing. He argues further, using fiduciary principles and agency cost theory, that financial incentives for physician rationing should be permitted if reasonable and disclosed Professor Hall concludes by calling for an end to the debate over whether bedside rationing is ever justified so that we can proceed with the important task of developing a new ethical framework that incorporates physician rationing.