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To the Editor
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Daniel Callahan, in his thoughtful essay, sums up the consensus among ethicists regarding rationing: “if not at once, then sooner or later, rationing will be necessary; bedside rationing will not be acceptable; rationing will have to be done at the policy level; . . . not case by case.” But as he points out, “there is a deeply embedded hostility to government interference in the doctor-patient relationship,” and efforts to make decisions at a policy level seem fraught with politics.

Is there an alternative? Perhaps we could maintain the current level of patient autonomy in decision-making, but ration our resources. What if each individual, at some predetermined advanced age or at the onset of some predetermined health condition, were allotted a fixed amount of money to be used for health care? The funds might be used to treat trauma, dementia, prolonged coma, the persistent vegetative state, or heart, liver, or kidney failure, or they could be used to purchase hearing aids or physical therapy sessions. The decision would remain with the patient or the family. With trauma or coma, the funds could be used quickly in an intensive care unit, more slowly on a regular hospital unit, even more slowly at home or in hospice. If the patient dies, half of any residual money in his or her account would go to the estate, and half would be returned to the government, thus removing an incentive to prolong care. If the money runs out before the patient dies, then the patient could use his or her own funds, or receive only comfort care.

Such an approach would maintain the patient’s and the family’s autonomy while limiting the currently unlimited costs of end-of-life care and possibly discouraging the use of some expensive therapies or devices. Such a policy would also remove the potential biases of “death panels” and would strengthen the physician-patient relationship: the physician would need to explain possible outcomes, different scenarios and their costs, and the unclear benefits and exorbitant prices of some new medicines and devices. (Materials to aid in these explanations should be developed by the government and health care organizations.) The appropriate age to institute an individual’s fund and the amount of funding allotted could be determined actuarially.

Copyright © 2011 The Hastings Center
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Eric J. Cassell. "Rationing and Reality." Hastings Center Report 41.6 (2011): 4-4. Project MUSE. Web. 9 Jul. 2014. <http://muse.jhu.edu/>.
Cassell, E. J.(2011). Rationing and Reality. Hastings Center Report 41(6), 4. The Hastings Center. Retrieved July 9, 2014, from Project MUSE database.
Eric J. Cassell. "Rationing and Reality." Hastings Center Report 41, no. 6 (2011): 4-4. http://muse.jhu.edu/ (accessed July 9, 2014).
T1 - Rationing and Reality
A1 - Cassell, Eric J.
JF - Hastings Center Report
VL - 41
IS - 6
SP - 4
EP - 4
PY - 2011
PB - The Hastings Center
SN - 1552-146X
UR - http://muse.jhu.edu/journals/hastings_center_report/v041/41.6.cassell.html
N1 - Volume 41, Number 6, November-December 2011
ER -


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