Health systems need to set priorities fairly. In one way or another, part of this important task will fall to physicians. How do they make judgments about resource stewardship, and how should they do so? How can they make such decisions in a manner that is compatible with their clinical duties to patients? In this book, philosophers, bioethicists, physicians, lawyers and health policy experts make the case that priority setting and rationing contribute significantly to the possibility of affordable and fair healthcare and that clinicians play an indispensable role in that process. The book depicts the results of a survey of European physicians about their experiences with rationing and other cost containment strategies, and their perception of scarcity and fairness in their health care systems. Responding to and complementing these findings, commentators discuss why resource allocation and bedside rationing is necessary and justifiable. The book explores how bedside rationing relates to clinical judgments about medical necessity and medical indications, marginal benefits, weak evidence based medicine, off-label use. The book highlights how comparative studies of health care systems can advance more effective and fair bedside rationing through learning from one another. From a practical standpoint, the book offers a number of strategies for health care systems and clinicians to work in tandem to allocate and ration resources as fairly as possible: how to foster more attention to fairness when rationing at the bedside, how to avoid exacerbating health disparities when allocating resources, how to teach about bedside rationing to students, how to discuss rationing more explicitly in the public arena and in the doctor's office.

IntroductionMarion Danis, Reidun Forde, Leonard M. Fleck, Samia A. Hurst, Anne SlowtherPart I. A European Survey of Bedside RationingChapter 1. The Values at the Bedside Study: Bedside rationing by physiciansSamia A. Hurst, Anne Slowther, Reidun Forde, and Marion DanisChapter 2. The interaction of bedside rationing and the fairness of healthcare systems: Physicians' viewsSamia A. Hurst, Reidun Forde, Anne Slowther, and Marion DanisPart II The Societal ContextChapter 3. The Swiss Context.Samia A. HurstChapter 4. The UK Context.Anne SlowtherChapter 5. The Norwegian Context.Reidun FordeChapter 6. The Italian ContextRenzo Pegoraro and Alessandra BernardiPart III Analysis of Bedside RationingChapter 7. How Do Economic Incentive Schemes Influence Rationing Decisions by Primary Care Physicians?Tommy Allen, Matt Sutton, and Richard CooksonChapter 8. The legal context of bedside rationing.Keith SyrettChapter 9. Bedside Rationing or Rational Planning: In Search of Perspective on Medical Benefit and SafetyMichael BarilanChapter 10. Just Caring: The Ethics Challenges of Bedside RationingLeonard M. FleckChapter 11. Overdiagnosis and Overtreatment: Implications for Bedside RationingHoward BrodyChapter 12. How can bedside rationing be justified despite coexisting inefficiency? The need for "benchmarks of efficiency"Daniel Strech and Marion DanisChapter 13. The Collective Action ProblemBob GoodinChapter 14. Statistical vs. Identifiable Lives: Why Not to Use the R Word.Paul MenzelChapter 15. Give to The Doctor What is Due to The Doctor! Why 'Fair Rationing at The Bedside' is ImpossibleVegard Bruun WyllerPart IV. Strategies for Promoting Fair Bedside RationingChapter 16. Priority Setting in Hospital Care: Implementing National Legislation and Guidelines in a Hospital TrustOdd Søreide, Stener Kvinnsland, and Torhild HeggestadChapter 17. Rationing by Clinical JudgmentSamia A. Hurst and Marion DanisChapter 18. Fairness and Transparency in Bedside Micro-allocation: Improving the Ethical Competence of Clinical StaffJan Schürmann, Barbara Meyer-Zehnder, Marcel Mertz, Heidi Albisser Schleger, Mathias Schlögl, Reto Kressig, Hans Pargger, and Stella Reiter-TheilChapter 19. Fair Resource Allocation in Clinical Care for Socially Disadvantaged Groups and Health Disparity Populations: Issues and StrategiesIrene Dankwa-Mullan, Paula Goodwin, and Matthew WyniaChapter 20. Bedside Rationing After Health Care Reform in the United States: The Emergence of Accountable Care OrganizationsSteven D. PearsonChapter 21. Priority Setting Through Clinical Practice Guidelines: Lessons LearnedOle NorheimChapter 22. Physicians as Bellwethers.Susan Dorr GooldChapter 23. Moving Away from Silent Trepidation: Changing the Discussion of Rationing and Resource AllocationMarion Danis, Greer Donley and Reidun FordeChapter 24. Priority Setting As a Clinical Skill: How Do We Educate Physicians?Anne Slowther and Benjamin P BennettAfterword