• Leslie P Scheunemann and Douglas B White.
• Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. scheunemannlp@upmc.edu
• Semin Respir Crit Care Med. 2012 Aug 1;33(4):421-6.

AbstractAlthough the need to ration health care is increasingly accepted, the need for bedside physicians to participate in it is not. There are three common perspectives on physicians' roles in rationing: one is that bedside physicians should advocate fully for their patients and eschew rationing; another is that some rationing is permissible but should be imposed from outside the patient-physician relationship; the third is that bedside physicians should simultaneously advocate for their individual patients and make bedside rationing decisions that incorporate societal interests. The first two conceptualizations are at odds with empirical evidence that physicians do ration at the bedside and the idea that doing so may be a necessary part of efforts to control costs, whereas the third raises difficult ethical questions about the extent of physicians' obligations to advocate maximally for their individual patients.Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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