Can Rationing through Inconvenience Be Ethical? image

Hasting Center Report, Volume 48, Issue 1
Nir Eyal, Paul L. Romain, and Christopher T. Robertson (Academic Fellow alumnus)

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From the Article:

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a nonfinancial burden (the inconvenience) that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health‐related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods.

We take it as a starting assumption that rationing, understood as scarce‐resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair.

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Want to learn more about the use of ordeals in the health sphere? Join all three authors of this article on May 10 and 11, at Harvard Law School for the conference "Ordeals in Health Care: Ethics and Efficient Delivery"!

bioethics christopher robertson economics global health health care finance health care reform public health