BACKGROUND: Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent
and character of bedside rationing.
DESIGN, SETTING, AND PARTICIPANTS: We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity
was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and
administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to
identify the variables associated with reported rationing.
RESULTS: Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some
degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria
for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life
when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was
positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16),
perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23).
CONCLUSION: Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability.
The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance
of discussions regarding how to ration care in the most ethically justifiable manner.
Key Words health care rationing - health resources - attitude of health personnel - ethics - clinical - Europe
The views expressed here are the authors’ own and do not reflect the position of the National Institutes of Health, of the
Public Health Service, or of the Department of Health and Human Services.
Conflict of interest statement for authors: none
This work was funded by the Department of Clinical Bioethics at the National Institutes of Health, and was conducted while
S.A.H. was a fellow at this Department. S.A.H. was funded in part by the University Hospitals of Geneva, by the Oltramare
Foundation, and by the Centre Lémanique d’Ethique. The views expressed here are the authors’ own, and not necessarily those
of the University Hospitals of Geneva, the Oltramare Foundation, or the Centre Lémanique d’Ethique.
The funding sources were not involved in the study design, the collection, analysis, or interpretation of data, in the writing
of the report, or in the decision to submit the paper for publication.
S.A.H. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy
of the data analysis.