Transparent Rationing at the Bedside

About a year ago, NPR, the Washington Post, and others reviewed Gregg Bloche's new book, The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise their Promise to Heal.  

[M]edicine’s capabilities and costs will inexorably grow. Increasingly, doctors will need to say no to care that’s technologically possible and that could prolong life, but that does so in competition with other national priorities. We must empower them to do so even when the consequences seem tragic. But we must give them this power without asking them to break faith at the bedside. To this end, the current regime of covert rationing, under cover of ‘medical necessity,’ should be supplanted by visible resource allocation rules–rules set for doctors and patients by social institutions.

To this end, it is a positive development that cases like Rasouli are being litigated in the very highest courts.  And it is a positive development that legislatures and regulators in several states are now designing new dispute resolution mechanisms for end-of-life treatment disputes.