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February 27, 2013

Why the Ethics of Parsimonious Medicine Is Not the Ethics of Rationing

Author Affiliations

Author Affiliations: Division of General Internal Medicine, Biomedical Ethics Research Unit, Knowledge and Evaluation Research Unit, Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota (Dr Tilburt); and American Board of Internal Medicine, Philadelphia, Pennsylvania (Dr Cassel).

JAMA. 2013;309(8):773-774. doi:10.1001/jama.2013.368

The ethics of rationing health care resources has been debated for decades. Opponents of rationing are concerned that societal interests will supplant respect for individual patient choice and professional judgment. Advocates argue that injustices in the current system necessitate that physicians use resources prudently on behalf of society, even in their daily work with individual patients. The debate is important, potentially divisive, and unavoidable.

Various groups have championed the cause of medicine practiced leanly, consistent with the professional responsibility to use resources wisely. These initiatives, which champion “parsimonious medicine,”1 have highlighted the 20% of routine practices in US medicine that add no demonstrable value to health care but that persist in the inertia and rituals of clinical work.2 The specialty societies and the Choosing Wisely collaborative3 outline commonsense principles for avoiding unnecessary, wasteful care.

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