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June 17, 1992

The Risk of Redefining Rationing

Author Affiliations

Greenville, SC

JAMA. 1992;267(23):3152. doi:10.1001/jama.1992.03480230044017

To the Editor.  —I respond to a problem in the article by Drs Hadorn and Brook on definition of terms and "The Health Care Resource Allocation Debate."1 Hadorn and Brook state that the "use of the word rationing has clearly transcended its original meaning." I agree that clear definition of terms is necessary for discussion participants. I disagree with altering the meaning of clearly defined terms, particularly when misconceptions are perpetuated.The authors first review some erroneous concepts about rationing and give examples of inappropriate use of the word rationing such as "deliberate curtailment" and "rationing through inconvenience." They then redefine rationing as "toleration of inequitable access to beneficial services" with the modification "withholding of care duly deemed necessary." The remainder of the article answers some of the necessary questions about who they think should be given the authority to make the subjective decisions on equity, benefit, and necessity.