Überlegungen zur Notwendigkeit einer offenen Rationierungsdebatte

Abstract.

Definition of the problem. It seems to be generally accepted that the public health care system is in serious financial trouble, and some experts are even calling for rationing medical services on the basis of transparent criteria. However, apart from scientific discussions there has been no public debate on the scope of rationing in medicine and the adequacy of alternative criteria of rationing – including those actually used in medical practice. Arguments. Such a debate is important because the scarcity of resources is compelling physicians to make decisions that go (at least partially) beyond their professional competence. Since it is to be expected that the problem of financing public health care will become more and more urgent, the burden of making momentous moral decisions will presumably increase as long as they ration medical care without any assistance from society. Furthermore, an open debate is desirable because transparency clashes with widely acknowledged ethical principles are missing. On the other hand, there are possible hindrances such as the ambiguity of the concept of rationing and the questionable definitions of ”rationing” presented in recent literature. Conclusion: There are good reasons for stimulating an open debate on health care rationing. Whether such a debate takes place successfully could depend on the willingness of people to agree on an unbiased concept of rationing. However, for the time being, it would be too pessimistic to believe that the idea of an open debate is therefore unrealizable.

Zusammenfassung.

Obwohl sich das Gesundheitswesen in einer Krise befindet und Experten argumentieren, dass es angezeigt sei, medizinische Leistungen auf der Basis transparenter Kriterien zu rationieren, gibt es bislang (abgesehen von wissenschaftlichen Diskussionen) im Grunde keine öffentliche Debatte über das Ausmaß faktischer Rationierung und die Adäquatheit alternativer Rationierungskriterien. Zahlreiche Gründe sprechen für die Notwendigkeit, eine solche Debatte zu führen. Auch wenn mögliche Hemmnisse in Rechnung zu stellen sind, wäre es zum gegenwärtigen Zeitpunkt verfrüht, die Idee einer offenen Rationierungsdebatte als unrealisierbar zu betrachten.