Whether to Discontinue Nonfutile Use of a Scarce Resource

This chapter examines whether-and if so, how-the efficacy of a treatment should factor into health care rationing decisions. More specifically, it considers some of the ethical problems presented by the desire to discontinue the nonfutile use of scarce resources. It might be said that doctors should not do "rationing at the bedside" with patients. Rather, rationing should result from system-wide macro policy that ties doctors' hands and prevents them from allocating resources as they wish. However, this chapter argues that there may be an in-between case: when individuals are involved in trials for use of drugs, treatment to them might be discontinued because they do not do well enough, if and only if treating those who do better makes it possible to treat more candidates who are equally worthy. It also discusses three major issues that arise in the morality of discontinuing aid: regression, doctors' commitments to patients, and the temporal gap between denying aid to one person and providing better aid to someone else.