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. 2001 Feb;27(1):25–29. doi: 10.1136/jme.27.1.25

Balancing rationalities: gatekeeping in health care

D Willems 1
PMCID: PMC1733346  PMID: 11233373

Abstract

Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role?

Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities.

Key Words: Allocation • gatekeeper • physician-patient relations • justice • balancing • ethics

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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