Am. J. Respir. Crit. Care Med., Vol 150, No. 1, Jul 1994, 266-270.
The changing physician-patient relationship in critical care medicine under health care reform
JM Luce
Division of Pulmonary and Critical Care Medicine, University of California, San Francisco.
American society and the medical profession have historically been
dominated by a "single master" view that emphasizes unrestrained advocacy
for individual patients and prohibits physicians, including those who work
in critical care units, from being providers and rationers of health care
services simultaneously. With its emphasis on universal access and cost
containment, health care reform requires that society and the medical
profession balance this individualistic ethic with a communitarian ethic
that stresses proportional advocacy for all patients and encourages
physicians and patients to help define the scope of services their health
care institutions provide. Ideally, this balance will allow the transition
from a "rule of rescue" in which large sums of money are spent on therapies
that may have only marginal benefit to a "rule of reason" in which this
money can be used for primary and preventive care.
