Lawrence J. Schneiderman, MD, professor emeritus, Medicine/Family & Preventive Medicine, University of California, San Diego (UCSD), discusses preparing doctors for the fact that medical care will have to be rationed in the future.

Schneiderman says there is always going to be a greater demand for medicine than will be available. Since there is little help from Congress, Schneiderman says, physicians need to start thinking about where and how to reduce the amount of money spent on medical care due to soaring costs.

Currently, there is no good system for determining who gets procedures such as heart and kidney transplants. There is a system that lists eligible patients but patients who have the money to pay for the procedure move up on the list. When considering future rationing, Schneiderman suggests physicians should determine who get life-sustaining treatment as a guaranteed access and who should get function-comfort treatment as a decent minimum. This way, everyone will get at least decent medical care, Schneiderman says.

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Dr. Schneiderman on Rationing Medical Care

Lawrence J. Schneiderman, MD, professor emeritus, Medicine/Family & Preventive Medicine, University of California, San Diego (UCSD), discusses futility policies in relation to cancer drugs.

Schneiderman says that physicians can affect sick patients in many ways, but if the patient is too sick to benefit from a treatment, then that treatment should be declared futile.

At UCSD, there is a futility policy in place that states any treatment that does not have a reasonable chance of benefitting a patient should be considered futile and not obligatory. The American Medical Association’s Code of Medical Ethics says all hospitals should have a futility policy, Schneiderman says.

Physicians are sometimes concerned that a patient, or, more likely, a family will demand a treatment. The fact remains, Schneiderman says, that a patient or family can refuse a treatment but cannot demand a treatment.

Lawrence J. Schneiderman, MD

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Dr. Schneiderman on Rationing Medical Care

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