The Physician's Role in the Distribution of Limited Resources

The physician must routinely decide whether to use limited resources for an individual patient and may be tempted to justify denial of care in an attempt to conserve resources for other current and future patients. This justification puts the physician's fiduciary duty to the individual patient in jeopardy. However, if the physician abdicates the role of decision-maker, it may be undertaken by someone whose interests conflict with those of the patient, such as a third party payer. The case presentation in this article illustrates some of the features of this dilemma, and the case discussion argues that the physician's fiduciary duty to an individual patient supercedes any duty to ensure equitable distribution of resources. However, outside of this primary fiduciary duty, physicians have a separate duty to prospectively study treatment outcomes and use this information to ensure that resources are distributed appropriately.