Rationing: Theory, Politics, And Passions‪.‬

A confession is in order. As did almost everyone else of a certain persuasion, I recoiled when Sarah Palin invoked the notion of a "death panel" to characterize reform efforts to improve end-of-life counseling. That was wrong and unfair. But I was left uneasy by her phrase. Had I not been one of a handful of bioethicists over the years who had pushed to bring the need for rationing of health care to public attention and proposed ways to carry it out? And was not a common thread running through the latter efforts the likely necessity of some kind of committee or other public mechanism to make the hard decisions? Were we not in other words talking about a "death panel," even if none of us has been so imprudent to use such a phrase? And did we not regularly bemoan the fact that politicians, left and right, would not go near the word "rationing"? My answer to all those questions is yes, but with some important distinctions. One of them bears on the theoretical efforts to make a case for rationing and to propose means to carry it out. Another is the gap between that effort and the political realities of bringing rationing theory before the public eye. Still another is whether it is possible to envision an ethical theory that takes politics fully into account. But there is first a larger background story to be told about all that.