J Med Ethics 30:207-211 doi:10.1136/jme.2003.003681
  • Research ethics

Medical decision making in scarcity situations

  1. J J M van Delden2,
  2. A M Vrakking1,
  3. A van der Heide1,
  4. P J van der Maas1
  1. 1Department of Public Health, Erasmus MC, Rotterdam, Netherlands
  2. 2Julius Center for Health Sciences, University Medical Centre, Utrecht, Netherlands
  1. Correspondence to:
 Johannes J M van Delden;
  • Accepted 2 June 2003
  • Revised 23 April 2003


The issue of the allocation of resources in health care is here to stay. The goal of this study was to explore the views of physicians on several topics that have arisen in the debate on the allocation of scarce resources and to compare these with the views of policy makers. We asked physicians (oncologists, cardiologists, and nursing home physicians) and policy makers to participate in an interview about their practices and opinions concerning factors playing a role in decision making for patients in different age groups. Both physicians and policy makers recognised allocation decisions as part of their reality. One of the strong general opinions of both physicians and policy makers was the rejection of age discrimination. Making allocation decisions as such seemed to be regarded as a foreign entity to the practice of medicine. In spite of the reluctance to make allocation decisions, physicians sometimes do. This would seem to be only acceptable if it is justified in terms of the best interests of the patient from whom treatment is withheld.


  • This study was supported by a grant from the Dutch Organisation for Scientific Research.

  • At the time of the study JMM van Delden was at the Centre for Bioethics and Health Law, Utrecht University, Netherlands.