Article Text

Download PDFPDF

Balancing rationalities: gatekeeping in health care
  1. Dick L Willems
  1. University of Amsterdam, Amsterdam, the Netherlands

    Abstract

    Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role?

    Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities.

    • Allocation
    • gatekeeper
    • physician-patient relations
    • justice
    • balancing
    • ethics
    View Full Text

    Statistics from Altmetric.com

    Footnotes

    • Dick L Willems, MD, PhD is a General Practitioner and a Senior Researcher in Ethics at the Department of General Practice, Division of Public Health, Academic Medical Centre and University of Amsterdam, Amsterdam, the Netherlands.

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.