ABSTRACT

In the absence of emergency or selectivity, Americans are likely to accept–emotionally and politically–less medical treatment only if it occurs within a story that makes specific rationing, implicit rationing, and personal wishes to refuse care contextually understandable. Physicians who have difficulty accepting the deaths of patients for whom everything was tried will have far more difficulty if they personally choose–especially on their own initiative–not to try everything, or to try nothing. "Healing the Patient" is a narrative that does not necessarily accept direct rationing, but would be amenable to implicit rationing and to less dependence upon medical technology, procedures, and drugs. Oregon's initial success at rationing specific life-saving treatments may derive from the fact that they eliminated organ transplants for a dozen or so people on Medicaid. There are worse choices than starting the discussion on the rationing of health care by returning to a now-lost discussion about the purpose of health-care and about the purpose of health-care professionals.