Medicine and Health Sciences | Open Access Articles

Downward Delegation Of Implantable Cardioverter Defibrillator Decision-Making In A Restricted-Resource Environment: The Pitfalls Of Bedside Rationing, Christopher Simpson, Barry Hoffmaster, Paul Dorian

C. Barry Hoffmaster

Implantable cardioverter defibrillators have been shown to reduce all-cause mortality in some patient populations at risk of sudden death. New Canadian guidelines recommend implantable cardioverter defibrillator therapy for these patients. However, the need for these devices exceeds the funded volumes in many Canadian jurisdictions. As a result, rationing of this resource has been necessary. While rationing at the macro (Ministry of Health) and meso (hospital) levels has achieved some level of acceptance by society, the responsibility for the decisions taken at the micro (individual) patient level actually rests with the physician at the bedside. This 'bedside rationing' creates a moral …

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