This leaves clinicians & administrators to their own devices to attempt to “flatten the rationing curve” - slowing the use rate of potentially scarce resources in hopes that they never have to be explicitly rationed.
BUT such "implicit rationing" at the individual clinician level may lead to unacceptable variations in care as well as compounding existing health system biases
First, it is important for clinicians to be able to recognize the difference b/w medical futility and rationing

Medical futility is a clinical assessment of an individual patient and an intervention

Rationing is a public health assessment of a community and a scarce resource
We are concerned re rationing creep, where interventions consuming scarce resources are deemed "futile" for a pt

Scarce is not the same as futile and patients deserve honestly and transparency regarding reasoning when interventions are withheld
Second, institutions limiting explicit rationing guidelines to high-profile interventions (like vents) unfairly morally burdens the front-line clinician to implicitly ration other scarce resources b/w patients, when they should be allowed to focus on providing individual care
We argue that bioethicists and administrators need to provide a framework for standard rationing criteria across all scarce resources, rather than encumbering individual clinicians with implicit rationing decisions and patients with additional opportunities for discrimination
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