Resource allocation and the Code of Ethics / Response

In the article "Bioethics for clinicians: 13. Resource allocation" (Can Med Assoc] 1997;157[2]:163-7), Dr. Martin McKneally and colleagues state "The clinician's goal is to provide optimal care within the limits imposed by the allocation of resources to health care generally and to the institution, program and specific situation in which an individual patient is treated." Any physician who follows this advice would violate the CMA's Code of Ethics, the first canon of which is "Consider first the well-being of the patient." [One of the authors responds:] Dr. Baltzan raises the central issue in resource allocation that troubles every caregiver. Does the physidan's fiduciary obligation, expressed in the CMA canon discussed by Baltzan, require us to "do everything that may benefit each patient without regard to costs or other societal considerations"?' Can we simultaneously ignore the potential harm to other patients, including some we ourselves will be forced to treat suboptimally because of our earlier expenditure of finite resources? Our answer to both questions is No.