The ideal advocate and limited resources

Abstract

The central thesis of this paper is that cost-containment challenges to an Ideal Advocate model of the physician-patient relationship can be met under proper circumstances. More specifically, it is possible for physicians to constrain costs while still making clinical decisions that are free from considerations of the physician's own interests and are uninfluenced by judgements about the patient's worth. But what is required is a closed distributive system, in which savings of resources at one point are applied to others' care of higher priority and a just system, that is, a system whose distributive priorities are consistent with relevant principles of justice under moderate scarcity. The historical context of the argument and a stopgap, “palliative,” step are also developed.