Why should explicit rationing be preferred over implicit rationing?

Implicit rationing pushes the decision onto the individual doctor at the bedside, does not guarantee that the criteria are applied uniformly, and damages trust between doctor and patient (the doctor becomes a "double agent").

Three reasons against implicit rationing:

1. It offloads the decision onto the doctor in a concrete situation with concrete people, exactly the case-by-case weighing that is hardly defensible. Doctors have a legitimate claim on society to be relieved of such decisions.
2. No uniform application: each doctor rations by their own criteria, so equal cases are not treated equally.
3. It damages trust: the patient can no longer be sure whether the doctor acts for them or for the budget. The doctor becomes a "double agent".

Hence the proposal: establish general prioritisation and rationing rules that are transparent, clearly and understandably formulated (as options for action), partly to protect the sensitive doctor-patient relationship. The pressure is expected to grow with demographic change, so the rules are needed before the shortage, not during it.

Go deeper:

• SAMW: Triage guidelines FAQ (German) — a real example of explicit prioritisation rules set in advance (Swiss ICU triage).