Intended for healthcare professionals

Education And Debate

Rationing in general practice: The Asbury draft policy on ethical use of resources

BMJ 1996; 312 doi: (Published 15 June 1996) Cite this as: BMJ 1996;312:1528
  1. Roger Crisp, fellow in philosophya,
  2. Tony Hope, lecturer in practice skillsb,
  3. David Ebbs, general practitionerc
  1. a St Anne's College, University of Oxford, Oxford
  2. b Department of Public Health and Primary Care, University of Oxford
  3. c Didcot Health Centre Practice, Didcot, Berkshire
  1. Correspondence to:. Dr T Hope, University of Oxford Medical School, John Radcliffe Hospital, Oxford OX3 9DU.
  • Accepted 12 April 1996

Many doctors find themselves torn between two contradictory principles: to do the best for the individual patient and to be responsible for an overall budget that is insufficient for the best care for each individual patient. Little guidance is available for doctors on how to resolve this conflict. Crisp et al present a draft document that one fundholding general practice has developed to clarify the ethical basis for rationing decisions. We invited three interested professionals to comment on the draft.

The general practice partners invited two medical ethicists (RC and TH) to meet them to develop the document. The partners met RC and TH for one and a half hours on eight occasions over one year and met without them on eight further occasions. The entire general practice also had an all day session to discuss in detail an advanced version of the draft. The developmental process was of great value to the partnership and has led to appreciable change in individuals' views. The draft policy presented here is intended to start the ball rolling, so that proper guidelines will be developed at whatever level in the NHS is most appropriate. Comments and feedback are welcomed.


  • The primary aim of this policy document is to provide a principled basis for the distribution of financial and medical resources within the practice.

  • The practice is assumed to have a responsibility to provide health care within budgetary constraints. It is also recognised that differences of opinion between partners about the use of resources are inevitable. A secondary aim of the document, therefore, is to provide machinery for making decisions in cases of disagreement.

  • We believe it is important to consult widely before producing the final document. This draft, therefore, will be discussed with other members of the practice, with patient forums, and with …

View Full Text

Log in

Log in through your institution


* For online subscription