Informed consent to rationing decisions by managed care organizations

It has been argued that the rationing of medical resources effected by managed care organizations violates the philosophical doctrine of informed consent, which is linked to the principle of respect for patient autonomy. Two models which purport to protect patient autonomy, in consonance with the doctrine of informed consent, and in the face of institutional rationing decisions, via prior disclosure, are examined. It is found that the ‘prior global consent’ model is less effective at preserving patient autonomy through prior disclosure than is the ‘waiver of informed consent’ model. The immediate conclusion for managed care is that institutional rationing need not be antithetical to the doctrine of informed consent. The broader philosophical conclusion is that the hierarchical notion of autonomy espoused by the ‘waiver’ model is, in some cases, more effective than the integrated notion espoused by the ‘global consent’ model.