RESOURCE ALLOCATION AND THE STANDARD OF CARE OF PHYSICIANS

Abstract

Often referred to as the ‘gate keepers’ of the health care system, physicians, as the primary providers of medical care, are increasingly required to implement the resource allocation decisions made at the various levels of government and health care administration. To date, courts have been unwilling to alter the standard of care imposed on physicians to reflect systemic realities or to recognize the defense of economic justification in medical liability claims. Instead, they have responded by extending the standard of care and, in some cases, requiring that physicians assume heightened obligations to act as advocates for their patients. If, as it appears, the prevailing principles of professional and civil liability are not sufficiently flexible to adapt to the consequences of costcontainment measures, alternative mechanisms must be available for physicians to protect themselves from professional liability. In Quebec, the provisions of the Act Respecting Health Care Services and Social Services may serve that purpose. First, the Act recognizes the resource limitations inherent in the health care system and expressly provides health institutions with the latitude to make decisions about how to allocate the resources available. Second, it circumscribes the physician’s disclosure obligations to the patient with respect to service limitations and institutionalizes the physician’s role in the administration of the hospital. Finally, the most recent amendments to the Act, which provide for the creation of risk management and quality control committees, provide physicians with a formal procedure to signal deficiencies, report ‘near misses’ and highlight any weaknesses or risk factors within the system.