Ethical considerations related to outcome studies-based clinical practice guidelines.

Expanding demand for health services is occurring in the face of diminishing resources. Root causes for this phenomenon include advancing expensive new technology and marked variations in quality of care and patterns of practice. Practice guidelines resulting from valid and appropriate outcome studies have the potential to promote consistency and quality. Perceived drawbacks to such guidelines include over-regulation and loss of autonomy for both physicians and patients. Clinical practice guidelines are discussed in the context of major ethical theories, including deontology, utilitarianism, and contractarianism. The conflicting needs and motivations of physicians, patients, third-party carriers, and society as a whole are discussed relative to these different ethical perspectives. Although contrasting ethical foundations likely will lead to significantly different solutions to the healthcare resource problem, it is only through educated and reasoned discussion that this difficult problem can be tackled. Sound ethical discipline is imperative when considering the related issues of equity, justice, and autonomy in a society with progressively decreasing resources.