Abstract

Rationing and patient selection is inevitable in medical care, but in its most extreme form—when doctors and nurses decide about life and death—it is an almost unbearable burden for the profession. Eric Goemare, the Head of the South African Mission of Médicins Sans Frontières and his staff faced three equally difficult selection issues when rolling out antiretroviral treatment to HIV/AIDS patients in South Africa. Initially, the treatment had to be rationed due to lack of financial resources. Today, rationing is mostly due to lack of human resources. But at the same time, patients are being deselected because of nonadherence to the treatment regime to avoid the creation of multi-drug-resistant strains of the HIV virus