Nonclinical factors in patient selection for surgery
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* Aldo Mariotto

Mita Giacomini and colleagues have skillfully captured the important role that nonclinical factors play in selecting patients for cardiac procedures.1 Anyone who has managed a waiting list knows that personal opinions, even among health care professionals, vary widely on the use of parameters such as age and occupational status in determining priority. 

Members of the medical profession can arguably reach a consensus on the clinical factors that will be used to assign priority to patients, but where nonclinical factors are concerned any shift from a first-come, first-served system must involve all potential stakeholders. Besides, patients' opinions are in some cases surprisingly generous, as demonstrated by a recent study in which elderly respondents reported that they were willing to give up their place on a heart-surgery waiting list to another patient, simply because the latter was younger or self employed.2

However, great caution should be used when considering public attitudes in setting criteria for patient selection. Giving informed consent to violate one's own rights, thereby exposing oneself to potential harm, is not wholly acceptable.

## References

1.  1. Giacomini MK, Cook DJ, Streiner DL, Anand SS. Guidelines as rationing tools: a qualitative analysis of psychosocial patient selection criteria for cardiac procedures. CMAJ 2001;164(5):634-40.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjQvNS82MzQiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY1LzIvMTUzLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Mariotto A, De Leo D, Dello Buono M, Favaretti C, Austin P, Naylor CD. Will elderly patients stand aside for younger patients in the queue for cardiac services? Lancet 1999;354:467-70. 
    
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