BACKGROUND Rationing and allocation decisions at the clinical level - bedside rationing - entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees (CECs) sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing? MAIN TEXT Aided by two frameworks for legitimate priority setting, we discuss how CECs can contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CEC's deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make. CONCLUSIONS On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions.

中文翻译：

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临床伦理委员会可以成为床边配给的合法参与者吗？

背景技术在临床水平上的配给和分配决策-床边配给-带来了临床医生和管理人员通常难以处理的复杂难题。缺乏促进公平决策的机制和手段，特别是在困难的情况下。报告表明，临床伦理委员会（CEC）有时会处理涉及床边配给困境的案件。CEC在床边配给中可以发挥合法作用吗？正文在两个用于合理确定优先顺序的框架的帮助下，我们讨论了CEC如何在床边配给决策中为增强认知，程序和政治合法性做出贡献。根据先前的工作，我们将介绍一些简短的案例，并概述CEC可能扮演的几种潜在角色，然后讨论这些角色是否可能有助于配给决策成为合法。在此过程中，确定了此类合法性的关键前提。合法性对诸如CEC的审议过程，利益相关者的参与，过程的透明性，上诉决定的机会以及CEC成员的能力等方面提出了要求。在这些情况下，CEC可以帮助加强临床医生和管理人员必须做出的某些配给决策的合法性。结论在特定条件下，CEC可以发挥充分合理的咨询作用，以增强床旁配给决定的合法性。在这些情况下，CEC可以帮助加强临床医生和管理人员必须做出的某些配给决策的合法性。结论在特定条件下，CEC可以发挥充分合理的咨询作用，以增强床旁配给决定的合法性。在这些情况下，CEC可以帮助加强临床医生和管理人员必须做出的某些配给决策的合法性。结论在特定条件下，CEC可以发挥充分合理的咨询作用，以增强床旁配给决定的合法性。