Rationing through risk assessment in clinical genetics: all categories have wheels.

This paper focuses on issues relating to rationing in the context of cancer genetics. It indicates how the allocation of scarce resources to patients in need is not simply a managerial process, but something that is routinely woven into the fine web of organisational activity. In the framework of this study – executed within a UK regional cancer genetics clinic – much of that activity circulates around issues relating to risk assessment. The author first illustrates how risk assessments in cancer genetics affect the distribution of clinical benefits in general. Following that, it is explained how professionals assemble risk categories and how the assembly work relates to rationing. The paper concludes by suggesting that rationing principles should more properly be seen as stratagems that are called upon and manipulated by lay and professional parties, rather than as a set of guide rules imposed top-down by managerial agents. [ABSTRACT FROM AUTHOR]