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August 22, 1980

Wanted: A Heisenberg for an Orwell-Reply

Author Affiliations

Kennedy Institute of Ethics Georgetown University Washington, DC

JAMA. 1980;244(8):767-768. doi:10.1001/jama.1980.03310080009005

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In Reply.—  I am afraid that Dr Dibbell has seriously misunderstood the nature of my article. First, it was largely an ethical analysis of a complex problem where I, as much as he, am aware of the enormous ethical dangers in shifting away from the traditional medical model to one where persons are seen as responsible for some portion of their health and medical needs. Yet I am also concerned about arguments from justice. Many feel it is unfair that all must share equally in the enormous costs of health care provided to patch people up after they have voluntarily assumed risks to their health to enjoy some nonmedical benefits. If there is an argument for a plan to make people pay for the medical costs of their voluntary behavior, it is an argument from justice.Somehow Dr Dibbell has the impression that I envision some sinister, bureaucratic, omniscient body