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June 22, 1994

Rationing and the Americans With Disabilities Act-Reply

Author Affiliations

Council on Scientific Affairs American Medical Association Chicago, Ill

JAMA. 1994;271(24):1903-1904. doi:10.1001/jama.1994.03510480027012

In Reply.  —Although Dr Kopelman's letter suggests that important differences exist between her views and mine, in fact we are in substantial agreement. The concerns that she mentions reflect a misreading of my article.As Kopelman observes and as I argue, constraints of cost and efficiency should not vitiate the right of persons with disabilities to equality of treatment, and as she suggests, criteria for allocating health care must be articulated openly and subjected to public scrutiny. My article proposes such criteria and indicates how the criteria should be applied. Specifically, I argue that rationing decisions must be justified by legitimate nondiscriminatory factors, and I put forth the five criteria that Kopelman quotes.I do not pretend that these criteria provide a complete guide to rationing, however. The criteria are difficult to quantify and are not as objective and ethically neutral as they appear. For example, treatments for persons with

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