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Article
March 22, 1995

Essential vs Discretionary Health Care in System Reform-Reply

Author Affiliations

Council on Ethical and Judicial Affairs American Medical Association Chicago, Ill

JAMA. 1995;273(12):919. doi:10.1001/jama.1995.03520360032027
Abstract

In Reply.  —Dr Ashley makes several important points. In particular, he rightly draws attention to the distinction between essential and discretionary care. However, in arguing for a greater role for professional judgment in resource allocation decisions, Ashley both mischaracterizes the Council's report and misjudges the role that professional judgment can play.First, the Council does not simply advocate either a democratic process or an equal consideration mechanism to identify the package of basic health services for all citizens. The Council enunciated several ethical criteria that can be used to identify certain medical services as clearly essential, and that therefore should be included in a basic benefits package, and other medical services as clearly discretionary, and that therefore should not be included in a basic benefits package. The ethical criteria include degree of benefit, likelihood of benefit, duration of benefit, number of people benefiting, and cost. For example, an appendectomy is

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