To the Editor.
—The description by Dr Eddy1 of how we might "help patients understand the consequences of a limited resource pool and the need to be fair" conflicts with the idea of informed consent and full patient participation in decision making. This conflict needs to be addressed explicitly if we are to make any headway in reducing the rate of increase in costs. Eddy suggests that as physicians guide patients toward accepting collectively better but individually worse options that "in most cases there will be no need to say anything at all. In other cases the explanation might be, 'Well, for patients like you the appropriate approach is....'" While many (including me) agree with Eddy's position that it is not unethical to weigh economic costs against health benefit,2 his recommendation that physicians should simply fail to mention the existence of a therapeutic alternative (offering greater benefit but
Wears RL. Rationing Resources While Improving Quality. JAMA. 1995;273(13):995-996. doi:10.1001/jama.1995.03520370035020