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April 5, 1995

Rationing Resources While Improving Quality

Author Affiliations

Houston, Tex

JAMA. 1995;273(13):996. doi:10.1001/jama.1995.03520370035021

To the Editor.  —In the most recent of a series of articles by Dr Eddy1 featuring the merits of clinical decision analysis, he claims to offer what many may think impossible: to contain medical costs while increasing quality. However, to do this, "quality" has to be defined in a particular way and his proposals involve major and dramatic changes. The following appear to be required: (1) acceptance of the utilitarian philosophy by a society in which to date no particular secular philosophy is dominant, (2) widespread acceptance of decision analysis in clinical medicine, and (3) a complete reversal and denial of the major tenet of medical ethics—the primacy of the individual patient's well-being. Utilitarian philosophy becomes the controlling principle in health care decisions. Eddy states that the goal of a health care system should be the maximization of the health of the group, ie, the greatest good for the

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