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April 5, 1985

Ethics and Cost Containment

JAMA. 1985;253(13):1875-1876. doi:10.1001/jama.1985.03350370055009

To the Editor.—  Dr Johnson's article, "Life, Death, and the Dollar Sign,"1 makes a number of valid and important points about the impact of cost-containment efforts on the ethical decision making of physicians. In fact, the article sheds light on some of the most important questions that physicians and hospitals will face in the near future. However, I find the author's "doomsayer" attitude distressing and believe your readers should know of the many efforts already under way by hospitals and physicians that address many of the concerns Dr Johnson expresses.To begin with, Dr Johnson appears to have little faith in the ethical conviction of his colleagues. While it may be true that cost-containment mechanisms may test the medical profession's moral caliber, it is unjustified and unfair to imply that the quality of physicians' decisions in difficult cases involving ethical concerns will deteriorate as a result of such efforts.To