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April 5, 1985

Ethics and Cost Containment-Reply

Author Affiliations

University of Minnesota Hospitals Newborn Intensive Care Unit Minneapolis

JAMA. 1985;253(13):1876. doi:10.1001/jama.1985.03350370055010

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In Reply.—  The purpose of my article was not gloomily to predict an inevitable erosion in the moral caliber of American medicine, but rather to outline potential problems that could occur given the rapid changes occurring in health care provision. Neither did I mean to imply that health care providers were unaware of the possible influence of fiscal restraint on ethical decision making nor minimize the programs that have been developed to address these issues directly. My implicit purpose was to encourage such introspective efforts. If the negative aspects of this situation appear emphasized, it is only because of my personal feeling that, in our rush to contain costs, we generally have paid more attention to the bottom line than we have to the possible effects of cost-cutting on patient care.The salvation of American medicine may lie in providing more cost-effective care, but not at the expense of the