May 19, 1993

Balancing Act: The New Medical Ethics of Medicine's New Economics

Author Affiliations

Kennedy Institute of Ethics Georgetown University Washington, DC


by E. Haavi Morreim (Clinical Medical Ethics, vol 3), 184 pp, $49, ISBN 0-7923-1170-1, Norwell, Mass, Kluwer Academic Publishers, 1991.

JAMA. 1993;269(19):2558. doi:10.1001/jama.1993.03500190102046

The economic pressure on clinical caregivers to be cost-conscious in health care decisions is the greatest new ethical challenge facing physicians today. There have been other volumes written recently on the ethics of health resource allocation (including those by Paul Menzel, Frank Marsh, Daniel Callahan, and Norman Daniels), but none focuses as sharply and effectively on pressures experienced by the practicing clinician at the bedside as Haavi Morreim's Balancing Act. Appearing in Kluwer's unfortunately expensive Clinical Medical Ethics series, Morreim's treatment of the subject carries the analysis to new levels of specificity and sophistication.

For example, she offers the first serious, extended discussion of the ethics of physicians "gaming the system" to get what they believe will benefit their patients. She examines and ultimately provides ethical arguments against physicians stretching the truth or telling outright lies on insurance claim forms to get payments for a patient's needs that could not