We appreciate the comments by Stimler. We believe that chutzpah is a virtue. Stimler's major objections can be summarized in one question. Why should we compromise individual freedom when we have no guarantees that the greater community will benefit (ie, we will control costs) from new do-not-resuscitate policies? Stimler seems to suggest that we really do not need to set these or other limits as a matter of policy to control costs.
We believe that successful health care reform, including sustained cost control, will involve limits that our society has not yet had to live with. We believe that do-not-resuscitate policies can be useful vehicles for exploring limits.
Stimler suggests that our proposal is "no less than a proposition for the tyranny of the majority." We value the pluralism in our society. Society may respect preferences shared by a minority, but society should not necessarily pay the medical bills generated
Murphy DJ, Finucane TE. No Ultimatums for Resuscitation Policy-Reply. Arch Intern Med. 1994;154(6):700. doi:10.1001/archinte.1994.00420060139017