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June 24, 1996

The Public's Preference for Bedside Rationing-Reply

Author Affiliations

Philadelphia, Pa

Pittsburgh, Pa

Arch Intern Med. 1996;156(12):1353-1354. doi:10.1001/archinte.1996.00440110125020

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We thank Hall for pointing out survey findings that show that the public is not completely opposed to the idea of physicians' rationing at the bedside. While these polls are important, it is not clear whether patients will feel the same when they find out that their own physicians actually withheld beneficial services from them. That is an empirical question that still needs answering. Nonetheless, the time is ripe, as Hall points out, to begin a serious discussion of the ethical implications of bedside rationing rather than denying its existence. One important question is what informed consent requires physicians to tell patients when limiting therapies based on economic incentives. At a minimum, patients should be told that physicians may have more in mind than merely obtaining every possible incremental unit of benefit for the patients. Some authors, like Hall, argue that it is enough to inform patients at the time

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