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April 25, 2001

Bedside Rationing of Health Care

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

JAMA. 2001;285(16):2078-2079. doi:10.1001/jama.285.16.2078

To the Editor: Dr Bloche and Mr Jacobson1 have clearly presented the dilemma that arises when physicians are mandated to become surrogates for a society that seeks to escape its responsibility for allocating health care to its individual members. While it may be necessary to "ration" health care, this policy should be decided openly and its consequences should apply to all—society should not risk the obvious conflicts of interest analyzed by the court in the Pegram case2 to conceal its role in decision making, no matter how unpleasant the consequences. The concept of "fiduciary" in the Pegram decision vitiates this principle by allowing hidden economic incentives to play an inappropriate role in the actions of individual physicians treating individual patients.

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