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March 4, 1998

Potentially Ineffective Care in Intensive Care

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(9):651-654. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-9-jbk0304

To the Editor.—Drs Cher and Lenert1 in their report on the relation of reimbursement method to the rate of PIC propose several factors that may underlie the reduction of possibly futile ICU treatment in dying Medicare patients. One of these is reduced cost to the treating organization in a capitated setting, but the authors acknowledged that there are insufficient data to decide whether this is the primary factor. In contrast, Drs Curtis and Rubenfeld2—in the accompanying Editorial—appear to believe that cost cutting, and only cost cutting, is the driving force for the reduced intensity of end-of-life treatment. Their unsupported statement that "It is currently popular to assume that many patients receive more technological end-of-life care than they would want" trivializes the likelihood that these other factors need to be considered seriously.