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June 5, 2013

Ethics of Parsimonious Medicine—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota (Dr Tilburt) (tilburt.jon@mayo.edu); and American Board of Internal Medicine, Philadelphia, Pennsylvania (Dr Cassel).

JAMA. 2013;309(21):2209-2210. doi:10.1001/jama.2013.5573

In Reply: Words do matter. Our summary paragraph may have unnecessarily muddied the clear water we were promoting. The suspicion of Dr Fleming and Ms Snyder Sulmasy is correct; we agree with their distinction. Strictly speaking, parsimonious medicine cannot and ought not aim ultimately at reducing resources, even if that is one of its collateral effects. We argue that very point in our article.

However, in a broader sense, a contemporary practice of medicine that intends the good of the patient as its ultimate target in a context characterized by overconsumption may (more often than not) end up aiming at the patient's good through the proximate scope of parsimonious medicine—a scope that in modern medicine must involve restraint in many cases to achieve its patient-centered end. In restraint, rationing and parsimonious medicine share some resemblances even though their ends differ in ethically crucial ways.