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August 22, 1980

Wanted: A Heisenberg for an Orwell

JAMA. 1980;244(8):767. doi:10.1001/jama.1980.03310080009004

To the Editor.—  The serious reader scarcely knows whether to be pleased or appalled at the discourse of Robert M. Veatch, PhD, "Voluntary Risks to Health: The Ethical Issues" (243:50, 1980)—pleased, that somewhere, someone is grappling with such thorny problems—appalled at the unstated and implied assumptions over which Dr Veatch has glossed.Let us start with the simplest criticism.Does Dr Veatch seriously suggest that a multicausal health-tax model could work in a practical way? Does he believe that some omniscient body could define the plethora of health factors (we certainly had problems defining the missile gap and the physician shortage); could rate these factors in terms of social cost; (the danger of bonbons and television vs climbing Mt McKinley); determine to what financial degree they should be penalized; and finally exempt specific risk factors for their social utility (ie, firemen, radiology technicians, inhabitants of Gary, Ind).Does he believe