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June 22, 1994

Rationing and the Americans With Disabilities Act

JAMA. 1994;271(24):1903. doi:10.1001/jama.1994.03510480027011

To the Editor.  —In a comprehensive and insightful discussion of the possible impact of the Americans With Disabilities Act (ADA) on health care rationing of beneficial treatments,1 Dr Orentlicher recommends some moral guidelines for ADA's interpretation to balance people's competing needs: "If rationing decisions will disproportionately affect persons with disabilities, the decisions need to be justified by legitimate nondiscriminatory reasons. Ethically relevant criteria include (1) likelihood of benefit, (2) duration of benefit, (3) degree of benefit, (4) cost, and (5) number of people who will benefit. It would not be appropriate to consider ethically irrelevant criteria like social worth."1(p312)The solution, however, presupposes social agreement about, first, what counts as a benefit and, second, how to access and compare degrees of benefit in themselves and in relation to their costs. Unfortunately, a series of court cases show we as a society do not agree. In the cases of

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