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October 20, 1989

Linking Payment for Care to Informed Consent

JAMA. 1989;262(15):2091. doi:10.1001/jama.1989.03430150051016

To the Editor.—  I concur with Dr Faden1 that a mechanism that claims to protect patients' rights, but does so by fortuitously also saving money, not for the patient mind you, but for the said "protector," is gravely suspect as to its true motivation.While in principle it makes sense simply to deny payment for an unwanted service, I can only shudder when I envision the results of a consistent application of Mr Kapp's2 proposal. Can you imagine the insane and unconscionable delays and confusion in an emergency department in which the physician, the staff, and the clerical personnel are concerned, foremost, with obtaining legally foolproof documentation (that is, not just legally valid, but that provides legally provable evidence of the patient's consent) rather than with providing what is clinically the best intervention?It is illogical that Mr Kapp is unwilling to suspect that clinicians may fake such