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May 15, 1991

Medicine and Money: A Study of the Role of Beneficence in Health Care Cost Containment

JAMA. 1991;265(19):2588. doi:10.1001/jama.1991.03460190168041

No subject in medical ethics is more important today than the moral problems underlying the pressures of cost containment. Frank H. Marsh and Mark Yarborough have, in a modestly sized volume, attacked ethics and health care at its most vulnerable underbelly. Their thesis is that "the principle of beneficence [doing good] as structured within the physician-patient relationship can become a formidable resource to be used in the struggle against inflationary health care expenditures" (p 5). In fact, they claim that the principle, properly applied, can produce substantial savings, bringing escalating health care expenditures under control (p 86).

They first point to expenditures for futile care and care that actually does patients more harm than good. Simply doing what will benefit the patient would actually save money as a fringe benefit. If that were sufficient savings, Marsh and Yarborough would have solved the most difficult medical ethical problem of the generation.

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