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November 20, 1996

The Houston Citywide Policy on Medical Futility-Reply

Author Affiliations

Baylor College of Medicine Houston, Tex

JAMA. 1996;276(19):1550. doi:10.1001/jama.1996.03540190022013

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In Reply.  —We are pleased that Drs Bauman and Vawter support the general direction of the Houston policy and that their groups are in the process of developing similar policies.We agree with Bauman that society as a whole needs to address the issues of resource allocation and rationing. However, that does not free institutions from their duty as responsible stewards of the resources made available to them, to consider the allocation of those resources as they decide whether providing demanded interventions is appropriate. Institutional integrity, we have argued, demands that this be considered. We also believe, in disagreement with Bauman, that a failure to provide the intervention unless the patient ultimately agrees is not abandonment. It must be remembered that all appropriate care would, according to step 7 of our protocol, continue to be provided, and abandonment is only the failure to provide appropriate care. A failure to provide inappropriate care