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April 25, 2001, Vol 285, No. 16 >

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Letters | April 25, 2001

Bedside Rationing of Health Care—Reply

M. Gregg Bloche, MD, JD; Peter D. Jacobson, JD, MPH
JAMA. 2001;285(16):2078-2079. doi:10.1001/jama.285.16.2078.
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In Reply: We share Dr Cohen's belief in the ethical primacy of fidelity to patients; indeed this is why we urged the US Supreme Court in Pegram v Herdrich to limit monetary rewards to physicians for withholding care.1 Yet we do not believe physicians should be "reckless of the consequences" of rising clinical spending: we think the social consequences of medical work, including medical costs, matter ethically for clinical caretakers. The common challenge for medical ethics and the courts is to protect the central place of fidelity in clinical work while accommodating, to some degree, society's most pressing needs.2

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