Rationing and the Americans With Disabilities Act

David Orentlicher, JD, MD
JAMA. 1994;271(4):308-314. doi:10.1001/jama.1994.03510280070036.
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LAST year, when the Bush administration rejected Oregon's plan to ration medical care, it surprised observers with its reliance on the Americans With Disabilities Act (ADA) as the basis for the rejection.1 When limitations in health care coverage have been challenged under other laws protecting the disabled, courts have not been sympathetic. In addition, in concluding that quality of life and functional status should not be taken into account at all in making rationing decisions,2 the Bush administration called into question any serious attempts to ration health care (Am Med News. November 9, 1992:1).

Nevertheless, there were problems with the Oregon plan. For example, there was unfair discrimination in Oregon's decision to deny liver transplants to rehabilitated patients with alcoholic liver disease but not to patients with other causes of liver failure.3 Oregon modified its plan in response to the rejection and in response to further objections


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