Linking Payment for Care to Informed Consent

To the Editor. —  The article by Mr Kapp¹ and the accompanying editorial by Faden² in the April 7 issue of JAMA deserve comment. Once again, we find nonphysicians making policy statements regarding the dynamics between physicians and patients for which they have no empirical data and little practical experience. In this case, proposed interventions by Mr Kapp center on the process of informed consent. He contends that patients unnecessarily undergo life-sustaining procedures against their will without adequate informed consent. Furthermore, he believes that coupling reimbursement for these services to informed consent will preserve patient autonomy and may have a "salutary" effect of financial savings to third-party payers.Perhaps it is a result of having trained in a highly litigious atmosphere such as New York, but in my clinical experience virtually all medical services rendered in life-sustaining situations are in the setting of informed consent. Imposition of proposed regulations