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December 1993 (Volume 71)
Mark A. Hall
Milbank Memorial Fund
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The prevailing legal and ethical opinion that rationing decisions must always be disclosed to patients is countered. Although conventional informed consent law could theoretically extend to decisions to decline treatment because of costs, it has not yet done so. Moreover, abandonment law does not prohibit declining treatment for economic reasons. A new theory of economic informed consent would stipulate that when patients make informed decisions to purchase less expensive health insurance, they are consenting in advance either to limiting marginally beneficial treatment or to waiving their right to be informed of particular decisions not to treat. Whether this will prove workable or will be accepted by the courts depends on the specifics of the enrollment disclosures, the range of choices given to subscribers, and their capacity to understand them.
Author(s): Mark A. Hall
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Volume 71, Issue 4 (pages 645–668) Published in 1993
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.