Autonomy Reconsidered

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Abstract
In 2001, 50 percent of deaths of Medicare beneficiaries occurred in hospitals, often after stays in intensive care units, visits to multiple physicians in the months before death, and enormous expenditures for treatments intended to prolong life.1 Many argue that it is ethical to provide marginally effective treatments if sick patients want them, regardless of the resulting quality of life. However, this approach entails substantial trade-offs2 — expensive procedures are reimbursed under Medicare, whereas prescription medications, nursing home care, and home care services are not. We have done little to address these trade-offs in the United States, since a long . . .

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