The current Medicare operation—reimbursing medical goods and services to a growing number of people without basing the reimbursement benefit on the actual cost of the services—is unsustainable, but there are some possible remedies.
Physicians have an obligation to consider a patient’s quality of life when making treatment decisions and should consider giving patients the options of withholding or withdrawing aggressive treatment if that treatment will not restore the kind of life the patient finds meaningful.
A philosophical analysis of how physician actions and treatment goals are defined and interpreted and how understanding this process can affect the success of the clinical encounter.
Physicians are cautioned that the two obstacles to reforming post-marketing clinical trials are the FDA's reluctance to revisit past approvals and its inability to enforce pharmaceutical companies' commitment to conduct Phase IV trials.
The conventional quality-adjusted life years approach to resource allocation has greater societal value if it is distributed among many rather than concentrated on a few, assuming that severity of illness is the same.