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Fredrick R. Abrams, MD
The Center for Applied Biomedical Ethics at Rose Medical Center Denver

JAMA. 1987;257(9):1175-1176.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

I am sorry that Dr O'Malley inferred from my remarks that the point of my commentary was to contrast the health delivery systems and the morality of American physicians with that of their British colleagues. I was in fact lamenting the trend for physicians of both countries to abandon the traditional role of patient advocacy by accepting the role of fiscal gatekeeper for whomever pays the bill—whether it be a government or a private health care enterprise.

If the president of the British Kidney Association was neither accurate nor representative when he said, "Usually the patient does not understand that he could have been treated and goes away to die quietly," then I am glad. I can only reiterate that "if the physician fails to inform because a beneficial treatment is politically (economically) unavailable, he has deceived the patient by implying a medical decision, not a political decision, . . . [Full Text PDF of this Article]

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