Paulshock's view on cardiopulmonary resuscitation where the survival rates are very low is simple: "it is clinically inappropriate, and thus immoral." Writing for the American College of Physicians, Farber expressed a simple, but opposite, point of view. "The physician's decision ought only to be that in his or her judgment there is no medical benefit, not that the patient will not be resuscitated."1 We believe that these decisions are often not simple at all. Likelihood of dying is only one factor in determining what is inappropriate.2,3 Likewise, the stance that physicians should avoid "using cost as a major change agent" is, if we understand correctly, a very simple rule, but we disagree. Physicians have unique perspectives about the worth of various treatments. If we do not participate, decisions will be made and they will be less informed.
Small refers to the Oregon experiment, a well-known political initiative referenced