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Autonomy, consent, and limiting healthcare costs
  1. M A Graber1,
  2. J F Tansey2
  1. 1Departments of Family Medicine and Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
  2. 2Department of Psychiatry and Program in Biomedical Ethics and Medical Humanities, University of Iowa Carver College of Medicine, Iowa City, IA, USA
  1. Correspondence to:
 Dr M A Graber
 Department of Family Medicine, Pomerantz Family Pavilion, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52246;


While protection of autonomy is crucial to the practice of medicine, there is the persistent risk of a disconnect between the notion of self-determination and the need for a socially responsible medical system. An example of unbridled autonomy is the preferential use of costly medications without an appreciation of the impact of using these more expensive drugs on the resource pool of others. In the USA, costly medications of questionable incremental benefit are frequently prescribed with the complicity of both doctors and patients. Limiting self-determination in medication choices via an appreciation of the principle of justice reaches a better moral balance, while at the same time acknowledging the goals of doing good and avoiding harm in patient care.

  • autonomy
  • ethics
  • informed consent
  • health care policy
  • pharmaceutical industry

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