ABSTRACT
Two social movements of health care in the United States have attracted the particular attention of ethicists. One, in response to soaring costs, is the urgent call for rationing and resource allocation that is more specific and consistent than the haphazard socioeconomic forms in place. The second movement is the rising tide of patient autonomy including demands to be involved in terminal health-care decisions even after the loss of mental competence. Those who proposed rationing criteria to hold down costs rarely considered patient preferences; those who advocated patient autonomy rarely referred to cost considerations. The solution to rising health costs-at least with regard to high-technology terminal care–could be seen less in terms of imposing limits by rationing and more in terms of enhancing patient autonomy. The patients were interviewed in their homes at regular intervals to obtain data with respect to their general well-being, satisfaction with health care, health status, and health-care utilization.
