ABSTRACT
As expected, Daniel Callahan's comments require careful consideration. Callahan attempts to distinguish between "health needs" and "needs for health care," claiming that "there are some medical needs that available treatment can not meet at all." In view of the critical importance of the problem of the "average patient," a careful exploration of this issue is warranted. Much of this discussion will take us across the border into the technical arena of guideline development. But ethical and technical issues are inextricably interwoven in several domains within the health care system; attempting to neatly separate discussions on these issues is often difficult, if not impossible. Prediction rules have been developed for a large number of clinical situations, including the estimation of survival following myocardial infarction, liver transplantation, out-of-hospital cardiac arrest, or after treatment in a medical intensive care unit.
