We find the letter from Drs. Jederlinic and Rockwell regarding the expense involved in the care of our patient shocking. We reject the notion that our patient's survival resulted from a misuse of resources, despite a hospital bill of $120 593, of which $56 571 was collected.
We did indeed discuss the complex ethical issue of providing expensive alternative therapies to a patient who refuses traditional therapies and cited an article that reviews this topic . We are unaware of any societal consensus that a patient's therapeutic options be limited because of choices of conscience (or even because of self-destructive behaviors). In fact, the focus of medical ethics during the past decade has been to empower the patient to make life-essential decisions, whether they be to pursue life support in opting for long-term mechanical ventilation or to refuse life-sustaining interventions. Opting for treatment without blood transfusion is only one example of a decision made by a patient that results in increased expense. The implication that a decision by us not to misuse resources for this patient would lead to allocation of additional resources to prenatal care or vaccination programs is unsupportable.