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 [1]. 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.

As Dr. Nissen suggests, the tension between respect for patient autonomy and the just allocation of resources certainly deserves attention. However, any change in physicians' approaches to these issues awaits the development of an as-yet-undefined societal consensus.