Michael Lissack message: the needs and rights of women and children are determined not by universal standards but by the nature of their poor relationship to a man. Why punish the mother and children for the negligence or inability of the father to provide? Americans also believe that doing something is better than doing noth- ing. Ambiguities should be avoided, since they often signal a failure of re- solve. The public expects to get better when they see a doctor, but that isn't always possible. Doctors and patients tend to believe that medicine can always offer something. But this is only true in the sense that medicine can relieve pain and suffering, that death can be eased. Medicine man not be able to change the course of disease. Unfortunately, people often want to leave no stone unturned. With regard to medical care as with regard to government programs, there is little understanding of the problem of "marginal benefits," of bene- fits that are too meager to pursue or too costly to justify. Patients are often reluctant to accept the ambiguity that "something" could be done but that it isn't worth doing. Instead, it is increasingly common for all the stops to be pulled all the time. This mechanized, no-holds-barred approach sidesteps the need for medical judgment. In our current medical climate, in which patients mistrust doctors and physicians fear malpractice suits, this course is often easier for both patients and doctors. Unfortunately, the cycle pushes costs upward and leaves everyone dissatisfied. A recent study found that the majority of primary care doctors felt that patients sought too much care. Another study found that the difference in cost between the attitudes "when in doubt, do it" and "when in doubt, stop" could add up to $100 billion a year. If this same approach were extended to other government programs the savings would eliminate the so-called budget deficit for at least a decade. Government programs have become an organized form of the tragedy of the commons. Suppose that three people in a rural neighborhood share a pri- vate road or driveway. They might easily form a group to repave their road; each one will pay something, but all will benefit. If all three chip in, the road is fixed at minimal cost to each. But now suppose there are a hundred people sharing the road. Now the temptation becomes strong for each person not to
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