Quality and cost: choices and responsibilities.

Practitioners are at least obligated to provide the most effective care most efficiently. But when added benefits are small relative to added cost, practitioners may stop short of the most effective care in obedience to patient preferences. If society imposes a different standard of optimal care, I suggest that health care professionals will respond in one of three ways: oppose social intervention, adopt the social optimum, or take an intermediate position by accepting the social specification of optimal care but safeguarding the individual practitioner's role as an advocate for each patient and the profession's role as an advocate its view of the public good.