An impoverished 63-year-old woman is diagnosed with squamous-cell carcinoma of the lung with extensive metastases. There is no hope for cure, but radiation and chemotherapy, which could cost more than $100,000, may extend her life for a few months. If this patient unambiguously requests treatment, her doctors may struggle with the decision but will probably provide the treatment, ignoring the cost as a matter of principle.
On the other hand, a health department — or a hospital — proposes an action that would prevent many cases of lung cancer by helping smokers quit. It could be offering free nicotine-replacement therapy to every smoker or running smoking counter-advertisements on television. The organization will immediately face resistance: Can we afford that?
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