Can help for patients be too expensive? Ethical considerations and end-stage lung disease

The treatment of patients with end-stage lung disease is very expensive. In an era of cost containment, the physician could be forced to restrict his therapy in order to spend less. But does the physician really have the right to restrict a reasonable therapy for economic reasons? It is argued that the mission of medicine is to help people in need and that any confidence is shaken if the physician is forced to be both physician and gatekeeper at the same time. It is argued that medicine as a central form of care will only be able to survive if it has the chance to remain a free profession, a profession which has the liberty to help each individual patient even if this help is expensive. However, it remains a duty of the physician to accept limits and to learn that for a good death it is necessary to be honest and to talk early enough about the possibilities of palliative care.