The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

As a matter of justice, what do we owe each other to promote and protect health in a population and to assist people when they are ill and disabled? This is the fundamental question of Norman Daniels’ new book on justice and health. Just health is in many ways a successor to Daniels’ seminal classic Just health care. As foreshadowed by a 2001 target article in the American Journal of Bioethics, Just health integrates Daniels’ account of the special moral importance (...) of health and healthcare with his interim work on the social determinants of health4 and the fairness of health sector reform and limit-setting in healthcare. The change of title already indicates that Just health no longer focuses solely on the provision of healthcare, but spans all socially controllable factors of health. The book’s ambitious aim is to provide an integrated theory of justice and health. (shrink)