This chapter examines the ways race should and should not affect the delivery of health care benefits in a system that is just. To show how race affects the distribution of health care, it highlights disquieting similarities between the infamous Tuskegee study of fifty years ago and contemporary public health efforts directed at reducing HIV infection/AIDS in the African-American community that may detract from the effectiveness of these programs. It argues that a just society’s (...) stability may require resource allocation for the purpose of demonstrating the extent of justice in the system. Furthermore, patients’ trust in their physicians is important to good health care and distrust is a disadvantage in obtaining effective health care. The chapter also proposes a series of remedies. In an illustrative postscript, it considers Michelle Obama’s initiative to reduce the incidence of obesity in U.S. children and contends that, given the history of anti-black racism in America, African Americans still have special reasons to distrust programs that would alter their eating habits and lifestyles. (shrink)

This paper aims to provide an argument for saying that a publicly funded health care system, available to all free at the point of delivery, is morally superior to a market system, and to provide a framework for deciding questions about which forms of health care should be included in such a public system. The argument presents health care as a ‘head’, in the sense of something to which human beings are morally entitled (...) as a necessary condition for a life worthy of human dignity. Alternative arguments for similar conclusions, proposed by Daniels and Buchanan, are critically examined and rejected. (shrink)

Many health care organizations made public commitments to become antiracist in the wake of George Floyd's murder. These actions raise questions about the appropriateness of health care's engagement in racial justice and social justice movements generally. We argue that health care organizations can be usefully thought of as having two roles: a functional role to care for the sick and a meta‐role as an organizational citizen. Fulfilling the role of citizen may require participating (...) in the pursuit of social justice, including efforts to achieve racial equity. The demands of these two roles will need to be balanced, but the role of organizational citizen has been largely ignored and merits serious attention. (shrink)

As the saying goes, “The road to hell is paved with good intentions.” And in the recent burst of clinical attention being paid to the needs of lesbian, gay, bisexual, and transgender patients, good intentions abound. But while this long‐overdue interest in LGBT health care aims to highlight important gaps and bring into relief serious issues in health care delivery for LGBT persons, such work can inadvertently reinforce both the marginalization of sexual minorities and the (...) cultural norms related to sexuality, gender identity, and the conventional family. To ensure that positive outcomes for LGBT patients are inextricably paired with those noble intentions, we advocate for a new, queer bioethics—a methodology of scholastic, bioethical, and critical scrutiny that not only addresses the needs of LGBT persons in health care settings but also considers the perspectives, histories, and feelings of such parties. (shrink)

Edited by four leading members of the new generation of medical and healthcare ethicists working in the UK, respected worldwide for their work in medical ethics, Principles of Health Care Ethics, Second Edition_is a standard resource for students, professionals, and academics wishing to understand current and future issues in healthcare ethics. With a distinguished international panel of contributors working at the leading edge of academia, this volume presents a comprehensive guide to the field, with state of the art (...) introductions to the wide range of topics in modern healthcare ethics, from consent to human rights, from utilitarianism to feminism, from the doctor-patient relationship to xenotransplantation. This volume is the Second Edition of the highly successful work edited by Professor Raanan Gillon, Emeritus Professor of Medical Ethics at Imperial College London and former editor of the Journal of Medical Ethics, the leading journal in this field. Developments from the First Edition include:_ The focus on ‘Four Principles Method’ is relaxed to cover more different methods in health care ethics. More material on new medical technologies is included, the coverage of issues on the doctor/patient relationship is expanded, and material on ethics and public health is brought together into a new section. (shrink)

Donald A. Barr's Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America (second edition, 2007) offers a lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face. Barr has provided a balanced introduction to the way health care is organized, financed, and delivered in the United States. The thirteen chapters of the book are quite comprehensive in the topics they cover. Even (...) those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking in the text. The book can also appropriately serve as a basic text for a health policy course or in the medical or nursing school curriculum. (shrink)

Donald A. Barr's Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America (second edition, 2007) offers a lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face. Barr has provided a balanced introduction to the way health care is organized, financed, and delivered in the United States. The thirteen chapters of the book are quite comprehensive in the topics they cover. Even (...) those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking in the text. The book can also appropriately serve as a basic text for a health policy course or in the medical or nursing school curriculum. (shrink)

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day‐to‐day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to (...) day‐to‐day struggles elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day‐to‐day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance. (shrink)

Partially because of the high cost of developing and maintaining cold chains, systems needed to keep heat-labile vaccines under adequate refrigeration from their points of manufacture to their administration in the field, the Joint WHO/FAO Expert Committee on Zoonoses (i.e., the approximately four fifths of all described human infections that people share with other vertebrate animals) recommended in 1982 operation of common cold chains by health and veterinary services in rural areas. Following this recommendation, a 1984 pilot level initiative (...) in medical-veterinary intersectoral cooperation should be regarded as a practical way to deliver human primary health care to currently neglected African pastoralists, and as a potential core program for development efforts overall within arid and semiarid areas of the African continent. (shrink)

The accounts of Wunderlich and Lee, which have been presented in the second part of this brief series, are two representative examples of a well-respected 19th-century genre of international comparison of medical systems. Since these early comparative accounts consist of observations on medical systems by doctor-travellers at a time when intense medical reform debates about the national significance of medicine were taking place, the focus of attention is often intra-professional. In texts such as those by Wunderlich and Lee, creating coherence (...) within a national health care system was primarily understood as constructing national coherence within the medical profession. The comparisons which derived from international travellers of the period were on the whole cast in a literary, narrative form, and were based on personal observation and occasional hands-on experience in foreign practice. The relevance of this type of publication for national policy at this early stage of national system development was defined in terms of the perceived advantages which a more detailed explication of differences between the medical educational structures, medical philosophies and practical professional roles in different nations might bring. (shrink)

An incisive examination of bioethics and American healthcare, and their profound affects on American culture over the last sixty years, from two eminent scholars. An eye-opening look at the inevitable moral choices that come along with tremendous medical progress, Everybody Wants to Go to Heaven but Nobody Wants to Die is a primer for all Americans to talk more honestly about health care. Beginning in the 1950s when doctors still paid house calls but regularly withheld the truth from (...) their patients, Amy Gutmann and Jonathan D. Moreno explore an unprecedented revolution in health care and explain the problem with America’s wanting everything that medical science has to offer without debating its merits and its limits. The result: Americans today pay far more for health care while having among the lowest life expectancies and highest infant mortality of any affluent nation. Gutmann and Moreno—“incisive, influential, and pragmatic thinkers” (Arthur Caplan)—demonstrate that the stakes have never been higher for prolonging and improving life. From health care reform and death-with-dignity to child vaccinations and gene editing, they explain how bioethics came to dominate the national spotlight, leading and responding to a revolution in doctor-patient relations, a burgeoning world of organ transplants, and new reproductive technologies that benefit millions but create a host of legal and ethical challenges. With striking examples, the authors show how breakthroughs in cancer research, infectious disease, and drug development provide Americans with exciting new alternatives, yet often painful choices. They address head-on the most fundamental challenges in American health care: Why do we pay so much for health care while still lacking universal coverage? How can medical studies adequately protect individuals who volunteer for them? What’s fair when it comes to allocating organs for transplants in truly life-and-death situations? A lucid and provocative blend of history and public policy, this urgent work exposes the American paradox of wanting to have it all without paying the price. (shrink)

Theory of health care ethics -- Principles of health care ethics -- The moral status of gametes and embryos : storage and surrogacy -- The ethical challenges of the new reproductive technology -- Ethics and aging in America -- -- Healthcare ethics committees : roles, memberships, structure, and difficulties -- Ethics in the management of health information systems -- Technological advances in health care : blessing or ethics nightmare? -- Ethics and safe patient (...) handling and mobility -- Spirituality and healthcare organizations -- A new era of health care : the ethics of healthcare reform -- Health inequalities and health inequities -- The ethics of epidemics -- Ethics of disasters : planning and response -- Domestic violence : changing theory, changing practice -- Looking toward the future. (shrink)

Political theorists generally defend the moral importance of health care by appealing to its purported importance in promoting good health and saving lives. Recent research on the social determinants of health demonstrates, however, that health care actually does relatively little to promote good health or save lives in comparison with other social and environmental factors. This article assesses the implications of the social determinants of health literature for existing theories of health (...) care justice, and outlines a new approach that can justify publicly subsidized comprehensive health care despite its limited contribution to good health. Even if health care plays a relatively limited role in promoting good health, it remains morally important because of the care it provides to individuals. As such, it can be justified in terms of care ethics. When health care is justified primarily in terms of care rather than health, however, the goals of a just health-care system shift. The measure of a just health-care system is no longer strictly its ability to generate good health outcomes but also its ability to provide individuals with accessible, good quality daily care. This different focus has important consequences for the way we think about the institutions of a just health-care system as well as for the delivery and allocation of medical goods and services. (shrink)

Being a patient and living a life -- Clinical space and traits of healing -- False starts and frequent failures -- Three journeys : A.'Ibuprofen and love', B. 'Staying tuned up', C. 'We all want the same things' -- Being a patient : the moral field -- Rethinking healthcare ethics : the patient's moral authority.

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the (...) wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (...) (HCEC) standards. This revised report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

This article describes the causes and health consequences of environmental degradation and social injustice. These issues, which impact primarily on the poor and underserved (both in the United States and internationally) are rarely or inadequately covered in the curriculums of traditional health care professions. The discussion offers ways for health care professionals to promote equality and justice and uses the example of Rudolph Virchow’s social activinsm to illustrate how one physician can lead society toward major (...) public health gains. There is also an examination of the roles of institutions and organisations in enhancing environmental preservation and promoting social justice. Specific curricular suggestions from history and the humanities are offered for those teaching and mentoring new health professionals. (shrink)

The relationship of religion and health is often misunderstood owing to a tendency to concentrate on the medical model and to ignore the wider context of heath care. A conceptual--as opposed to a historical--examination of this context reveals nine central religious ideas or categories which provide an ethical foundation and heritage for medical practice and health care delivery. These include doctrines of creation; dominion or stewardship; freedom and responsibility; human dignity or sanctity of life; love (...) or compassion; covenant; justice; vocation; and finitude. A discussion of the complementarity of religion and medicine is necessary and should proceed from these shared values and common concerns. (shrink)

From a giant of health care policy, an engaging and enlightening account of why American health care is so expensive -- and why it doesn't have to be. Uwe Reinhardt was a towering figure and moral conscience of health care policy in the United States and beyond. Famously bipartisan, he advised presidents and Congress on health reform and originated central features of the Affordable Care Act. In Priced Out, Reinhardt offers an engaging (...) and enlightening account of today's U.S. health care system, explaining why it costs so much more and delivers so much less than the systems of every other advanced country, why this situation is morally indefensible, and how we might improve it. The problem, Reinhardt says, is not one of economics but of social ethics. There is no American political consensus on a fundamental question other countries settled long ago: to what extent should we be our brothers' and sisters' keepers when it comes to health care? Drawing on the best evidence, he guides readers through the chaotic, secretive, and inefficient way America finances health care, and he offers a penetrating ethical analysis of recent reform proposals. At this point, he argues, the United States appears to have three stark choices: the government can make the rich help pay for the health care of the poor, ration care by income, or control costs. Reinhardt proposes an alternative path: that by age 26 all Americans must choose either to join an insurance arrangement with community-rated premiums, or take a chance on being uninsured or relying on a health insurance market that charges premiums based on health status. An incisive look at the American health care system, Priced Out dispels the confusion, ignorance, myths, and misinformation that hinder effective reform. (shrink)

Health care is provided in many contexts—not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of (...) doctors and nurses working within two women’s prisons in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics. (shrink)

The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician’s role in managed care take root in medicine’s past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical (...) narratives can function as “master narratives” that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform. (shrink)

Review of Andrew Webster, Health, Technology and Society: A Sociological Critique. Hampshire: Palgrave MacMillan, 2007. Pp. 213. UK£20.99 PB.

: Widespread collection and use of identifiable information can promote social goods while, at the same time, infringing on personal privacy. Information systems are developing within the context of a fundamental transformation in the organization, delivery, and financing of health care. Changes in the health care system include rapid development of employer-sponsored health coverage, managed care organizations, and integrated delivery systems. These complex, multifaceted arrangements for delivering and paying for health (...) class='Hi'>care require ever-more-sophisticated information systems that facilitate extensive sharing of personal data. Systemic flows of sensitive health information occur both vertically and horizontally among employers, hospitals, insurers, laboratories, and suppliers. Beyond this complex web of vertical and horizontal sharing are the multiple demands for information management, quality assurance, research, governmental regulation, and public health. Theoretical problems exist with the law and ethics of informational privacy. The traditional method of exercising control over personal health information is through informed consent. Informed consent, however, within a modern health information infrastructure becomes highly complex. In this kind of environment, the doctrine of informed consent is flawed and does not provide sufficient control over personal information to assure adequate protection of privacy. (shrink)

Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, (...) medical research, and the education of medical students. The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health. The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless. (shrink)

Undisputedly, the United States’ health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty‐five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create (...) ethical questions about the balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy‐makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice. (shrink)

Reason and Rationality in Health and Human Services Delivery is the first book to discuss the topic of decisionmaking and services from a multidisciplinary approach. It uses theory and social considerations, not just technology, as a basis for improved services. Health and human service students and professionals will learn how to form rational and reasonable decisions that take their clients'cultural backgrounds into consideration when identifying an illness or appropriating any kind of intervention. With a particular emphasis on (...) theories, models, organizational settings, technologies, and practitioner training methods that lead to culturally sensitive decisions, Reason and Rationality will help you deliver efficient and improved medical and social services to clients from all ethnic backgrounds. Recognizing reason as the centerpiece of most of Western philosophy, this text reveals how our idea of truth, fact, and order are wrongly thought to be universal; yet, Western principles are continually used in the decision-making process for health and social services. Focusing on the policy implications of decisionmaking in medical and social service settings, this text works to incorporate a broad range of factors into the reasoning process, such as cultural traditions and beliefs, that will result in better treatment for patients. Giving you suggestions and strategies for upgrading reasoning and decision-making processes and applying them to every area of service, Reason and Rationality discusses different themes that will help you improve services to patients, such as: the rationale currently used to justify decision-making strategies concerning medical and human services using computer technology to make clinical assessments revising administrative structure, management theories, and organizational strategies so that decision-making processes enhance the overall quality of service delivery how the practitioner/patient relationship is important in choosing the proper treatment soliciting community-based input to assess the public's health and human service needs in order to lessen political involvement in decision-making stages In addition, Reason and Rationality provides information and examples that show why you should consider the "life-world"--the values, beliefs, and commitments of a culture's history-- as the key to understanding the powers of reasoning that specify parameters of health and illness. (shrink)

The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in “voluntourism,” health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in (...) short term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data. (shrink)

Cochran has argued that Catholic health care occupies a “unique place on the border of public and private life”. Catholic health care is accountable to both its religious and sacramental traditions and its public responsibilities. It is inevitable that “border skirmishes” will arise. Yet there is no single formula for suggesting what public-private collaboration should comprise or how conflicts between values ought to be resolved. It may be, as Cochran suggests, that increasingly bitter conflicts over widely (...) valued services such as sterilization, combined with market pressures to conform to for-profit trends in health care, will make divestiture of faith-based hospitals in favor of other types of church-community partnerships the best course for the future. (shrink)

A considerable section of the population in India accesses the services of individual private medical practitioners (PMPs) for primary level care. In rural areas, these providers include MBBS doctors, practitioners of alternative systems of medicine, herbalists, indigenous and folk practitioners, compounders and others. This paper describes the profile, knowledge and some practices of the rural doctor in India and then discusses the reasons for lack of equity in health care access in rural areas and possible solutions to (...) the problem. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health (...) class='Hi'>Care Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The aims of this paper are threefold. The first aim is to provide a critique of the reform proposal of the Harvard School of Public Health for Hong Kong's health care system through privatization of the public sector services. The second aim is to argue for the duty of society to guarantee every member equal access to a basic level of health care based on the values of equity, care and free choice. The third (...) aim is to explore some suggestions about delivery structures and financial arrangements of a dual sector health care system which will better enable society to provide a basic level of health care that is sustainable and affordable, while being at the same time consistent with the values of care, equity and free choice. (shrink)

An ethics concerned with health care developments and systems must be historically continuous, especially as it concerns the application to managed structures of key moral-epistemic concepts such as care, love and empathy. These concepts are traditionally most at home in the personal, individual domain. Human beings have non-instrumental worth just because they are human beings and not by virtue of their capacities. Managed health care systems tend to abstract from this worth in respect of both (...) individuals' distinctness and individual identity. The first, a common feature of quantitative approaches to health care assessment and delivery, is avoidable. The second, by contrast, is necessarily sacrificed in impersonally managed structures. Failure to distinguish the two encourages confusion and distress, and the demand for impossible medico-moral relationships. (shrink)

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing (...) any action contrary to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

The incredible complexity of the United States health care system can be connected to three simple outcomes: access, affordability, and quality. We should measure our progress against these three measures. While historic progress on access was made through implementation of the Affordable Care Act, the next area of focus for more results across all three measures is delivery system reform.

Not all actions that are legal are necessarily morally correct. However, there are few protections for providers who are pressured to comply with actions and procedures that infringe on their religious beliefs regarding human dignity. The right of health care providers to freely act on religious convictions and refrain from cooperating with morally reprehensible tasks is often eschewed in favor of political correctness or is branded as discrimination. Adequate safeguards are urgently needed for health care workers (...) at all levels to ensure that they can continue to care for the sick and most vulnerable members of the community without violating the dictates of their conscience. This article examines the free exercise of religion as it pertains to medical provider conscience protections. The author argues for conscience protection legislation with a right of action. (shrink)