U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for?as though health care is a commodity that needs no examination?or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with ?health care,? the terminology used in the current debate, but with the more modest and limited topic of (...) medical care. Integral to this rationing proposal?which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society?is a definition of a ?decent minimum,? the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span. (shrink)
Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled (...) to at least a decent minimum level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of rudimentary decent minimum granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants. (shrink)
The paper explores the ethical and psychological issues that arise when family members request that "everything possible" be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not be abandoned (...) or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions. Keywords: medical futility, medical decision-making, palliative care, autonomy, paternalism CiteULike Connotea Del.icio.us What's this? (shrink)
