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Watching Coby Howard Die: Ethics, Economics and Politics in the Allocation of Medical Care

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  1. Earlier versions of these remarks were presented as the Fasacht Lecture at the University of Laverne and at the Fourth National Conference of Bioethics sponsored by Sydney Adventist Hospital. The author wishes to thank participants at these conferences for their helpful comments and criticisms.

  2. Paul Starr, “Medical Care and the Pursuit of Equity in America,” in President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research, Securing Access to Health Care, Volume II, Appendices (Washington, D.C.: United States Government Printing Office, 1883), pp. 3–22.

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  3. See for example, Harry Schwartz, “Access, Equality, and Equality in American Medical Care,” Ibid., pp. 67–78.

  4. A previous account of this case is in Gerald Winslow, “A Test of Ethical Principles,” Business and Health, April, 1986, pp. 11–12.

  5. Oregon Legislative Assembly, House Bill 2909, June, 1988.

  6. It should be noted that it is not just Medicaid beneficiaries who may find themselves ineligible, because many private insurance plans also exclude some or all organ transplantation.

  7. Alasdair MacIntyre, After Virtue (Notre Dame, Indiana: University of Notre Dame Press, 1981), p. 6.

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  8. Charles Fried, “Equality and Rights in Medical Care,” Hastings Center Report 6:1 (February, 1976) p.31.

  9. Robert Nozick, Anarchy, State and Utopia, (New York: Basic Books, 1974).

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  10. Ibid., p. 234.

  11. W.D. Ross, The Right and the Good (Oxford: Clarendon Press, 1973).

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  12. This story is probably best told in Renee Fox and Judith Swazey, The Courage to Fail (Chicago: University of Chicago Press, 1974), see also Gerald Winslow, Triage and Justice (Berkeley, University of California Press, 1982).

  13. H. Tristram Englehardt, “Health Care Allocations: Responses to the Unjust, the Unfortunate, and the Undesirable,” in Justice and Health Care edited by Earl E. Shelp (Dordrecht: D. Reidel Publishing Co., 1981), pp. 121–37.

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  14. James Childress, “Who Shall Live When Not All Can Live?”, Soundings, 43 (1970) pp. 339–62.

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  15. Mishnah Sanhedrin 4:5.

  16. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research, Securing Access to Health Care, Volume 1, Report, (Washington, D.C.: United States Government Printing Office, 1983).

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  17. Ibid., p.37.

  18. I have attempted to make the case for public knowledge of rules for rationing health care in “Rationing and Publicity,” in The Price of Health, edited by George J. Agich and Charles E. Begley (Dordrecht: D. Reidel Publishing Co., 1986), pp. 199–215.

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  1. Gerald R. Winslow Ph.D.
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Winslow, G.R. Watching Coby Howard Die: Ethics, Economics and Politics in the Allocation of Medical Care. Monash Bioethics Review 8, 14–26 (1989). https://doi.org/10.1007/BF03351161

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