Resistance to rationing health care to the elderly is enormous. This article lays out the need for rationing, based on projections of Medicare expenditure in the near future, and the judgment of policy experts that there will be no technological breakthrough that might lower costs. Various forms of rationing possibilities are discussed as well as cultural and political obstacles to needed reform. Some general principles for thinking about health care for the elderly are presented.
In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...) on health care resources. If age were to become a limiting factor, as Dr. Callahan suggests it should, the limits that will be set are limits that will affect women more drastically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)
Fifteen original essays open up a novel area of inquiry: the distinctively ethical dimensions of women's experiences of and in aging. Contributors distinguished in the fields of feminist ethics and the ethics of aging explore assumptions, experiences, practices, and public policies that affect women's well-being and dignity in later life. The book brings to the study of women's aging a reflective dimension missing from the empirical work that has predominated to date. Ethical studies of aging have so far failed to (...) emphasize gender. And feminist ethics has neglected older women, even when emphasizing other dimensions of 'difference.' Finally work on aging in all fields has focused on the elderly, while this volume sees aging as an extended process of negotiating personal and social change. (shrink)
Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and Angela (...) A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world -- from Canada and the United States to Western Europe, Latin America, and many African and Asian countries -- they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised. This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide. (shrink)
A confession is in order. As did almost everyone else of a certain persuasion, I recoiled when Sarah Palin invoked the notion of a "death panel" to characterize reform efforts to improve end-of-life counseling. That was wrong and unfair. But I was left uneasy by her phrase. Had I not been one of a handful of bioethicists over the years who had pushed to bring the need for rationing of health care to public attention and proposed ways to carry it (...) out? And was not a common thread running through the latter efforts the likely necessity of some kind of committee or other public mechanism to make the hard decisions? Were we not in other words talking about a "death panel," even if none of us has been so imprudent to .. (shrink)
This paper looks at the future from the perspective of the way in which present thinking can influence what the future might be. It assumes that history shapes the future and that the present generation is in a position to shape it. It looks at the future of medicine as a science and a professional discipline, of health care as policy and politics, of culture and ideology as forces shaping medicine and health care, and of biomedical ethics as an influential (...) source of wisdom and perspective. The paper argues that a strong future for bioethics requires a broad rather than a reductionistic vision of its proper work. (shrink)
The Hastings Center was founded in 1969 to study ethical problems in medicine and biology. The Center arose from a confluence of three social currents: the increased public scrutiny of medicine and its practices, the concern about the moral problems being generated by technological developments, and the desire of one of its founders (Callahan) to make use of his philosophical training in a more applied way. The early years of the Center were devoted to raising money, developing an early agenda (...) of issues, and identifying a cadre of people around the country interested in the issues. Various stresses and strains in the Center and the field are identified, and some final reflections are offered on the nature and value of the contributions made by bioethics as an academic field. (shrink)
American bioethics began in the late 1960s, stimulated by a plethora of new medical technologies and biological knowledge and by a scandal-induced interest in human subject research. Although it was understood that there would be ethical debate , no one thought the disputes would be ideological in character, as if part of one's voting pattern as liberal or conservative, Democrat or Republican. There were arguments, often sharp, but no culture wars.
One of the most important developments in international medicine over the past two decades has been a turn to the market as a way of coping with rising costs and responding to calls for more freedom from government control. A full moral evaluation of the relationship of medicine and the market requires asking a wide range of questions bearing on the meaning and impact of market strategies on the economics of health care and on the clinical and public health outcomes (...) of those strategies. A number of the leading questions are presented and some provisional answers offered. (shrink)
The United States is culturally oriented more toward individual rights and values than to communitarian values. That proclivity has made it hard to develop a common good, or solidarity-based, perspective on health care. Too many people believe they have no obligation to support the health care of others and resist a strong role for government, higher taxation, or reduced health benefits. I argue that we need to build a communitarian perspective on the concept of solidarity, which has been the concept (...) underlying European health care systems, by focusing not on individual needs, but rather, on those of different age groups—that is, what people need at different stages of life. (shrink)
When the Karen Ann Quinlan case emerged in the mid-1970s and the New Jersey Supreme Court made mention of the role that ethics committees might play in such cases, no one could have predicted at the time what the consequences of that observation might be. It took a while for momentum to build, but we are now seeing the flowering of what is an important movement in the field of bioethics: the interplay of ethics committees and broader societal issues.