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Leonard M. Fleck [65]Leonard Michael Fleck [5]
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Leonard M. Fleck
Michigan State University
  1.  10
    Precision medicine and the fragmentation of solidarity (and justice).Leonard M. Fleck - 2022 - Medicine, Health Care and Philosophy 25 (2):191-206.
    Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...)
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  2.  8
    Commentary: Medical Ethics: A Distinctive Species of Ethics.Leonard M. Fleck - 2020 - Cambridge Quarterly of Healthcare Ethics 29 (3):421-425.
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  3.  8
    Alzheimer's and Aducanumab: Unjust Profits and False Hopes.Leonard M. Fleck - 2021 - Hastings Center Report 51 (4):9-11.
    Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...)
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  4.  54
    Whoopie Pies, Supersized Fries.Leonard M. Fleck - 2012 - Cambridge Quarterly of Healthcare Ethics 21 (1):5-19.
    The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).
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  5.  18
    Abortion, Artificial Wombs, and the “No Difference” Argument.Leonard Michael Fleck - 2023 - American Journal of Bioethics 23 (5):94-97.
    De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...
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  6.  42
    Abortion, deformed fetuses, and the omega pill.Leonard M. Fleck - 1979 - Philosophical Studies 36 (3):271 - 283.
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  7.  53
    Personalized Medicine's Ragged Edge.Leonard M. Fleck - 2012 - Hastings Center Report 40 (5):16-18.
    The phrase "personalized medicine" has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?If there were a (...)
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  8.  12
    ECMO: What Would a Deliberative Public Judge?Leonard Michael Fleck - 2023 - American Journal of Bioethics 23 (6):46-48.
    I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...
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  9.  20
    Whoopie Pies, Supersized Fries.Leonard M. Fleck - 2012 - Cambridge Quarterly of Healthcare Ethics 21 (1):5-19.
    The annual cost of healthcare in the United States reached $2.5 trillion in 2009 (about 17.6% of GDP) with projections to 2019 of about $4.5 trillion (about 20% of likely GDP).
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  10.  11
    The Dobbs Decision: Can It Be Justified by Public Reason?Leonard M. Fleck - 2023 - Cambridge Quarterly of Healthcare Ethics 32 (3):310-322.
    John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito’s emphasis on “ordered liberty” seems completely at odds with the “disordered liberty” regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until (...)
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  11.  47
    Just caring: Oregon, health care rationing, and informed democratic deliberation.Leonard M. Fleck - 1994 - Journal of Medicine and Philosophy 19 (4):367-388.
    This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...)
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  12. On being genetically "irresponsible".Judith Andre, Leonard M. Fleck & Thomas Tomlinson - 2000 - Kennedy Institute of Ethics Journal 10 (2):129-146.
    : New genetic technologies continue to emerge that allow us to control the genetic endowment of future children. Increasingly the claim is made that it is morally "irresponsible" for parents to fail to use such technologies when they know their possible children are at risk for a serious genetic disorder. We believe such charges are often unwarranted. Our goal in this article is to offer a careful conceptual analysis of the language of irresponsibility in an effort to encourage more care (...)
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  13.  20
    First Come, First Served in the Intensive Care Unit: Always?Leonard M. Fleck & Timothy F. Murphy - 2018 - Cambridge Quarterly of Healthcare Ethics 27 (1):52-61.
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  14.  13
    Miscellaneous.Leonard M. Fleck - 2012 - Hastings Center Report 32 (2):35-36.
    It's not only necessary, but possible, if the public can be educated.
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  15.  13
    Choosing Wisely.Leonard M. Fleck - 2016 - Cambridge Quarterly of Healthcare Ethics 25 (3):366-376.
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  16.  38
    Just caring: Health reform and health care rationing.Leonard M. Fleck - 1994 - Journal of Medicine and Philosophy 19 (5):435-443.
    Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. (...)
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  17.  36
    Just Solidarity: The Key to Fair Health Care Rationing.Leonard M. Fleck - 2015 - Diametros 43:44-54.
    I agree with Professor ter Meulen that there is no need to make a forced choice between “justice” and “solidarity” when it comes to determining what should count as fair access to needed health care. But he also asserts that solidarity is more fundamental than justice. That claim needs critical assessment. Ter Meulen recognizes that the concept of solidarity has been criticized for being excessively vague. He addresses this criticism by introducing the more precise notion of “humanitarian solidarity.” However, I (...)
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  18.  70
    Just Caring: In Defense of Limited Age-Based Healthcare Rationing.Leonard M. Fleck - 2010 - Cambridge Quarterly of Healthcare Ethics 19 (1):27.
    The debate around age-based healthcare rationing was precipitated by two books in the late 1980s, one by Daniel Callahan and the other by Norman Daniels. These books ignited a firestorm of criticism, best captured in the claim that any form of age-based healthcare rationing was fundamentally ageist, discriminatory in a morally objectionable sense. That is, the elderly had equal moral worth and an equal right to life as the nonelderly. If an elderly and nonelderly person each had essentially the same (...)
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  19.  12
    Miscellaneous.Leonard M. Fleck - 2002 - Hastings Center Report 32 (2):35-36.
    It's not only necessary, but possible, if the public can be educated.
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  20.  10
    Public Reason, Bioethics, and Public Policy: A Seductive Delusion or Ambitious Aspiration?Leonard M. Fleck - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-15.
    Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) (...)
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  21.  8
    Precision Public Health Equity: Another Utopian Mirage?Leonard Michael Fleck - 2024 - American Journal of Bioethics 24 (3):98-100.
    Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...
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  22.  7
    Bioethics and Public Policy: Is There Hope for Public Reason?Leonard M. Fleck - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-6.
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  23.  13
    Just Caring: Do Future Possible Children Have a Just Claim to a Sufficiently Healthy Genome?Leonard M. Fleck - 2002 - In Rosamond Rhodes, Margaret P. Battin & Anita Silvers (eds.), Medicine and Social Justice: Essays on the Distribution of Health Care. Oup Usa. pp. 446.
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  24.  36
    The Oregon Medicaid Experiment.Leonard M. Fleck - 1990 - Business and Professional Ethics Journal 9 (3-4):201-217.
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  25.  23
    Children and Organ Donation: Some Cautionary Remarks.Leonard M. Fleck - 2004 - Cambridge Quarterly of Healthcare Ethics 13 (2):161-166.
    My task is to provide some critical commentary on the preceding essays. My unfortunate conclusion will be that the issues that are their primary focus are more likely to become more ethically intractable over the next several years as medicine progresses. I do not see any easy or obvious way to avoid this conclusion.
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  26. Deliberative democracy for bioethics: could the web help?Leonard M. Fleck - 2001 - Hastings Center Report 31 (4):7.
     
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  27.  8
    Teaching Bioethics Today: Waking from Dogmatic Curricular Slumbers.Leonard M. Fleck - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-8.
    The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for (...)
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  28.  16
    Precision Medicine and Rough Justice: Wicked Problems.Leonard M. Fleck - 2024 - Cambridge Quarterly of Healthcare Ethics 33 (1):1-4.
    What exactly is a “wicked problem”? It is a social or economic problem that is so complex and so interconnected with other issues that it is extraordinarily difficult or impossible to resolve. This is because all proposed resolutions generate equally complex, equally wicked problems. In this essay, I argue that precision medicine, especially in the context of the U.S. healthcare system, generates numerous wicked problems related to distributive justice. Further, I argue that there are no easy solutions to these wicked (...)
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  29.  25
    The Costs of Caring: Who Pays? Who Profits? Who Panders?Leonard M. Fleck - 2006 - Hastings Center Report 36 (3):13-17.
  30.  40
    DRGs: Justice and the invisible rationing of health care resources.Leonard M. Fleck - 1987 - Journal of Medicine and Philosophy 12 (2):165-196.
    Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of “interstitial justice,” that is, an approach to making justice judgments that is suitable (...)
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  31.  21
    Justice, hmos, and the invisible rationing of health care resources.Leonard M. Fleck - 1990 - Bioethics 4 (2):97–120.
  32.  10
    Justice, HMOs, and the invisible rationing of health care resources.Leonard M. Fleck - 1990 - Bioethics 4 (2):97-120.
    If we accept the premise that some sort of rationing of access to health care resources is necessary to contain escalating health care costs effectively, then we need to ask how that rationing might be accomplished most fairly. Calabresi and Bobbitt have argued in their book Tragic Choices that there is no 'perfectly fair' or even 'reasonably fair' way to bring this about.
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  33.  28
    Bette Anton, MLS, is Head Librarian of the Pamela and Kenneth Fong Optometry and Health Sciences Library. This library serves the University of California, Berkeley–University of California, San Francisco Joint Medical Pro-gram and the University of California, Berkeley School of Optometry.Richard E. Champlin, Ka Wah Chan, Leonard M. Fleck, John Harris, Matti Häyry, Søren Holm, Kenneth V. Iserson, Lynn A. Jansen & Martin Korbling - 2004 - Cambridge Quarterly of Healthcare Ethics 13:117-118.
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  34.  34
    Courtney S. Campbell is the Hundere.Helen Stanton Chapple, Jessica C. Cox, Leonard M. Fleck, Marian Fontana, Susan Gilbert & Lawrence O. Gostin - forthcoming - Hastings Center Report.
  35.  10
    Abortion and “Zombie” Laws: Who Is Accountable?Leonard M. Fleck - 2023 - Cambridge Quarterly of Healthcare Ethics 32 (3):307-308.
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  36.  34
    Controlling Healthcare Costs: Just Cost Effectiveness or “Just” Cost Effectiveness?Leonard M. Fleck - 2018 - Cambridge Quarterly of Healthcare Ethics 27 (2):271-283.
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  37.  41
    Can we trust "democratic deliberation"?Leonard M. Fleck - 2007 - Hastings Center Report 37 (4):22-25.
  38.  13
    Despairing about Health Disparities.Leonard M. Fleck - 2017 - Hastings Center Report 47 (5):43-44.
    I have never doubted that the problem of inequalities in health status and access to needed care is a difficult ethical and political challenge. After reading the essays in Understanding Health Inequalities and Justice: New Conversations across the Disciplines, edited by Mara Buchbinder, Michele Rivkin-Fish, and Rebecca Walker, I concluded that despair was the only suitable response in the face of daunting ethical and political complexity. The editors of this volume have three questions in mind that they asked contributors to (...)
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  39.  7
    Friedman Howard Steven. Ultimate Price: The Value We Place on Life.Leonard M. Fleck - 2021 - Public Health Ethics 14 (2):218-220.
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  40.  49
    Just Caring: Health Care Rationing, Terminal Illness, and the Medically Least Well Off.Leonard M. Fleck - 2011 - Journal of Law, Medicine and Ethics 39 (2):156-171.
    What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? That question is the focus of this essay. Put another way: relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought the health care needs of persons who are terminally ill have? (...)
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  41.  18
    Just Caring: Health Care Rationing, Terminal Illness, and the Medically Least Well off.Leonard M. Fleck - 2011 - Journal of Law, Medicine and Ethics 39 (2):156-171.
    What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? This is the question that will be the focus of this essay. Another way of asking our question would be the following: Relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought (...)
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  42.  12
    Just caring: screening needs limits.Leonard Michael Fleck - 2020 - Journal of Medical Ethics 46 (4):253-254.
    This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of them equally (...)
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  43.  3
    Just Caring: The Challenges of Priority‐Setting in Public Health.Leonard M. Fleck - 2007 - In Rosamond Rhodes, Leslie P. Francis & Anita Silvers (eds.), The Blackwell Guide to Medical Ethics. Oxford, UK: Blackwell. pp. 323–340.
    The prelims comprise: The Scope of Public Health: Challenges and Choices Health Care Justice and Public Health: When Is Enough Enough? Setting Public Health Priorities Justly: The Limits of Moral Theory References.
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  44. Just health care : Is beneficence enough?Leonard M. Fleck - 1989 - Theoretical Medicine and Bioethics 10 (2).
    Few in our society believe that access to health care should be determined primarily by ability to pay. We believe instead that society has an obligation to assure access to adequate health care for all. This is the view explicitly endorsed in the President's Commission Report Securing Access to Health Care. But there is an important moral ambiguity here, for this obligation may be construed as being either beneficence-based or justice -based. A beneficience-based construal would yield a much weaker obligation (...)
     
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  45. Just health care : Is equality too much?Leonard M. Fleck - 1989 - Theoretical Medicine and Bioethics 10 (4).
    In a previous essay I criticized Engelhardt's libertarian conception of justice, which grounds the view that society's obligation to assure access to adequate health care for all is a matter of beneficence [1].Beneficence fails to capture the moral stringency associated with many claims for access to health care. In the present paper I argue that these claims are really matters of justice proper, where justice is conceived along moderate egalitarian lines, such as those suggested by Rawls and Daniels, rather than (...)
     
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  46.  5
    JUST Rationing or just Rationing? THE Challenge of Health Reform.Leonard M. Fleck - 2015 - Jurisprudence 6 (1):131-137.
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  47.  18
    Leonard M. Fleck replies.Leonard M. Fleck - 2011 - Hastings Center Report 41 (3):7-8.
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  48.  17
    Mending mother nature: Alpha, beta and omega pills.Leonard M. Fleck - 1984 - Philosophical Studies 46 (3):381 - 393.
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  49.  25
    Pricing Human Life.Leonard M. Fleck - 1989 - Social Philosophy Today 2:286-299.
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  50.  6
    Pricing Human Life.Leonard M. Fleck - 1989 - Social Philosophy Today 2:286-299.
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