-
27It’s not fair! Or is it? The promise and the tyranny of evidence-based performance assessmentTheoretical Medicine and Bioethics 33 (4): 293-311. 2012.Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it…Read more
-
70Just Caring: In Defense of Limited Age-Based Healthcare RationingCambridge Quarterly of Healthcare Ethics 19 (1): 27. 2010.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 …Read more
-
51Pricing Life: Why It's Time for Health Care Rationing, by Peter A. Ubel, M.D. Cambridge, Mass.: MIT Press, 2000. 208 pp. $25.00 (review)Cambridge Quarterly of Healthcare Ethics 10 (2): 214-218. 2001.This is a book for reflective laypersons and health professionals who wish to better understand what the problem of healthcare rationing is all about. Ubel says clearly in the Introduction that it is unlikely that professional economists or philosophers are going to be very satisfied with this effort. For him it is more important (p. xix). This is a reasonable aim made achievable by Ubel's clear and engaging writing style. Probably the people who most need to be drawn into these debates are phys…Read more
-
74Just health care : Is equality too much?Theoretical Medicine and Bioethics 10 (4). 1989.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 Da…Read more
-
38Just caring: Health reform and health care rationingJournal of Medicine and Philosophy 19 (5): 435-443. 1994.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 includ…Read more
-
1
-
20Review of shlomi segall, Health, Luck, and Justice (review)Notre Dame Philosophical Reviews 2010 (2). 2010.
-
33Medical Ethics Resource Network of Michigan: Development of a statewide Ethics NetworkCambridge Quarterly of Healthcare Ethics 1 (3): 271. 1992.
-
12MiscellaneousHastings Center Report 32 (2): 35-36. 2002.It's not only necessary, but possible, if the public can be educated.
-
52Just caring: Oregon, health care rationing, and informed democratic deliberationJournal of Medicine and Philosophy 19 (4): 367-388. 1994.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 ration…Read more
-
23
-
53Personalized Medicine's Ragged EdgeHastings Center Report 40 (5): 16-18. 2012.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 thos…Read more
-
5JUST Rationing or just Rationing? THE Challenge of Health ReformJurisprudence 6 (1): 131-137. 2015.
-
775On being genetically "irresponsible"Kennedy Institute of Ethics Journal 10 (2): 129-146. 2000.: 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 in its …Read more
East Lansing, Michigan, United States of America
Areas of Interest
Applied Ethics |
Social and Political Philosophy |