Health Care Rationing

Publication Title: 
Kennedy Institute of Ethics Journal

As the twentieth century closes, marked by triumphal strides in medical advances, the American society has yet to ensure that each person has access to affordable health care. To correct this injustice, this article calls on the nation's political and corporate leaders, providers, and faith-based groups to join all Americans in a new national conversation on systemic health care reform.

Author(s): 
Place, Michael D.
Publication Title: 
Kennedy Institute of Ethics Journal

In addressing issues of access to health care and rationing, Jewish and Roman Catholic writers identify similar guiding values and specific concerns. Moral thinkers in each tradition tend to support the guarantee of universal access to at least a basic level of health care for all members of society, based on such values as human dignity, justice, and healing. Catholic writers are more likely to frame their arguments in terms of the common good and to be more accepting of rationing that denies beneficial and needed health care to some persons.

Author(s): 
Mackler, A. L.
Publication Title: 
Christian Bioethics

The author comments on the consensus statement from the point of view of an ethics consultant in Germany. Since many hospitals in Germany are under considerable competitive pressure, mission statements are becoming more and more important in order to draw a distinction between the different hospital types and to convey the meaning of the corporate identity both internally and externally. The Consensus Statement, which provides basic orientation without going into too much detail, can be a helpful initial document.

Author(s): 
Schmidt, K. W.
Publication Title: 
Christian Bioethics

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care.

Author(s): 
Pellegrino, Edmund D.
Publication Title: 
The Journal of Clinical Ethics

How might clinicians best try to retain the trust of patients and family members after clinicians oppose giving a treatment? If clinicians can maintain the trust of patients and families in these situations, this may soften what may be the greatest possible loss--the death of a loved one. I discuss what clinicians seeking to retain trust should not do--namely impose their values and reason wrongly--and introduce strategies that clinicians may use to reduce both. I present five principles that clinicians can follow to try to retain trust, with examples that illustrate each.

Author(s): 
Howe, Edmund G.
Publication Title: 
Journal of Health and Human Services Administration

Urban trauma centers have been shown in the medical literature to be effective resources for dealing with traumatic injury in a manner which results in demonstrated increases in survival rates. Given that much debate exists over the relative efficacy of various technological medical interventions, the acceptance and diffusion of a "proven" technology, such as trauma centers, should be assured.

Author(s): 
Culbertson, R. A.
Publication Title: 
Journal of Health and Human Services Administration

Urban trauma centers have been shown in the medical literature to be effective resources for dealing with traumatic injury in a manner which results in demonstrated increases in survival rates. Given that much debate exists over the relative efficacy of various technological medical interventions, the acceptance and diffusion of a "proven" technology, such as trauma centers, should be assured.

Author(s): 
Culbertson, R. A.
Publication Title: 
JAMA

... One is struck by the high level of organ procurement charges in spite of the characterization of organ procurement as altruistic. Although the median organ procurement charges in 1988, documented by Evans, ranged from nearly $16,000 to nearly $21,000 (1991 dollars), there was not a penny for the accident victim's/organ donor's family. That some transplant hospitals routinely marked up charges they paid to organ procurement organizations by as much as 200% hardly seems consistent with altruism.

Author(s): 
Sloan, Frank A.
Publication Title: 
The Journal of Social Issues

With tens of thousands of waiting recipients but only 4000-5000 organs available annually, there is a chronic and largely insatiable demand for organ transplants. This article draws on three sources of data regarding the sources of organs donated: a survey of the families of organ donors, a survey of the general public, and a prospective data collection effort from organ procurement agencies. It considers which Americans are willing to engage in this kind of altruism.

Author(s): 
Prottas, J. M.
Publication Title: 
Bioethics

The analogy between gift-giving and organ donation was first suggested at the beginning of the transplantation era, when policy makers and legislators were promoting voluntary organ donation as the preferred procurement procedure. It was believed that the practice of gift-giving had some features which were also thought to be necessary to ensure that an organ procurement procedure would be morally acceptable, namely voluntarism and altruism.

Author(s): 
Gerrand, Nicole

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