Churchill argues that every society rations health care-the problem is to do so justly. The central claim of the book is that a more "social" or communitarian starting point is needed. The book concludes with a brief discussion of health care rights and a sketchy account of the role of the physician in rationing.

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by (...) those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups. (shrink)

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for—as though health care is a commodity that needs no examination—or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with “health care,” the terminology used in the current debate, but with the more modest and limited topic of (...) medical care. Integral to this rationing proposal—which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society—is a definition of a “decent minimum,” the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span. (shrink)

As the only nation in the western world without a national health insurance program, the United States faces ongoing issues of access and fairness in health care coverage. The Clinton administration tried and failed to address the problem of universal coverage. Since then we have focused on the narrower, but nonetheless real, issues of fairness and equity in the benefits package provided in insurance plans. The LORAN Commission spent two years trying to devise agreed-upon principles to govern such issues. The (...) lesson learned was the same as that of the Ethics Force study: there was no possibility of getting agreement, let alone consensus, among the participants on how to decide what should be a covered benefit. There were, however, two generally agreed upon principles that emerged regarding health care: “Every individual should be treated alike,” and “When it comes to health, cost cannot be a consideration.” That formula translated into providing everyone with everything. The only certain outcome from such a policy would be fiscal insolvency and ultimately bankruptcy. (shrink)

Whatever specific beliefs pragmatists share concerning experience, knowledge, value, and meaning, they generally agree that a central part of the business of life is to make life better. James speaks of the ideal of meeting all needs, Royce of defeating evil, and Dewey of making experience richer and more secure. They are at one in thinking that human intelligence can make a vast difference to how well we live, and they extol the possibility of improving our circumstances. They tend to (...) be dissatisfied with the status quo and see indefinitely sustained amelioration as the solution to our problems. Stoics, in sharp contrast, are quick to call attention to the limits of our powers and recommend accepting them without complaint. They tend to think that only our beliefs and attitudes fall securely in our control. Epictetus, Seneca, and Marcus Aurelius agree that anything we would consider an improvement of the human condition is temporary and that, in any case, fulfilling our desires accomplishes little. The key to living well, they maintain, is control over self, not over circumstance, and they embrace inner calm in the face of whatever misfortune befalls us. Even such a brief characterization of these two great philosophical traditions makes it clear that pragmatic ambition and... (shrink)

John Lachs, one of American philosophy's most distinguished interpreters, turns to William James, Josiah Royce, Charles S. Peirce, John Dewey, and George Santayana to elaborate stoic pragmatism, or a way to live life within reasonable limits. Stoic pragmatism makes sense of our moral obligations in a world driven by perfectionist human ambition and unreachable standards of achievement. Lachs proposes a corrective to pragmatist amelioration and stoic acquiescence by being satisfied with what is good enough. This personal, yet modest, philosophy offers (...) penetrating insights into the American way of life and our human character. (shrink)

From the author of Setting Limits comes a challenging exploration of the proper goals of medicine in our rapidly changing society--a work destined to spark debate and influence policy for years to come.