: Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection—e.g., patents—of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniels's and Sabin's (...) "accountability for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation. (shrink)

Ongoing research in the fields of genetics and biotechnology hold the promise of improved diagnosis and treatment of genetic diseases, and potentially the development of individually tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how these services are to be evaluated and integrated equitably into public health care systems such as Canada's. The current context is one of increasing fiscal restraint on the part of governments, limited financial resources being dedicated to health care, and rising costs for new (...) health care services and technologies. This has led to increasing public debate in the last few years about how to reform public health care, and whether we should prohibit, permit or perhaps even encourage private purchase of health care services. ;In Canada, some of these concerns have crystallized around the issue of gene patents and commercial genetic testing, in particular as illustrated by the case of Myriad Genetics' patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians who currently access genetic services do so through the public health care system, for those with the means, private purchase is becoming an option. This situation raises serious concerns---about justice in access to health care; about continued access to safe and reliable genetic testing supported by unbiased patient information; and about the broader effects of commercialization for ongoing research and the Canadian public health care system. Commercial genetic testing presents a challenge to health care professionals, policy analysts, and academics concerned with the social, ethical and policy implications of new genetic technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social sciences, and health policy and law will be brought to bear on the larger issues of how as a society we should regulate commercial research and product development, and more coherently decide which services to cover under public health insurance and which to leave to private purchase. Generally, the thesis is concerned with the question of "how best to bring capital, morality, and knowledge into a productive and ethical relationship". (shrink)

Iniaalok ng pag-aaral na ito ang isang panunuring Foucauldian sa pangkasariang karanasan ng babaeng may breast cancer (BRCA). Inihahain din ng mga may-akda ang mga sumusunod na tanong: Paano naaapi ang babaeng may BRCA? Paano hinahamon ng kanyang karanasan ang konsepto ng seksuwalidad? Maaari bang ituring ang kanyang karanasan bilang anyo ng pagbalikwas? Tutugunan ng mga may-akda ang naturang mga tanong gamit ang kapangyarihan-diskurso-seksuwalidad ni Foucault habang ipinapalagay na: (1) matagumpay na naipapakita ng talaangkanan ng seksuwalidad ni Foucault (...) kung paanong ang seksuwalidad, bilang isang diskursibong kontrak, ay ginagamit bilang isang teknik ng pangongontrol, at (2) nabibigyan tayo ni Foucault ng isang paraan ng pag-unawa sa kung papaano tumutugon ang indibidwal sa iba’t ibang sistema ng kontrol, maging ng isang balangkas na makapagpapaliwanag sa maraming relasyong pangkapangyarihan na siyang tumutukoy sa moda ng pag-iral ng indibidwal. Nahahati ang papel na ito sa tatlong pangunahing bahagi: (1) Ang Panunuring Feminista ng Sabjek na Foucauldian, (2) Ang Pangkasariang Karanasan ng Babaeng may BRCA, at (3) Pagbalikwas bilang Diskurso-Konstrak at Binuong Tugon. (shrink)