Journal Article•
Some obstacles to applying the principle of individual responsibility for illness in the rationing of medical services
TL;DR: The intention in this study is to highlight some very serious obstacles looming against the attempt to apply the principle of individual responsibility for illness in the distribution of the medical services with limited availability.
Abstract: Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical services with limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession.
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Journal Article•
TL;DR: In this article, the authors draw attention to the need for an efficient ethical model that should regulate the activity and resource allocation in the healthcare system, and particularly in granting access to healthcare to families with high poverty rates, as well as in caring for children.
Abstract: The present text intends to draw attention to the need for an efficient ethical model that should regulate the activity and resource allocation in the healthcare system, and particularly in granting access to healthcare to families with high poverty rates, as well as in caring for children. Thus, the paper focuses on an ethical perspective using the idea of the social responsibility of organizations and especially of the state as an organization that takes responsibility in the social field. From an ethical point of view, the social responsibility principle eliminates the divergences between ethical responsibility and financial responsibility that may appear in establishing public health policies and in the construction of an ethical model for service providing and resource allocation. The intention of the paper is not to propose a model but rather to emphasize the need for creating an ethical model in the Romanian public health system starting from the National Strategy and the Report of the presidential committee for analyzing and elaborating public health policies in Romania.
12 citations
01 Jan 2011
TL;DR: The need for creating an ethical model in the Romanian public health system starting from the National Strategy and the Report of the presidential committee for analyzing and elaborating public health policies in Romania is emphasized.
Abstract: The present text intends to draw attention to the need for an efficient ethical model that should regulate the activity and resource allocation in the healthcare system, and particularly in granting access to healthcare to families with high poverty rates, as well as in caring for children. Thus, the paper focuses on an ethical perspective using the idea of the social responsibility of organizations and especially of the state as an organization that takes responsibility in the social field. From an ethical point of view, the social responsibility principle eliminates the divergences between ethical responsibility and financial responsibility that may appear in establishing public health policies and in the construction of an ethical model for service providing and resource allocation. The intention of the paper is not to propose a model but rather to emphasize the need for creating an ethical model in the Romanian public health system starting from the National Strategy and the Report of the presidential committee for analyzing and elaborating public health policies in Romania.
4 citations
Journal Article•
TL;DR: It is argued that egalitarianism is, in any of its versions, at least a problematic answer to this question: and that a revised, idealized, version of sufficientism has a high chance to best answer this question.
Abstract: This paper defends a particular answer to the question about the adequate ideal of justice in the distribution of health care. It argues for two main ideas: 1) that egalitarianism is, in any of its versions, at least a problematic answer to this question: and 2) that a revised, idealized, version of sufficientism has a high chance to best answer this question.
3 citations
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...“judges” [33] 7 ....
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Book•
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01 Jan 1985
TL;DR: In this article, the authors discuss the moral significance of age, the moral advantage of dependants and friends, the advantage of usefulness, and the moral worth of living and death.
Abstract: Preface. Acknowledgments. Introduction. 1. Beings, human beings and persons I. When does life begin? II. When does life begin to matter morally? III. How do we recognise persons? IV. Persons and full human beings V. Once a person always a person? VI. Conclusion 2. Above all do no harm 3. Must doctors help their patients? 4. Killing: A caring thing to do? I. Death removes a threat II. Death is a benefit III. Wanting to live and wanting to die IV. Death promotes other values V. Safeguards VI. The justification of euthanasia 5. The value of life I. The moral significance of age II. Worthwhile lives III. The moral advantage of dependants and friends IV. The moral advantage of usefulness V. Moral worth VI. What should we do? 6. The beginnings of life I. What's happening now II. Experiments on embryos III. The slippery slope 7. Whose body is it anyway? I. Who's mother whose baby? II. Morally unsound parents 8. A woman's right to choose I. To be or not to be - a mother II. Doing it my way III. Final choice: the all-female world 9. Sexual morality and the natural 10. Respect for persons I I. Respect for persons II. What is autonomy? III. Is paternalist interference justified? IV. Consent 11. Respect for persons II I. Children, lunatics, barbarians and animals II. Respect for the dead III. Self-inflicted illness IV. Confidentiality V. Ultimate principles and moral values 12. Death is abolished I. What is dealth? II. Live persons and dead bodies III. Machine people IV. Death is abolished V. Are the frozen really persons? Notes. Suggested further reading. Index.
605 citations
TL;DR: The emergence of an ideology which blames the individual for her or his illness is described and it is proposed that, instead of relying on costly and inefficient medical services, the individual should take more responsibility for herself or his health.
Abstract: This article describes the emergence of an ideology which blames the individual for her or his illness and proposes that, instead of relying on costly and inefficient medical services, the individual should take more responsibility for her or his health. At-risk behavior is seen as the problem and changing life-style, through education and/or economic sanctions, as the solution. The emergence of the ideology is explained by the contradictions arising from the threat of high medical costs, popular expectations of medicine along with political pressures for protection or extension of entitlements, and the politicization of environmental and occupational health issues. These contradictions produce a crisis which is at once economic, political and ideological, and which requires responses to destabilizing conditions in each of these spheres. These ideological initiatives, on the one hand, serve to reorder expectations and to justify the retrenchment from rights and entitlements for access to medical services, and, on the other, attempt to divert attention from the social causation of disease in the commercial and industrial sectors.
600 citations
Book•
31 Dec 1990
TL;DR: Like all John Harris's work, this survey and proposed solution of some of the central problems in medical ethics, especially life and death issues, is brilliantly argued (always) and highly controversial (sometimes).
Abstract: Like all John Harris's work, this survey and proposed solution of some of the central problems in medical ethics, especially life and death issues, is brilliantly argued (always) and highly controversial (sometimes). Both characteristics stem from the fact that the book proceeds with strict consistency from the plausible but by no means inevitable unexpressed premiss that the only possible source of ethical values lies in what is actually found valuable. Thus freedom from suffering is valued by all sentient creatures, whether or not they can formulate their values and desires in words; and so we are morally obliged to cause as little pain as possible to humans or animals. But life can be valued only by a person, ie by a being that is capable of being self-conscious and of knowing it has a life to value; hence we must respect the lives of human beings already born, but not of plants, animals or human fetuses. Now, ifwhat is valuable is the same as what is valued, two values will be of supreme importance, because they are necessary conditions for realising all other values. These are the life and the autonomy, ie capacity for free choice, of persons. Hence the obligation to respect their life and autonomy is overriding, and extends to those who are currently not able to exercise personhood but may be reasonably expected to do so in the future, such as children or those temporarily unconscious. Moreover, the lives of all persons are equally important, since no external criteria exist to make their importance unequal; and to kill and to allow to die are morally identical, since their moral effect is exactly the same. So any action (or inaction) which can be seen in advance to result in the death of one or more persons can be justified only if (a) those persons are themselves intentionally threatening the life or autonomy of other persons, or (b) the death of a smaller number ofpeople is necessary in order to save the lives of a larger number, or (c) the persons have autonomously decided that their lives are no longer of value to them. If this is applied to medical ethics, the following conclusions, among others, can be drawn: 1. Abortions and experiments on human embryos present no moral problem, since no person is involved. 2. The withholding of treatment and/or nourishment from severely handicapped children is morally identical to killing them: indeed, worse, since it causes them more suffering. As such, there is at least a strong presumption that it is wrong. 3. Voluntary euthanasia, freely chosen, is not wrong. 4. On the other hand, the involuntary euthanasia practised by the government, whose failure to provide adequate health care makes it morally responsible for the resulting deaths, is certainly morally wrong. 5. The failure to provide patients with adequate information to make autonomous decisions is wrong. 6. There should be a very strong presumption against overriding patients' expressed wishes, unless there is good reason to think that defects of selfcontrol, reasoning or information make them non-autonomous. 7. No sexual practice or mode of bringing children into the world can be morally wrong unless it violates the autonomy of another person or causes them undesired physical or mental suffering. 8. The value of a life is given by its importance for its possessor, not by its usefulness to others: hence the lives of the old, as long as they wish to live, are just as important morally as those of the young.
254 citations
TL;DR: It is proposed that patients who develop end-stage liver disease through no fault of their own should have higher priority for receiving a liver transplant than those whose end-Stage liver disease results from failure to obtain treatment for alcoholism.
Abstract: The circumstances of liver transplantation are unique among organ transplantation because of the dire, absolute scarcity of donor livers and the predominance of one disease—alcohol-related end-stage liver disease—as the principal cause of liver failure. We propose that patients who develop end-stage liver disease through no fault of their own should have higher priority for receiving a liver transplant than those whose end-stage liver disease results from failure to obtain treatment for alcoholism. We base our proposal on considerations of fairness and on whether public support for liver transplantation can be maintained if, as a result of a first-come, first-served approach, patients with alcohol-related end-stage liver disease receive more than half the available donor livers. We conclude that since not all can live, priorities must be established for the use of scarce health care resources. ( JAMA . 1991;265:1295-1298)
227 citations
TL;DR: There is not good moral or medical reason for categorically precluding alcoholics as candidates for liver transplantation, and it would be unjust to implement such a preclusion simply because others might respond negatively if the authors do not.
Abstract: Two arguments underlie a widespread unwillingness to consider patients with alcoholic cirrhosis of the liver as candidates for transplantation. First, alcoholics are morally blameworthy, their condition the result of their own misconduct; such blameworthiness disqualifies alcoholics in unavoidable competition for organs with others who are equally sick but blameless. Second, because of their habits, alcoholics will not exhibit satisfactory rates of survival after transplantation; good stewardship of a scarce lifesaving resource therefore requires that alcoholics not be considered for liver transplantation. These arguments are carefully analyzed and shown to be defective. There is not good moral or medical reason for categorically precluding alcoholics as candidates for liver transplantation. It would, in addition, be unjust to implement such a preclusion simply because others might respond negatively if we do not. (JAMA. 1991;265:1299-1301)
124 citations