Just Caring Health Care Rationing and Democratic Deliberation

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  • Edition: 1st
  • Format: Hardcover
  • Copyright: 2009-03-30
  • Publisher: Oxford University Press

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What does it mean to be a "just" and "caring" society when we have only limited resources to meet unlimited health care needs? Do we believe that all lives are of equal value? Is human life priceless? Should a "just" and "caring" society refuse to put limits on health care spending? In Just Caring, Leonard Fleck reflects on the central moral and political challenges of health reform today. He cites the millions of Americans who go without health insurance, thousands of whom die prematurely, unable to afford the health care needed to save their lives. Fleck considers these deaths as contrary to our deepest social values, and makes a case for the necessity of health care rationing decisions. The core argument of this book is that no one has a moral right to impose rationing decisions on others if they are unwilling to impose those same rationing decisions on themselves in the same medical circumstances. Fleck argues we can make health care rationing fair, in ways that are mutually respectful, if we engage in honest rational democratic deliberation. Such civic engagement is rare in our society, but the alternative is endless destructive social controversy that is neither just nor caring.

Table of Contents

Just Caring: An Introductionp. 3
The "Just Caring" Problem: Core Argumentp. 5
Rationing Justly: The Moral Challengep. 11
Applications of the Deliberative Modelp. 20
The Ethical Challenges of Health Care Rationingp. 34
The Story of Coby Howard and Its Lessonsp. 35
Why Health Care Rationing Is Inescapablep. 39
Renal Dialysis and the Medicare End-Stage Renal Disease (ESRD) Amendmentsp. 44
The Totally Implantable Artificial Heart (TIAH)p. 55
Pricing Human Life: Getting Beyond Tragic Choicesp. 71
Is Human Life Priceless?p. 74
Tragic Choices or Tragic Disingenuousness? Invisible Rationingp. 81
Invisible Rationing and the Publicity Conditionp. 88
Managed Care and Health Care Rationingp. 95
Elements of Health Care Justicep. 100
Is Health Care Morally Special?p. 103
Non-ideal Justice: A Moral Analysis and Defensep. 112
Pluralism, Justice, and Rational Democratic Deliberationp. 124
Rational Democratic Deliberation: Scope and Structurep. 140
The Scope of Rational Democratic Deliberationp. 141
Fair Health Care Rationing: Not Markets, Not Physicians, Not Bureaucratsp. 148
Rational Democratic Deliberation: Taking Seriously the Tragedy of the Commonsp. 151
Rational Democratic Deliberation: Key Structural Featuresp. 160
Rational Democratic Deliberation and Fair Health Care Rationingp. 164
Wide Reflective Equilibrium and Just Health Care Rationingp. 171
Priority Setting, Wide Reflective Equilibrium, and Rational Democratic Deliberation: Addressing the Stability Problemp. 177
Facts, Wide Reflective Equilibrium, and Democratic Deliberationp. 181
Constitutional Principles of Health Care Justice and Rational Democratic Deliberationp. 184
Evaluating the Deliberative Processp. 195
Objections and Responsesp. 199
Setting Limits for Effective Costly Therapiesp. 202
Problem Introductionp. 202
Setting Limits: Options in the ESRD Programp. 205
Setting Limits: Options for HIV+/AIDS Patientsp. 208
Setting Limits: The Case of Artificial Heartsp. 219
Setting Limits: Concluding Commentsp. 227
Last-Chance Therapiesp. 229
Introduction: Scope of the Problemp. 229
Why Last-Chance Therapies? Weak Moral Argumentsp. 231
Last-Chance Therapies and Rational Democratic Deliberationp. 242
Futility and Last-Chance Therapiesp. 249
Rationing, Catastrophic Illness, and Disabled Patientsp. 254
Introduction: The Scope of the Problemp. 254
Needs Are Not Enough; Effectiveness Must Matterp. 256
The Oregon Plan and the Disability Critiquep. 259
Health Care Justice and the Disability Critiquep. 263
Defining the Disabled: Ethical Implicationsp. 268
Conclusionsp. 273
Is Age-Based Rationing Ever "Just Enough"?p. 276
Defining the Problem: Can We Accept Natural Limits to Life?p. 276
Justice and Age-Based Rationing: Fair Inningsp. 279
The Prudential Life Span Accountp. 285
Age-Based Rationing: Major Objectionsp. 290
Age-Based Rationing: Responses to Objectionsp. 291
Age-Based Rationing and the Duty to Rescuep. 294
Conclusionsp. 299
Do Future Possible Children Have a Just Claim to A Sufficiently Healthy Genome?p. 300
Framing the Issuep. 303
Preimplantation Genetic Diagnosis (PGD): A Historical Side Notep. 306
Does Justice Require Public Funding for Limited PGD?p. 308
Concluding Comments: Justice and Genetic Enhancementp. 316
Organ Transplantation: When is Enough Enough?p. 318
Scope of the Issuep. 318
The Maximization Argument: A Critical Moral Analysisp. 320
The Pittsburgh Protocol: How Dead Must Donors Be?p. 324
Organ Procurement and Financial Incentives: A Critical Assessmentp. 327
Presumed Consent/Duty to Donate: Critical Remarksp. 331
Justice and Multi-Organ Transplants or Retransplantsp. 333
Concluding Commentsp. 341
The Liberalism Problemp. 342
Justice, Health Care Needs, and Morally Controversial Interventionsp. 342
Liberal Communitarianism: Is It Just Enough? Is It Liberal Enough?p. 347
Resolving the Liberalism Problem: Public Reason and Public Interestsp. 352
Concluding Reflectionsp. 359
The Ethical Challenges of Priority Setting in Public Healthp. 362
Defining the Problemp. 362
The Scope of Public Health: Challenges and Choicesp. 365
Health Care Justice and Public Health: When Is Enough Enough?p. 368
Setting Public Health Priorities Justly: The Limits of Moral Theoryp. 375
Financing Health Care Fairlyp. 379
Why National Health Insurance?p. 379
Why Health Reform?p. 383
Assessing Competing Proposals for Health Reformp. 384
Health Savings Accounts: A Critical Assessmentp. 385
Health Care Vouchers: A Critical Assessmentp. 388
Single-Payer Reform: A Constructive Proposalp. 394
Summary and Reflective Conclusionsp. 399
Notesp. 403
Referencesp. 427
Indexp. 447
Table of Contents provided by Ingram. All Rights Reserved.

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