Healthcare

Healthcare and the Common Good

The U.S. healthcare system is at once the envy of the world and in very deep trouble. Some resist the word “crisis” to describe our situation, suggesting that the diagnosis is too cynical. Others, like the Hudson Institute, have predicted that the impact of Boomers on the healthcare system will lead to the collapse of employer-provided healthcare (see William Styring and Donald Jonas, Health Care 2020: The Coming Collapse of Employer-Provided Health Care).

Podcast Episode: 
91

What Has Justice to Do with Medical Quality and Safety? Care, Cultural Diversity, and the Vulnerable among Us

Issues: 

In 2007, the U.S. Agency for Healthcare Research and Policy (AHRQ) reported that not only do significant disparities in healthcare quality exist between whites and minorities, but that these disparities have not been reduced in recent years.1 In fact, 60% of the clearly documented disparities did not decrease significantly on follow up. The metrics applied were comprehensive in that 42 measures of quality and 8 measures of access to care were evaluated.

Podcast Episode: 
89

Christian-Hippocratism, Confidentiality, and Managed Care: A Volatile Mix

With these words the Hippocratic Oath places confidentiality squarely in the context of the medical ethos. Confidentiality in the physician-patient relationship is a good, but not an absolute good or the so-called summum bonum. The words of the Oath also imply that certain shared admissions--like threatened mortal danger to another--may supercede the relative good of confidentiality. Protection of life is something that allows sharing of what otherwise ought not to be spoken abroad.

Podcast Episode: 
78

Is Aging a Disease Worth Fighting?

Few people would have moral problems with research to find the genetic links to aging and to age-related diseases. Alzheimer's disease, atherosclerosis, cancer, and other illnesses generally associated with aging are clearly worth fighting. So the news that University of Illinois researchers have found a single gene, "p21," that might be linked to age-related diseases is, all things being equal, good news.

Podcast Episode: 
77

The Costs of Technology in Women's Health, Part II

Our technological society, ruled as it is by the technological imperative, is actively engaged in the pursuit of progress regardless of the cost.  This progress is often ill-defined; we are “committed to the quest for continually improved means to carelessly unexamined ends.”  While cost-benefit analyses are frequently performed to ascertain the efficiency of progressive techniques in terms of monetary value, seldom do we truly count the immaterial costs of progress.  One area of medicine where these changes are vividly portrayed is the arena of women’s reproductive health where to the goals of life, health, and happiness, “a perfect child of our own” is added.  Here, too, we have failed to count the immaterial costs of such a project.  We’ve failed to see how our blind pursuit of elusive but noble goals is threatening not only the profession of medicine, but the very nature of our humanity as well.  This paper will explore some of the costs of technology in women’s reproductive health—costs to the art of medicine as well as the nature of marriage, reproduction, and children.

Podcast Episode: 
62

The Costs of Technology in Women's Health, Part I

Our technological society, ruled as it is by the technological imperative, is actively engaged in the pursuit of progress regardless of the cost.  This progress is often ill-defined; we are “committed to the quest for continually improved means to carelessly unexamined ends.”  While cost-benefit analyses are frequently performed to ascertain the efficiency of progressive techniques in terms of monetary value, seldom do we truly count the immaterial costs of progress.  One area of medicine where these changes are vividly portrayed is the arena of women’s reproductive health where to the goals of life, health, and happiness, “a perfect child of our own” is added.  Here, too, we have failed to count the immaterial costs of such a project.  We’ve failed to see how our blind pursuit of elusive but noble goals is threatening not only the profession of medicine, but the very nature of our humanity as well.  This paper will explore some of the costs of technology in women’s reproductive health—costs to the art of medicine as well as the nature of marriage, reproduction, and children.

Podcast Episode: 
61

Donor after Cardiac Death: What Is the Christian’s Response?

The notion of organ donation after cardiac death (DCD) came into prominent public view in 1993, with the national awareness of the Pittsburgh Protocol.[1] More recently, the U.S. Department of Health and Human Services, through the Organ Transplantation Breakthrough Collaborative, strongly encouraged increased recognition and use of DCD in an attempt to increase the number of organs available for transplantation. Even more recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has stipulated that hospitals must have a DCD policy in place as of January 2007 in order to maintain accreditation. Consequentially, whereas some years ago, we might have sagely nodded our heads thinking, “this too will pass,” it is now quite apparent that the issue will not.

Podcast Episode: 
38

Please UNOS--Transplantation is a Fragile Public Trust

It has been said that, “. . . it takes years to build up trust, and it only takes suspicion, not proof, to destroy it.”[1] The words themselves tell us something about human nature, and unfortunately, are prescient in the context of organ transplants. At a time when a severe shortfall in donation has become emotionally palpable—approximately 18 people die every day while waiting—transplantation survives, imbedded within a fabric of trust. Those who donate their or their loved one’s organs expect that certain precepts will be honored. For example, there is the dead donor rule. If someone has agreed to donate organs after they die, either by whole brain or heart criteria, they must be dead and not merely dying when organs are retrieved. As a result, fiction like Robin Cook’s Comacan send a shudder throughout the transplant community. Similarly, in the mid 1990s, when newspapers intimated that cardiac criteria for death may have led to premature organ retrieval, concern was immediate and intense. Americans also respect a “level playing field.” Remember the public outcry surrounding Mickey Mantle’s liver transplant? Allowing the famous or rich to jump ahead of the vulnerable is not the American way. Finally, in an era of quality and safety concerns, the lifesaving process of transplantation should be transparent, compassionate, just, and as safe and quality laden as possible. There are diverse “patients” involved: donors, recipients, and both families. The public should continue to be very sensitive to potential abuses. This necessary vigilance represents transplantation’s critical check and balance.

Podcast Episode: 
36

When Will We Ever Learn? Social Valuation without Help from Henry David Thoreau and Alan Paton

Issues: 

It surely qualifies as a “worst of times” for medicine. Although it may be hard to believe today, beginning in the decade of the 1960s, dialysis therapy was rationed in the United States of America! The grim statistic for those outside the pale would be 100% mortality. In the group selected to receive life-saving treatment, one attribute was conspicuous by its presence—proof of “service to society.”[1] In fact, the infamous “Seattle committee” excluded people from treatment if they were not “self supporting.”[2] The rationing process itself was roundly and appropriately criticized for its transparent “prejudices . . . measuring people in accordance . . . (and solely by) middle class values.”[3] Those values also imposed a racial stigma, imbedded in service and self-support criteria. Someone commented dryly that Henry David Thoreau’s myriad eccentricities would have eliminated him from eligibility. The definition for “service” in Seattle wasn’t inclusive enough for Thoreau’s civil disobedience, ardent abolitionism, as well as his proclivities towards poetry and environmentalism. In the context of allocation decisions, these economic and sociological measures represent “social value” criteria. They have absolutely no place in the compassionate allocation of medical resources—whether the resources in question are scarce or not.

Podcast Episode: 
28

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