'The Patient as Victim and Vector' is jointly written by four authors at the University of Utah with expertise in bioethics health law, and both clinical practice and public health policy concerning infectious disease.

This essay serves as an introduction to this issue of the Journal of Medicine and Philosophy on commodification and health care. The essay attempts to sharpen the articulation of generally expressed worries about the commodification of health care. It does so by defining commodification, analyzing three components of the good of health care, and attempting to assess how commodification might distort the shape of each of those components. Next, it explores how the good of health care might be distorted by (...) the market-based principle of distributive justice, "to each according to ability to pay." Finally, it identifies two basic questions about the relationship of medicine and the market that merit further exploration. How does the market-based language of "incentives" so pervasive in the world of managed care distort the complex patterns of virtue and vice that motivate actors in the health care arena? If we recognize that we cannot eliminate the influence of money from the health care system, how can we insure that the good of health care remains, in Radin's terms, "incompletely commodified"? (shrink)

In this paper we will argue in favor of federal funding of elective abortion, more specifically in support of Medicaid funding. To do so, we will address the restrictions on public funding presently in place and demonstrate that the various justifications offered in their defense are in­adequate. We will then suggest that the ‘failure to enable’ represented by a ban on Federal funding is morally equivalent to an outright prohibition on abortion for the target population. Just as a moral equivalence (...) can be established between killing and letting die in symmetrical cases, like criteria for equivalence can be established that help to identify those failures to make possible that are morally indistinguishable from proscriptions. On this basis, it can be shown that restrictions on Federal funding in such contexts can be thought to carry the same moral liability as prohibitions. (shrink)

Describing the U.S. health care system meansdescribing managed care under commercial forces. Managed care creates new moral tension forpractitioners, but more importantly, in its currentform it intensifies the commercialization of healthexpectations and interactions. The largely unregulatedmarketing of health services under managed care hasbeen a major factor in the increasing number ofuninsured citizens, while claims for cost reductionthrough managed care are equivocal. Risk-ratingpractices integral to the current medical marketplacethwart concerns for justice in allocation and createvulnerabilities for almost everyone. Thepolitical-moral concern of (...) the early 1990s for a rightto health care is nowhere in sight. (shrink)