When deciding what disorders to screen newborns for, we should be guided by evidence of real effectiveness, take opportunity cost into account, distribute costs and benefits fairly, and respect human rights. Current newborn screening policy does not meet these requirements.
This paper uses the controversy over the denial of care on futility grounds as a window into the broader issue of the role of cost in decisions about treatment near the end of life. The focus is on a topic that has not received the attention it deserves: the difference between refusing medical treatment and demanding it. The author discusses health care reform and the ethics of cost control, arguing that we cannot achieve universal access to quality care at affordable (...) care without better public understanding of the moral legitimacy of taking cost into account in health care decisions, even decisions at the end of life. (shrink)
In 1989, Helga Wanglie, 86 years old, broke her hip. This began a medical downhill course that a year later caused her health care providers to conclude that she would not benefit from continued medical treatment. It would be futile, and therefore, should not be provided. Her husband disagreed, and the conflict eventually led to a lawsuit. The Wanglie case touched off an extended debate in the medical and bioethical literature about medical futility: what it means and how useful the (...) concept is in making ethical decisions about starting or stopping treatment. (shrink)
Paul Menzel and Donald Light ("A Conservative Case for Universal Access to Health Care," Jul-Aug 2006) tell a story that is plausible. However, based on my twenty-five years of experience as a policy analyst interested in access to health care, I find it inaccurate for a number of reasons.
It is good for people to understand their insurance coverage and the reasoning that has shaped it, to be able to contribute their two cents if they want to, and to know that their plan has at least attempted to make decisons that are consistent, fair and compassionate. It is also good for them to be told that attention to cost is ethically required. Nevertheless, while following the recommendations of Wynia et al (2004) might make benefits design and administration appear (...) more fair, it will not do as much as they suggest for them to be more fair. (shrink)
By and large, neither bioethicists nor economists have offered a satisfactory account of how managed care organizations should ration health care. Both disciplines would like to guarantee adequate care to all without defining adequacy. But it cannot be done. The more we rely on market forces to distribute health care, the more we need a national standard of care.