Social science & medicine. Part F, Medical & social ethics最新文献

Justice requires that health care facilities and physicians (and other providers) be available to meet health care needs. These obligations are primarily social. They constrain the institutions through which providers are trained and through which incentives to work in various specialities and locations are arranged. Individual physicians come to have particular obligations concerning the delivery of care through their responses to these institutions, not through the direct appeal to principles of distributive justice. It is argued that many institutional arrangements for distributing physicians in accordance with the requirement of justice violate no basic liberties, contrary to some libertarian views.

All developed, industrialized nations provide some system of health care for the treatment of acute and chronic illness. However, nations differ in terms of their policy toward the provision and distribution of health services. Basic to policy regarding access to medical care is the notion of health care as a right. This paper examines the evolution of the concept of a right to health care in three industrialized nations—the U.S.S.R., Great Britain and the U.S. Trends in the U.S. health care delivery system suggest an emerging policy which favors equity through federally subsidized care for the indigent. However, the U.S. health care system tolerates unequal distribution of services. The U.S.S.R. and U.K. health care systems have adopted explicit policies which support the right of all their citizens to health care. U.S. policy supporting the right to health care has been hampered by two primary factors. First is opposition within the medical profession toward the notion of health care as a right. Second is the inability of federal agencies to develop a comprehensive plan for health care delivery.

Some persons who are mentally ill and refuse treatment constitute a threat to themselves and/or others. Many psychiatrists, psychologists and jurists believe that society has only two ways of dealing with such individuals: it can involuntarily hospitalize these people for an indefinite amount of time and attempt to ‘cure’ them, or it can outlaw their behavior and incarcerate. In this essay I argue that neither of these options is morally defensible, and that it is far preferable when dealing with mentally ill persons who threaten either themselves or others to pursue a course of action which combines determinate sentencing with involuntary treatment. In developing my argument I proceed as follows. First, I consider the major justifications for the involuntary civil commitment of mentally ill persons and show that none is sound. Next, I argue that the only acceptable justification for denial of a mentally ill person's liberty is that he has broken some criminal law. Finally, I contend that involuntary hospitalization and treatment of some prisoners may be morally acceptable, but only when certain safeguards have been assured. Chiefly: (1) the prisoner must be judged to be incompetent to make an informed decision concerning treatment, and (2) the prisoner must serve the sentence imposed upon him by law, i.e. he cannot be forced to undergo treatment beyond the limit of his sentence, nor may he be released early because he is considered ‘cured’.

It is argued that waste during a period of scarcity which results in human suffering and death is bad. It is then argued that it is immoral for waste to continue especially if nonwaste requires no sacrifice to the responsible parties. Allowing one's organs, which might otherwise be transplanted to help others, to deteriorate in the grave is an example of waste. Since a prodigious number of people might benefit from an organ transplant, the waste of organs is wrong. Moreover, since the deceased no longer exists, the removal of his organs constitutes no sacrifice on the deceased's part. Therefore, it is immoral to waste transplantable human organs.

Because many medical practices in conditions of scarcity mimic triage decisions, this paper undertakes an examination of justifications for such practices.

The paper addresses, first, a very important principle commonly accepted in medical ethics—namely, other things being equal, it is ‘better’ to save more lives rather than less. It is argued that there are compelling reasons to challenge this principle—among them: (1) that acceptance of the principle commits one to an odd conception of valuing human life; and (2) that while ‘more is better’ may be a perfectly good reason for choosing the larger number, it doesn't have the status of a universally binding moral evaluation.

In the final section of the paper, it is argued that there is a basic disanalogy between triage in wartime or disaster contexts and in more general allocation contexts in medicine.

The first section of this article examines Sade's argument refuting the notion of a right to health care, showing that his argument is inconclusive. The second section sets out three principles of justice through an examination of one of the simplest instances of justice—a just exchange of goods or services between two persons. In the third section, a general theory of justice and of the just society is outlined; and in the fourth section an argument is presented to show that in any society which has the resources to provide basic health care to all its citizens, there is a universal right to basic health care.