For the past two decades, society has assumed that advance directives will eventually lead to a more cost-effective use of health care resources. Two recently reported studies come to differing conclusions on this matter.
For the past two decades, society has assumed that advance directives will eventually lead to a more cost-effective use of health care resources. Two recently reported studies come to differing conclusions on this matter.
Several years ago, central questions in the AIDS research field were: Is it possible to develop a vaccine against HIV? If so, when, and what strategies show the most promise? Now, even with no safe and effective vaccine in the pipeline, attention is nonetheless shifting towards potential problems associated with selecting the populations most in need of the product, conducting the clinical trials, and delivering the vaccine in a fair and equitable manner. These problems were the focus of a session at the annual meeting of the American Association for the Advancement of Science (AAAS), held in San Francisco in February. The following articles summarize two of the presentations at the session.
Although the withdrawal of treatment and active euthanasia are viewed as two different processes with two different objectives, the conditions under which these actions are justified by physicians have much in common, as the following articles on two new surveys show.
Confusion reigns in the care of two medically futile cases as one state's supreme court requires hospitals to ask the local state attorney's office to arbitrate conflicts between "acceptable medical treatment and the patient's wishes," and another court applies the federal Emergency Medical Treatment and Active Labor Act (EMTALA) to require a hospital to stabilize an anencephalic child's respiratory distress.
States are increasingly turning to managed care as a means of coping with exploding Medicaid costs (see Emily Friedman's article in the March 16 JAMA, pp. 875-78). Many managed care proposals depend on employer-based insurance as the primary source of financing health care reform. Debates continue, however, over the ability of both to provide adequate care for the diverse sets of populations in the United States.
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