President Clinton's health care reform package has been sent to Congress where it is expected to become a focus for target practice. Whether it remains a cohesive effort or becomes riddled with holes remains to be seen. The following articles show the importance of ethical considerations in reformulating the nation's health care system.
Staying current with the day-to-day drama surrounding Jack Kevorkian is nearly impossible for a bimonthly newsletter, but several significant events are worth exploring--rulings on the constitutionality of Michigan's law barring suicide assistance, the impact of the 20th Kevorkian-assisted suicide of a physician, and the public's response to the book Final Exit.
The development of integrated delivery networks under health care reform will entail a shift away from focusing on how to manage individual institutions to creating new relationships among provider and community organizations that have previously held unshared visions and values. The Catholic Health Association, St. Louis, has recognized the need for network sponsors to "be able to articulate the nonnegotiables for the Catholic ministry, yet be flexible to choose between having any presence and having presence through the power to influence." What exactly is negotiable will be put to the test in the near future, as the following articles point out.
Two separate clusters of events in recent months have spurred public discussions over the questions of how and to what degree the public should be involved in resource allocation decisions. In England, a group of physicians unilaterally decided to deny bypass surgery to heavy smokers, and in the United States, uninsured parents of conjoined twins elected to seek separation of the twins despite heavy odds against their survival, raising questions of whether health care reform will stymie such decisions in the future.
Efforts to come to grips with defining the conditions and boundaries of futile treatment continue to emerge in professional and lay discussions. One clear underlying premise that is taking hold is the idea that such definitions of futility are no longer the sole purview or responsibility of the medical establishment.
The paths taken by Drs. Jack Kevorkian and Timothy Quill, though very different, both carry messages that fuel not only the debate over assisted suicide but also the larger state initiatives for active euthanasia. The following articles update the activities surrounding these spokesmen.
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