The Journal of medicine and philosophy
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President Clinton, already facing formidable obstacles in reforming the health care system, denies that it will involve any rationing. This is politically understandable, but wrong. Infinite needs are rapidly overtaking finite resources. ⋯ As government undertakes to define what is "medically necessary or appropriate," it will unavoidably undertake a series of rationing decisions. Health care is being transformed from a private good to a public good. Government, when it reforms the health care system, must inevitably ask: How do we buy the most health for the public?
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Practices such as physician assisted suicide, even if legal, engender a range of moral conflicts to which many are oblivious. A recent proposal for physician assisted suicide provides an example by calling upon physicians opposed to suicide to refer patients to other, more sympathetic, physicians. However, the proposal does not address the moral concerns of those physicians for whom such referral would be morally objectionable.
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In 1991 and 1992, citizens of Washington State and California voted on whether "aid-in-dying" should be legalized. In both states, the proposition was defeated. In this article, the author, who participated in the Washington State campaign, imagines what might have happened in the fictitious State of Redwood, had such a proposal passed.
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Catholic natural law has had a long and evolving interest in bioethics. Thomas Aquinas left natural law a legacy of great flexibility in evaluating goods within a whole life. ⋯ The Vatican has developed new, holistic arguments to proscribe reproductive interventions, but critics remain unconvinced that marital relationships and goods have been adequately evaluated. The resolution of this debate will require further experience and reflection.
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This paper proposes an ethical framework for rationing publicly-financed health care. We begin by classifying alternative rationing criteria according to their ethical basis. ⋯ We submit that a just health care system will not limit basic health care to persons unable to pay for it. Furthermore, justice in health care requires limiting publicly-financed non-basic health care, striving for equality in access to basic health care, and relying on medical benefit to ration non-basic health care.