Hastings Cent Rep
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Biography Historical Article
Knowing when to stop: the limits of medicine.
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Since the proposal was first broached in 1987, a storm of controversy has engulfed Oregon's plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment... As part of the ongoing debate, the Hastings Center and the Wesley Foundation sponsored a two-day meeting in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform...a majority felt that OBHSA, in the framework of progress toward larger reform goals, is an experiment worth trying. Some felt that even if OBHSA doesn't attain its larger goals it should be tried since it will extend access and may lead to better health outcomes among the poor. But the general view was that OBHSA is a valuable experiment only to the extent that it leads to a statewide system of universal health insurance in Oregon without creating special burdens for the state's poor....
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We believe that a new agenda for the ethics of long-term nursing home care could be set by seeing nursing homes as communities of caring and interdependency. The goal should be not simply to eliminate or minimize dependency whenever possible, but to make a genuinely creative and nurturing use of the dependency that is an inevitable reality for most nursing home residents. Nursing homes are rarely places of curing, but they can and should be places of healing -- of making whole -- of enabling frail or chronically ill persons to use their dependency to grow as human beings... In general, nursing home regulation is a matter of striking a delicate balance between that degree of control necesary to ensure a basic standard of decent and humane care, and that degree of professional discretion needed to allow nursing homes to respond to their own particular problems of care as they make creative use of the dependency that is an essential fact of nursing home life.