tag:blogger.com,1999:blog-7476621888383604834.post7141273678615316588..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Peter Singer on RationingJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7476621888383604834.post-78456075811731927742009-08-03T08:33:49.585-04:002009-08-03T08:33:49.585-04:00Hello Kate
Thank you for this extraordinarily tho...Hello Kate<br /><br />Thank you for this extraordinarily thoughtful comment. The questions you raise are just the kind of questions that health systems, including ours, will ultimately need to address. And the spirit of thoughtful inquiry with which you raise the questions is the spirit a successful system will need.<br /><br />The "droopy eyelid" issue shows just how complex governing a health system can be - discerning the difference between improved vision (clearly a health-related value) from improved looks (perhaps a source of personal pleasure, but not a goal for a health fund).<br /><br />You might find the book Norman Daniels and I wrote on rationing ("Setting Limits Fairly: Learning to Share Resources for Health" - Oxford University Press, 2008) interesting. Our basic argument is that pluralistic societies do not have shared <i>principles</i> by which we can answer the kinds of questions you raise, with the result that we need a fair process. (The book delineates a view of what that process should look like.)<br /><br />Best<br /><br />JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-59901189665501808642009-07-28T15:04:36.361-04:002009-07-28T15:04:36.361-04:00When discussions are cast broadly about rationing ...When discussions are cast broadly about rationing it tends to invoke fear (no doubt intended by lobbyists) without necessarily promoting understanding. <br /><br />As with many complicated concepts, "rationing" comes bundled with layers of meaning and it is often the case that people talk past one another. Is rationing saying "no" to a second MRI or for coronary bypass surgery or a knee replacement? Is it asking folks to wait for some procedures? The criteria are important. <br /><br />One element adding complexity is that health and health care are themselves fuzzy concepts. And with new interventions minted weekly (note, I don't automatically say "advances"), these concepts evolve. All would agree, generally, with the need for emergency care, urgent care, and a wide range of surgical and medical interventions to save lives, prevent further harm, repair damage. Where it gets trickier is at the margins. <br /><br />My 78-year-old mother is delighted with her two Medicare-financed knees and there is no doubt that the surgeries have improved her quality of life directly by removing the pain of arthritis but, also, indirectly by permitting her to remain active, engage socially, keep her weight down, etc. But, if she were 90 with other health conditions, perhaps weighing that decision more carefully is the responsible thing for our health care system to do. Or if she had to wait a year or two to get her knees so my neighbor could have basic health care, that might also be a wise decision. <br /><br />She has also had her eyelids (droopy) done, also paid for by Medicare since they were (arguably) impeding her vision. Is this health? This procedure has not always been on the Medicare-financed list but many incremental procedures such as these are adopted each year. Is promoting the maximum quality of life medicine can provide what we are talking about when we talk about the goals of health care? Only with a very expansive view of what health is, I think.<br /><br />I agree with Singer that we are already rationing by virtue of supporting the health insurance coverage of some but not all of our citizens (whether by tax incentives, payroll taxes, or general revenues). At issue is how can we reasonably assure access to health care services, promote health, and limit publicly supported services that provide insufficient benefit. <br /><br />Kateklacuffnoreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-18949751169949272932009-07-21T07:30:36.794-04:002009-07-21T07:30:36.794-04:00For an excellent discussion of Peter Singer's ...For an excellent discussion of Peter Singer's article, see Bob Wachter's July 18 post on Wachter's World. There's a link to his blog on the right hand column of mine.Jim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.com