Rationing, equity, and affordable care.
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Biomedical subjects
Publications and source records attributed to D Callahan.
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In the United States, contemporary biomedical ethics began to develop in the 1960s, together with the advent of major advances in basic research and clinical application and the establishment of health care entitlement programs. Problems of a moral nature promptly arose in the fields of biology and medicine that have generated ongoing debate. Today, the five topics of greatest importance are the rights and autonomy of the patient, the meaning of the "sanctity of life" as opposed to the "quality of life," interventions in nature, the allocation of resources, and the function of the public in decision-making about health. Ethics committees have been set up in 60% of hospitals to examine the most difficult problems and provide pertinent advice. Another trend that may be very significant in the future is a politicization of bioethical questions and a division into factions that will introduce political rhetoric into the field of medicine.
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Realizing the promise of long-acting contraceptives depends on continuing efforts to distinguish appropriate from inappropriate policies and practices. The current debates concerning Norplant and other long-term methods generally have based ethical judgment on too slim a reed. It is insufficient and overly divisive to limit the tools of analysis to questions of freedom and coercion. A richer perspective is needed. We have sketched out an alternative approach that rests on a close, case-by-case analysis attentive to the social dimension and consequences of contraceptive decisionmaking, as well as to the individual interests at stake. The approach also takes special note of the need for access to long-acting contraceptive, the possibility for mistaken nonuse as well as mistaken use, and our country's past and present biases and power imbalances. We do not claim that this method will make judgments about justifiable or unjustifiable influence easy or automatic. However, it should prove adept at underscoring the factors that require particular scrutiny. Perhaps more importantly, the approach highlights that influences for the use of long-acting contraceptives ought to be judged, not merely dismissed.
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