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At least 667 records · Page 37Linked to original sources
PubMed1976

Exploring new ethics for public health: developing a fair alcohol policy.

Alcoholism policy since the repeal of Prohibition has been largely based on the assumption that alcohol problems are the result of the failure of a small minority to "control" their drinking. Thus, in sharp contrast to the approach to other drug policies, the problem of alcohol abuse has been viewed as one of "bad users" rather than "bad substances." This regard of alcoholism has helped exonerate the majority of drinkers and the alcohol industry from responsibility. However, mounting epidemiological evidence demonstrates that a primary factor in rates of diseases such as cirrhosis is the per capita use of alcohol and suggests that alcohol problems can be controlled or reduced only if all involved in the manufacture, sale or consumption of alcohol accept the burdens of restrictions over its availability and use. This acceptance will not be forthcoming, however, unless the prevailing market ethic of individual responsibility and minimal collective obligations to protect and preserve life is replaced with a new public health ethic rooted in social justice. This new ethic would assign the highest priority to life and would stress the obligations of all citizens to share the burdens of reasonable restrictions over all health hazards. In this paper a new alcohol policy is outlined based on just and reasonable limits on the availability, marketing and consumption of this substance.

Alcohol Drinking↗
PubMed1985

A proposal for cadaver organ procurement: routine removal with right of informed refusal.

In order to alleviate the shortage of vital organs for transplant, we propose a system of routine removal of cadaver organs with an option of informed refusal by family. Unless an individual registered an objection during his or her lifetime, or unless the family objected to the procedure, clinicians would be permitted routinely to salvage vital organs for transplant. Our proposal charts a middle path between the current ineffective policy based on "encouraged voluntarism" and "presumed consent" policies that promise effectiveness at the cost of violating traditional ethical and legal principles. In this article, we analyze the failure of the current regime, articulate a policy of routine removal subject to the right of informed refusal, and defend this policy against several possible objections.

Cadaver↗
PubMed1989

Government's role in organ transplantation policy.

This paper initially considers ways of thinking about organ transplantation: Should it be treated as a catastrophic disease or as an ordinary and accepted medical procedure? The analysis then shifts to the role the government has played in influencing organ transplantation policy. The federal government's involvement initially stemmed from its role as payer for end-stage renal disease services. In recent years, the rationale for intervention has changed, and the mechanism for implementing regulatory oversight has shifted to a private network run for the government by the United Network for Organ Sharing (UNOS). The government has delegated much policymaking authority to UNOS, although the author demonstrates that this is not required by the applicable legislation. The article raises questions about the relationship between UNOS and the federal government, about potential conflicts between UNOS guidelines and state laws under the Uniform Anatomical Gift Act, and about the ideological stance undergirding much of current federal policy in the organ transplantation arena.

Federal Government↗
PubMed1989

Ethical criteria for procuring and distributing organs for transplantation.

This article provides an ethical analysis and assessment of various actual and proposed policies of organ procurement and distribution in light of moral principles already embedded in U.S. institutions, laws, policies, and practices. Evaluating different methods of acquisition of human body parts--donation (express and presumed), sales, abandonment, and expropriation--the author argues for laws and policies, including required request, to maintain and facilitate express donation of organs by individuals and their families. Such laws and policies need adequate time for a determination of their effectiveness before society moves to other major alternatives, such as a market. In organ allocation and distribution, which have close moral connections with organ procurement, the author defends the judgment of the federal Task Force on Organ Transplantation that the community should have dispositional authority over donated organs, that professionals should be viewed as trustees and stewards of donated organs, and that the public should be heavily involved in the formation of policies of allocation and distribution. Concentrating on policies being developed in the United Network for Organ Sharing, the author examines the point system for cadaveric kidneys, the access of foreign nationals to organs donated in the U.S., and the multiple listings of patients seeking transplants. He concludes by identifying two major problems of equitable access to donated organs that will have to be addressed by social institutions other than UNOS: access to the waiting list for donated organs and the role of ability to pay in extrarenal transplants.

Beneficence↗
PubMed1989

Legal rights and communicable disease: AIDS, the police power, and individual liberty.

The policy debate over AIDS has focused on how to balance the rights of individuals who have the disease against the rights of the public. This paper examines the nature of both sets of rights by analyzing the development of public health law and its dominant visions today. The article argues that while once public health rights implied a vast reserve of community authority and obligation to prevent illness, today the rights of the public and those of individuals are seen as being in opposition. Public health jurisprudence now presupposes that illness is primarily a matter of individual concern. In this view, the science of medicine mediates the relationship between the individual and the public. This understanding of rights protects some of the interests of infected individuals, but is inadequate for addressing many of the major problems raised by the AIDS epidemic, particularly the spread of infection among the uninfected.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The medically uninsured: problems, policies, and politics.

The ranks of the medically uninsured have grown significantly in recent years, but no consensus on a policy solution has emerged. After summarizing the characteristics of the uninsured population, this paper reviews diverse policy responses and their troubled political prospects.

Federal Government↗
PubMed1994

Controlling resurgent tuberculosis: public health agencies, public policy, and law.

The reappearance of tuberculosis as a serious public health threat points up the fallacy of the widely held assumption that medical science had conquered the communicable diseases that were once leading causes of morbidity and mortality. In devising a strategy to prevent the spread of TB, public policymakers must adapt traditional TB control measures to reflect the current problem. Such a strategy can and should include the appropriate use of governmental coercion to compel observance of public health TB control measures. Public health approaches to control of human immunodeficiency virus, with their emphasis on the voluntary cooperation of those infected and at high risk for infection, are not a model for effective TB control. Additional resources, while needed, will not alone enable public health agencies to bring TB and other communicable diseases under control. In the present debate over health care reform, little attention has been paid to the importance of public health agencies in protecting the public health. The resurgence of TB is a warning of the consequences of neglecting public health agencies and ignoring the socioeconomic problems that underlie it and other communicable diseases.

Antitubercular Agents↗
PubMed1994

The importance of public health for twenty-first-century health care: lessons from tuberculosis.

Once epidemic, tuberculosis has re-emerged, often in newly drug-resistant forms. This public health threat calls for strong public action as well as improved private care. Action has been hampered by failures in public health infrastructure and legal-philosophical support for government intervention. Josephine Gittler's accompanying article usefully suggests rebuilding public-health agencies and adapting traditional authority and controls from the age of epidemics to take account of today's circumstances and sensibilities.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Compulsory removal from home under the National Assistance Act 1948.

District nurse Mary Thomas has had concerns about one of her older patients for some time. The lady, Miss Oates, is in her 80s and she lives alone in a bungalow with 30 cats. Her physical frailty is such that she is unable to care properly for herself or her cats. She has refused all offers of help from the social services authorities and only allows the district nurse in to dress an ulcer on her leg. The bungalow is filthy and stinks of urine. There is no heating or electricity. There is cat excrement and uneaten pet food everywhere. Today Sister Thomas has found her patient lying at the foot of her bed after falling the night before. She refuses to be helped into bed and seems determined to stay on the floor. Despite the urging of the district nurse and GP the patient has consistently refused to leave her bungalow. Both sister Thomas and the GP accept that the patient has no signs of a mental disorder or of mental incapacity, nevertheless they both consider that care and attention in a care home, even for a short period to allow her bungalow to be cleaned, would be of great benefit and wonder if the law could be used to compel Miss Oates to move to a care home.

Activities of Daily Living↗
PubMed2002

Social security reform in Latin America: policy challenges.

Over the last decade Latin American countries have served as the world's laboratory for pension systems based on individual retirement savings accounts. Some countries have adopted defined-contribution individual accounts as a replacement for state-run pension systems; other countries have embraced mixed systems of have made individual accounts optional and supplementary. This article outlines some of the most significant elements of recent Latin American pension reforms and examines some of the most serious policy challenges faced by governments implementing the new systems of individual accounts, including the need to reduce administrative costs, limit evasion, incorporate new categories of workers into the system, and improve competition in the pension fund industry. The authors conclude that there is no single Latin America model, and that reform itself has been and will continue to be an incremental process.

Aged↗
PubMed1989

HIV antibody testing: who benefits and who loses?

From a public health perspective, a significant milestone in the AIDS crisis so far has been the development of serologic tests to detect exposure to the HIV. With AIDS now reported in more than 124 countries and in every state of the Union, with the possibility that in excess of two million Americans have been infected and in the absence of a cure or vaccine, the issue of testing cannot be ignored anymore. Unfortunately, the testing debate has generated more heat than light. This paper examines the proposed "benefit" to public health in testing certain target groups deemed "at risk", and also discusses socio-ethical implications of such testing. The whole question of HIV antibody testing essentially raises the need for a balance between voluntary and mandatory testing; and society's commitment to protect public health as well as safeguard individual civil rights.

AIDS Serodiagnosis↗
PubMed2006

Life expectancy and productivity loss among narcotics addicts thirty-three years after index treatment.

This study computed the life expectancy of a cohort of male narcotics addicts followed for 33 years and assessed the productivity lost as a result of premature mortality. The future life expectancy was constructed for the narcotics addicts and for a comparable cohort from the general U.S. population. The average future life expectancy of the cohort was 18.84 years compared to 33.48 years for comparable U.S. males (t = 49.49, p < .00001). As a result of this premature mortality, the estimated monetary value of lost productivity was greater than 174 million dollars. The lives of heroin addicts were severely truncated at productive ages resulting in a loss of potential productivity that increases social and economic burdens.

Adult↗
PubMed1997

Single payers and multiple lists: must everyone get the same coverage in a universal health plan?

In spite of recent political setbacks for the movement toward universal health insurance, considerable support remains for the idea. Among those supporting such plans, most assume that a universal insurance system, especially if it is a single-payer system, would offer a single list of basic covered services. This paper challenges that assumption and argues for the availability of multiple lists of services in a universal insurance system. The claim is made that multiple lists will be both more efficient and more fair. Any single list will fund some services that are quite attractive to some people, but only marginally attractive to others. Thus any single-list plan will fund some services that produce only marginal benefit for the resources used. Moreover, since some people will hold values quite compatible with the single list and others will hold values leading to preferences for unfunded services, some people will get much more benefit from any single list than other people will. Fairness and efficiency require providing an entitlement to universal access to health insurance that could be purchased by typical consumers for a fixed price of perhaps $3500. By permitting everyone to pick their preferred list of services available at that price, each person will efficiently use his or her entitlement while getting more equal opportunity for benefits.

Abortion, Induced↗
PubMed2002

Predictive genetic testing for conditions that present in childhood.

There is a general consensus in the medical and medical ethics communities against predictive genetic testing of children for late onset conditions, but minimal consideration is given to predictive testing of asymptomatic children for disorders that present later in childhood when presymptomatic treatment cannot influence the course of the disease. In this paper, I examine the question of whether it is ethical to perform predictive testing and screening of newborns and young children for conditions that present later in childhood. I consider the risks and benefits of (1) predictive testing of children from high-risk families; (2) predictive population screening for conditions that are untreatable; and (3) predictive population screening for conditions in which the efficacy of presymptomatic treatment is equivocal. I conclude in favor of parental discretion for predictive genetic testing, but against state-sponsored predictive screening for conditions that do not fulfill public health screening criteria.

Age of Onset↗