Just Caring

• 1. Just Caring: An Introduction ; 1.1 The Just Caring Problem: Core Argument ; 1.2 Rationing Justly: The Moral Challenge ; 1.3 Applications of the Deliberative Model ; 2. Just Caring: The Ethical Challenges of Health Care Rationing ; 2.1 The Story of Coby Howard and Its Lessons ; 2.2 Why Health Care Rationing is Inescapable ; 2.3 Renal Dialysis and the Medicare End-Stage Renald Disease [ESRD] Amendments ; 2.4 The Totally Implantable Artificial Heart [TIAH] ; 3. Pricing Human Life: Getting Beyond Tragic Choice ; 3.1 Is Human Life Priceless? ; 3.2 Tragic Choices or Tragic Disingenuousness: Invisible Rationing ; 3.3 Invisible Rationing and the Publicity Condition ; 3.4 Managed Care and Health Rationing: ; 4. Elements of Health Care Justice ; 4.1 Is Health Care Morally Special? ; 4.2 Non-Ideal Justice: A Moral Analysis and Defense ; 4.3 Pluralism, Justice, and Rational Democratic Deliberation ; 5. Rational Democratic Deliberation: Scope and Structure ; 5.1 The Scope of Rational Democratic Deliberation ; 5.2 Fair Health Care Rationing: Not Markets, Not Physicians, Not Bureaucrats ; 5.3 Rational Democratic Deliberation: Taking Seriously the Tragedy of the Commons ; 5.4 Rational Democratic Deliberation: Key Structural Features ; 5.5 Rational Democratic Deliberation and Fair Health Care Rationing ; 5.6 Wide Reflective Equilibrium and Just Health Care Rationing ; 5.7 Priority-Setting, Wide Reflective Equilibrium, and Democratic Deliberation ; 5.8 Facts, Wide Reflective Equilibrium, and Democratic Deliberation ; 5.9 Constitutional Principles of Health Care Justice and Rational Democratic Deliberation ; 5.10 Evaluating the Deliberative Process ; 5.11 Objections and Responses ; 6. Just Caring: Setting Limits for Effective Costly Therapies ; 6.1 Problem Introduction ; 6.2 Setting Limits: Options in the ESRD Program ; 6.3 Setting Limits: Options for HIV/AIDS Patients ; 6.4 Setting Limits: The Case of Artificial Hearts ; 6.5 Setting Limits: Concluding Comments ; 7. Just Caring: Last Chance Therapies ; 7.1 Introduction: Scope of the Problem ; 7.2 Why Last Chance Therapies? Weak Moral Arguments ; 7.3 Last Chance Therapies and Rational Democratic Deliberation ; 7.4 Futility and Last Chacne Therapies ; 8. Just Caring: Rationing, Catastrophically Ill Patients, and Patients with Disabilities ; 8.1 Introduction: The Scope of the Problem ; 8.2 Needs Are Not Enough: Effectiveness Must Matter ; 8.3 The Oregon Plan and the Disability Critique ; 8.4 Health Care Justice and the Disability Critique ; 8.5 Defining the Disabled: Ethical Implications ; 8.6 Conclusions ; 9. Is Age-Based Rationing Ever 'Just Enough'? ; 9.1 Defining the Problem: Can We Accept Natural Limits to Life? ; 9.2 Justice and Age-Based Rationing: Fair Innings ; 9.3 The Prudential Life Span Account ; 9.4 Age-Based Rationing: Major Objections ; 9.5 Age-Based Rationing: Responses to Objections ; 9.6 Age-Based Rationing and the Duty to Rescue ; 9.7 Conclusions ; 10. Just Caring: Do Future Possible Children Have a Just Claim to a Sufficiently Healthy Genome? ; 10.1 Introduction ; 10.2 Framing the Issue ; 10.3 Preimplantation Genetic Diagnosis [PGD]: A Historical Side Note ; 10.4 Does Justice Require Public Funding for Limited PGD? ; 10.5 Concluding Comments: Justice and Genetic Enhancement ; 11. Organ Transplantation: When is Enough Enough? ; 11.1 Scope of the Issue ; 11.2 The Maximization Argument: A Critical Moral Analysis ; 11.3 The Pittsburg Protocol: How Dead Must Donors Be? ; 11.4 Organ Procurement and Financial Incentives: A Critical Assessment ; 11.5 Presumed Consent/Duty to Donate: Critical Remarks ; 11.6 Justice and Multi-Organ Transplants or Retransplants ; 11.7 Concluding Comments ; 12. Just Caring: The Liberalism Problem ; 12.1 Justice, Health Care Needs and Morally Controversial Interventions ; 12.2 Liberal Communitarianism: Is It Just Enough? Is It Liberal Enough? ; 12.3 Resolving the Liberalism Problem: Public Reason and Public Interests ; 12.4 Concluding Reflections ; 13. Just Caring: The Ethical Challenges of Priority Setting in Public Health ; 13.1 Defining the Problem ; 13.2 The Scope of Public Health: Challenges and Choices ; 13.3 Health Care Justice and Public Health: When is Enough Enough? ; 13.4 Setting Public Health Priorities Justly: The Limits of Moral Theory ; 14. Just Caring: Financing Health Care Fairly ; 14.1 Why National Health Insurance? ; 14.2 Why Health Reform? ; 14.3 Assessing Competing Proposals for Health Reform ; 14.4 Health Savings Accounts: A Critical Assessment ; 14.5 Health Care Vouchers: A Critical Assessment ; 14.6 Single-Player Reform: A Constructive Proposal

"Justice is a slippery concept. It becomes especially complex and controversial when we try to conceive what justice entails in the allocation of health care. This bold volume explains the need for rationing health care and provides the reader with clear and accessible accounts of the medical science, economics, demographics, and philosophic concepts involved in the decisions that have to be made. Fleck also offers his own process of rational democraticdeliberation as the means for achieving a just system of health care distribution based upon priorities that are publicly acknowledged and broadly accepted. Just Caring is a remarkably well-researched,scholarly achievement. It is a valuable resource and required reading for anyone who wants to grapple with the problems of allocating health care in today's world."--Rosamund Rhodes, PhD, Professor: Medical Education, Director: Bioethics Education, Mount Sinai School of Medicine, New York"Americans like to think that our society is both just and decent. Leonard Fleck challenges us to think about what health care choices would live up to the description. He shows us that the answer will lie in all of us having a special sort of conversation. He has here written a well-reasoned and comprehensive guide to getting that conversation up and running."--Howard Brody, MD, PhD, Institute for the Medical Humanities, University of Texas MedicalBranch-Galveston, and author of The Future of Bioethics"This should prove a very useful and important contribution to the field of healthcare reform, though since the book may reward only the meticulous and sophisticated reader, the form may undercut its populist function. However, the inherent messiness of the subject is probably too often ill-served by books and articles that reduce it to a tidy zero-sum game and thus this may be one of the few honest books dedicated to healthcare rationing in the UnitedStates."--Doody's Health Sciences Review"Just Caring: Health Care Rationing and Democratic Liveration vividly potrays the complexity and scope of problems related to allocation of health care resources. It leaves little doubt that the implications of these problems for the nation's well-being are alarming....Just Caring makes a compelling case that health care resources should be allocated in a far more transparent way than they are now."--JAMA"Leonard Fleck has written a well-researched and important contribution to health care reform. His answer to the problem of just distribution of health care is some kind of ongoing societal conversation. What is needed to get that conversation up and running the author describes at length. Whether such an idea will materialize in American politics is yet to be seen."--Medicine, Health Care, and Philosophy