Health Care Rationing and Democratic Deliberation
Leonard M. Fleck
Table of Contents
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
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
10: Just Caring: Do Future Possible Children Have a Just Claim to a Sufficiently Healthy Genome?
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