Robert Veatch
Georgetown University, Kennedy Institute of Ethics, Faculty Member
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Georgetown University, Philosophy, Faculty Member add
This essay is meant to be an account of an egalitarian theory of justice applied to health care. It will in part be a descriptive account of how those who favor some version of a qualified “right to equal health” or a principle of... more
This essay is meant to be an account of an egalitarian theory of justice applied to health care. It will in part be a descriptive account of how those who favor some version of a qualified “right to equal health” or a principle of distribution of health care based primarily on need have supported their views. In addition, it will in part be a normative account of the kinds of arguments and assumptions that might best support the egalitarian position and what qualifications might be necessary.
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JAMA, the Journal of the American Medical Association, is a highly cited weekly medical journal that publishes peer-reviewed original medical research findings and editorial opinion.
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ABSTRACT
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It seems generally correct that patients (or their valid surrogates) should be able to withdraw consent for the use of the total artificial heart (TAH) just as they presently may withdraw consent for other life-prolonging technologies... more
It seems generally correct that patients (or their valid surrogates) should be able to withdraw consent for the use of the total artificial heart (TAH) just as they presently may withdraw consent for other life-prolonging technologies such as the ventilator, but lingering moral problems remain with such decisions. First, should patients be permitted to demand actual removal of the TAH rather than mere deactivation? Second, foregoing other life-prolonging technologies is normally considered "indirect" killing and is therefore judged legal (as well as moral to those who accept only indirect killing). As long as the society includes irreversible stoppage of the heart as one of the criteria for death, however, stopping a TAH will be considered direct killing, i.e., murder. To circumvent this inconsistency, society must change its conclusion that stopping other life-prolonging technologies is merely indirect killing, explicitly legalize direct killing by means of stopping a TAH, or revisit the definition of death to eliminate the cardiac standard for death from the definition of death. Assuming that the stopping of the TAH with patient or surrogate consent is acceptable, we must then face the question of whether physicians who believe the TAH is serving no purpose can unilaterally stop the device against the wishes of a patient or surrogate who believes it is still serving a worthwhile purpose. Clinicians should be presumed authoritative in determining the predicted effect of the TAH, but, if the TAH can temporarily prolong life for a patient in a way that is desired by the patient or surrogate, case law, professional society recommendation, and moral analysis all support the conclusion that the TAH must be continued even against the conscientious objection of the physician
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Providing health care increasingly poses ethical choices. Over the past few decades pharmacy has undergone dramatic changes and evolved into a highly patientoriented profession. The changing role of the pharmacist, development of... more
Providing health care increasingly poses ethical choices. Over the past few decades pharmacy has undergone dramatic changes and evolved into a highly patientoriented profession. The changing role of the pharmacist, development of pharmaceutical care as a ...
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Page 1. INDIFFERENCE OF SUBJECTS: AN ALTERNATIVE TO EQUIPOISE IN RANDOMIZED CLINICAL TRIALS By Robert M. Veatch I. The Dilemma The physician who upholds the Hippocratic oath is supposed to be loyal to his or her patients. ...
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Philosophy, Decision Making, Research Design, Informed Consent, Conscience, and 18 moreTreatment Outcome, Medical Theory and Philosophy, Risk assessment, Uncertainty, Humans, Disclosure, Consensus, Physicians, Placebos, Patients, Coercion, Public Administration and Policy, Patient Participation, Risk Assessment, Ethics Research, Choice Behavior, Personal autonomy, and Randomized Controlled Trials as Topic
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“Triage” is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, com- mercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous... more
“Triage” is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, com- mercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous meaning referring to classifying battlefield casualties into three groups: those too well-off to be treated and then, among those more seriously
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Pharmacology, Ethics, Social Justice, Randomization, Medical Ethics, and 15 moreEthical Theory, Regulation, Risk assessment, Research, Clinical Pharmacy, Humans, United States, Paternalism, Beneficence, Codes of Ethics, Risk Assessment, Personal autonomy, Government Regulation, Random Allocation, and United States Food and Drug Administration
"Triage" is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, commercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous... more
"Triage" is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, commercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous meaning referring to classifying battlefield casualties into three groups: those too well-off to be treated and then, among those more seriously wounded, one group that will get medical attention and another that will not. The moral problem is how to distinguish between the latter two groups. The Hippocratic oath has been utterly useless in helping us do this sorting, since the oath commands the clinician to remain loyal to the individual patient and give no attention to the choice between two patients with different needs. Baker and Strosberg show that historically the British sorted following utilitarian principles, giving priority to the patients who could benefit the most even if they were not in greatest need, while the French arranged patients who could be helped in order of greatest need even if it was not maximally efficient to do so. Understanding how contemporary organ transplant policy utilizes triage can help us clarify our mass disaster triage policy. Two organ transplant examples--tissue typing for kidneys and geographical priority for allocating livers--show that American social policy, when forced to choose between allocating on the basis of efficiency or allocating on the basis of justice, will consider both principles, but give equal or dominant priority to justice--even though this priority is understood to be relatively inefficient. Since health care professionals have a recognized preference for efficiency over justice and lay people are inclined towards justice, leaving mass disaster triage policy in the hands of health professionals will predictably structure the policy in a way that conflicts with the moral priorities of the lay population. Formal public debate that recognizes the conflict between efficiency and equity--professional and lay priorities--is therefore essential.
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ABSTRACT
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ABSTRACT
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While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect... more
While twentieth-century medical ethics has focused on the duty of physicians to benefit their patients, the next century will see that duty challenged in three ways. First, we will increasingly recognize that it is unrealistic to expect physicians to be able to determine what will benefit their patients. Either they limit their attention to medical well-being when total well-being is the proper end of the patient or they strive for total well-being, which takes them beyond their expertise. Even within the medical sphere, they have no basis for choosing among the proper medical goals for medicine. Also, there are many plausible strategies for relating predicted benefits to harms, and physicians cannot be expert in picking among these strategies. Second, increasingly plausible ethical systems recognize that in some cases, patient benefit must be sacrificed to protect patient rights including the right to the truth, to have promises kept, to have autonomy respected, and to not be killed. Third, ethics of the next century will increasingly recognize that some patient benefits must be sacrificed to fulfill duties to others - either the duty to serve the interests of others or other duties such as keeping promises, telling the truth, and, particularly, promoting justice. Physicians in the twenty-first century will be seen as having a new, more limited duty to assist the patient in pursuing the patient's understanding of the patient's interest within the constraints of deontological ethical principles and externally imposed duties to promote justice. The result will be a duty to be loyal to the consumer of health care with the recognition that often this will mean that the physician is not permitted to pursue the physician's understanding of the patient's well-being.
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It is ably edited by Robert Veatch, a pharmacologist who has a Harvard Ph.D. in medical ethics, and is now at the Institute of Society, Ethics and the Life Sciences, and Roy Branson, a Senior Research Scholar at The Joseph and Rose... more
It is ably edited by Robert Veatch, a pharmacologist who has a Harvard Ph.D. in medical ethics, and is now at the Institute of Society, Ethics and the Life Sciences, and Roy Branson, a Senior Research Scholar at The Joseph and Rose Kennedy Institute for the Study of Human ...