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Document1Vogel,LaurenCanrationingpossiblyberational?CMAJ:CanadianMedicalAssociationjournal=journaldel'Associationmedicalecanadienne2011Aug9183(11):12423

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Document2Rosoff,PhilipMDeCamp,MatthewPreparingforaninfluenzapandemic:aresomepeoplemoreequalthanothers?Journalofhealthcareforthepoorandunderserved2011Aug22(3Suppl):1935Abstract:Planningforasevereinfluenzapandemicentailsfacingmanysubstantivepublichealthchallenges,especiallyintheareaofthedistributionofinsufficientsuppliesofmaterialsandpersonnel.Itisanticipatedthatrationingofhealthcareresourceswillberequired,thusdemandingthatchoicesbemadeaboutwhichindividualsshouldreceivepotentiallylifesavingcarewhennotallwhocanbesavedcanbeserved.


Document3Wynia,MatthewKGoold,SusanDorrFairnessandthepublic'sroleindefiningdecentbenefits.TheAmericanjournalofbioethics:AJOB2011Jul11(7):12


Document4Schneiderman,LawrenceJRationingjustmedicalcare.TheAmericanjournalofbioethics:AJOB2011Jul11(7):714Abstract:U.S.politiciansandpolicymakershavebeenpreoccupiedwithhowtopayforhealthcare.Hardlyanythoughthasbeengiventowhatshouldbepaidforasthoughhealthcareisacommoditythatneedsnoexaminationorwhathealthoutcomesshouldreceivepriorityinajustsociety,i.e.,rationing.Ipresentarationingproposal,consistentwithU.S.cultureandtraditions,thatdealsnotwith"healthcare,"theterminologyusedinthecurrentdebate,butwiththemoremodestandlimitedtopicofmedicalcare.Integraltothisrationingproposalwhichallowsscopetoindividualchoiceandatthesametimerecognizestheinterdependenceoftheindividualandsocietyisadefinitionofa"decentminimum,"thebasicpackageofmedicaltreatmentseveryoneshouldhaveaccesstoinajustsociety.Iapplyittoaspecificexample,diabetesmellitus,andtrackitthroughaperson'slifespan.

http://bioethics.georgetown.edu/databases/http://www11.georgetown.edu/research/nrcbl/databases/EthxWeb/ethxbool.htmhttp://kie.georgetown.edu/netacgi/nph-brs?co1=AND&co2=AND&co3=AND&co4=AND&d=EWEB&Sect2=THESON&u=http%3A%2F%2Fwww11.georgetown.edu%2Fresearch%2Fnrcbl%2Fdatabases%2FEthxWeb%2Fethxbool.htm&r=0&p=2&f=S&l=50&s4=9.4.pc.+and+%40yd+%3E%3D20000000&s2=&co5=AND&pg1=SUBJ&op1=AND&s1=&co6=AND&op6=AND&s6=&Sect3=PLURON&Sect5=HITOFF&l=0http://kie.georgetown.edu/netacgi/nph-brs?co1=AND&co2=AND&co3=AND&co4=AND&d=EWEB&Sect2=THESON&u=http%3A%2F%2Fwww11.georgetown.edu%2Fresearch%2Fnrcbl%2Fdatabases%2FEthxWeb%2Fethxbool.htm&r=0&p=1&f=1&l=50&s4=9.4.pc.+and+%40yd+%3E%3D20000000&s2=&co5=AND&pg1=SUBJ&op1=AND&s1=&co6=AND&op6=AND&s6=&Sect3=PLURON&Sect5=HITOFF&l=0http://ethicslab.org/openurl/wc/0000340307/http://ethicslab.org/openurl/gt/0000340307/http://ethicslab.org/openurl/wc/0000340226/http://ethicslab.org/openurl/gt/0000340226/http://ethicslab.org/openurl/wc/0000339725/http://ethicslab.org/openurl/gt/0000339725/http://ethicslab.org/openurl/wc/0000339723/


Document5Churchill,LarryRRationing,rightness,anddistinctivelyhumangoods.TheAmericanjournalofbioethics:AJOB2011Jul11(7):156


Document6Paris,JohnJRationing:a"decentminimum"ora"consumerdriven"healthcaresystem?TheAmericanjournalofbioethics:AJOB2011Jul11(7):168


Document7Klein,DavidAlanEvaluatingsocialvalue:ontheintersectionofmortalityandeconomicsinthedistributionofpubliclyfundedmedicalcare.TheAmericanjournalofbioethics:AJOB2011Jul11(7):1820


Document8Stark,MeredithShiftingthefocusofrationingdiscussions.TheAmericanjournalofbioethics:AJOB2011Jul11(7):202


Document9Fine,RobertRationingorstewardshipinpursuitofjustmedicalreform.TheAmericanjournalofbioethics:AJOB2011Jul11(7):223


Document10RamTiktin,EfratAdecentminimumforeveryoneasasufficiencyofbasichumanfunctionalcapabilities.TheAmericanjournalofbioethics:AJOB2011Jul11(7):245


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Document11Dineen,ChristinaFindingtherightwaytoration.TheAmericanjournalofbioethics:AJOB2011Jul11(7):268


Document12Friedman,AlexanderWRationingandsocialvaluejudgments.TheAmericanjournalofbioethics:AJOB2011Jul11(7):289


Document13McCullough,MelissaThesolitaryandindestructibleAmericancowboy:isthissymbolicherostandinginthewayofuniversalhealthcareinAmericaandridingroughshodoveritintheUK?TheAmericanjournalofbioethics:AJOB2011Jul11(7):301


Document14Koch,TomCare,compassion,orcost:redefiningthebasisoftreatmentinethicsandlaw.TheJournaloflaw,medicine&ethics:ajournaloftheAmericanSocietyofLaw,Medicine&Ethics2011Summer39(2):1309Abstract:Thereareintwoassumptionsinherentinthisissue'stheme,bothinimicaltothetraditionalgoalsofmedicineandtothestandardsofcareitproposed.First,theideathattreatmentmustbelimitedforsome(butnotothers)onthebasisofcostwasbornintheearlyliteratureofbioethics.Second,thatthereisaquantifiableanddiagnosticallypredictableperiodatthe"endoflife"wheretreatmentis"futile,"andthereforenotworthsupportinginacontextofscarcitygrewoutofbioethics'sconstructionofallocativeprotocolsinthe1990s.Thispapertracesthehistoryoftheseideasasconstructsgroundedinneithernaturalscarcitynorinfirmdiagnosticcategories.Theirrelationtoissuesofcareisthereforesuspect.


Document15Fleck,LeonardMJustcaring:healthcarerationing,terminalillness,andthemedicallyleastwelloff.TheJournaloflaw,medicine&ethics:ajournaloftheAmericanSocietyofLaw,Medicine&Ethics2011Summer39(2):15671Abstract:Whatdoesitmeantobea"just"and"caring"societyinmeetingthehealthcareneedsoftheterminallyillwhenwehaveonlylimitedresourcestomeetvirtuallyunlimitedhealthcareneeds?Thatquestionisthefocusofthisessay.Putanotherway:relativetoalltheotherhealthcareneedsinoursociety,especiallytheneedforlifesavingorlifeprolonginghealthcare,howhighapriorityoughtthehealthcareneedsofpersonswhoareterminallyillhave?Ontheonehand,wemightseetheterminallyillasbeingamongthe"medicallyleastwelloff"andthereforedeservingveryhighpriority.Ontheotherhand,wemightseethemassquanderingvastmedicalresourcesformarginalmedicalbenefits,therebydenyingneededresourcestootherswhowouldbenefitmuchmore.Webegintheessayby

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makinganumberofmorallyrelevantdistinctionswithregardtothecategoryof"beingterminallyill."Wenote,givencontemporarymedicine,thatindividualsmaybeterminallyillseveraltimesinthecourseofalife.Notallsuchcircumstancesmakeequaljustclaimstoneededhealthcare.Wealsonotethatourconceptionsofhealthcarejusticeareultimatelyincapableofmakingveryfinegrained,morallyjustifiedrationingjudgmentsincomplexmedicalcircumstances.Weconcludethatwemustfinallyrelyuponfairprocessesofrationaldemocraticdeliberationtoarticulatesuchjudgmentsforourownfuture,possiblyterminallyillselves,therebyundercuttingtherhetoricof"deathpanels."


Document16Hawryluck,LauraBouali,RedouaneMeth,NathalieDanjouxMultiprofessionalrecommendationsforaccessandutilizationofcriticalcareservices:towardsconsistencyinpracticeandethicaldecisionmakingprocesses.TheJournaloflaw,medicine&ethics:ajournaloftheAmericanSocietyofLaw,Medicine&Ethics2011Summer39(2):25462Abstract:Multiprofessionalguidelinesforfairaccesstoanduseofadultcriticalcareservicesaredesperatelyneededtodefineaconsistenttransparentstandardofcare:whensuchtherapieshavethepotentialtobenefitandhelpapatientastheyjourneywithillnessandwhentheycannot.


Document17Aronsohn,AndrewJensen,DonaldDistributivejusticeandthearrivalofdirectactingantivirals:whoshouldbefirstinline?Hepatology(Baltimore,Md.)2011Jun53(6):178991


Document18Fenton,ElizabethMindtheGap:ethicalissuesofprivatetreatmentinthepublichealthsystem.TheNewZealandmedicaljournal2011May13124(1334):8996Abstract:ThefundingofexpensivenewcancertreatmentsisadifficulthealthpolicyissueinNewZealandandaroundtheworld.Sincethepublichealthsystemcannotaffordtofundeverynewtreatment,complexdecisionsmustbemadeaboutwhichtreatmentstofundpublicly,andwhetherandhowtomakeunfundedtreatmentsavailabletopeoplewhomaywishtofundthemthemselves.Onerecentproposalisthatunfundedtreatmentsbemadeavailabletopatientsprivatelythroughthelocalpublichospital.Althoughultimatelydeclinedbythehealthminister,thisproposalmeritsseriousdebate,sinceitislikelytocontinuetoattractattentionasapolicyoption.Whiletheintegrationofpublicandprivatedeliverysystemshasclearbenefitsforpatientswiththemeanstopurchaseadditionaltreatments,itsoveralleffectmaybetoexacerbateexistinginequitiesintheNewZealandhealthsector.Thispaperbrieflyexploresthewiderramificationsofsuchschemesaspartoftheongoingpublicdiscussionthatshouldinformthedevelopmentofhealthpolicyonthisissue.


Document19Lampert,RachelHayes,DavidPacemakersandendoflifedecisions.JAMA:thejournaloftheAmericanMedicalAssociation2011May11305(18):18589authorreply1859



Document20Tnnessen,SiriNortvedt,PerFrde,ReidunRationinghomebasednursingcare:professionalethicalimplications.Nursingethics2011May18(3):38696Abstract:Thepurposeofthisstudywastoinvestigatenurses'decisionsaboutprioritiesinhomebasednursingcare.Qualitativeresearchinterviewswereconductedwith17nursesinhomebasedcare.Theinterviewswereanalyzedandinterpretedaccordingtoahermeneuticmethodology.Nursesdescribeclinicalprioritiesinhomebasedcareasrationingcaretomindthegapbetweenanextensiveworkloadandstaffshortages.Byorganizinghomebasedcareaccordingtotighttimeschedules,thenurses'areabletoprovidecareforasmanypatientsaspossible.Furthermore,legalnormssetboundariesforclinicalprioritydecisions,resultinginmarginalizedcare.Hence,rationingcarejeopardizesimportantvaluesinthenursepatientrelationship,inparticularthevalueofindividualizedandinclusivenursingcare.Thefindingsarehighlyrelevantforclinicalpractice,sincetheyhavemajorimplicationsforprovisionofnursingcare.Theyrevivedebatesabouttheprotectionofvaluesandstandardsofcare,andnurses'roleandresponsibilitywhenresourcesarelimited.


Document21Rogers,JamieKelly,UrsulaAFeministintersectionality:bringingsocialjusticetohealthdisparitiesresearch.Nursingethics2011May18(3):397407Abstract:Theprinciplesofautonomy,beneficence,nonmaleficence,andjusticearewellestablishedethicalprinciplesinhealthresearch.Oftheseprinciples,justicehasreceivedlessattentionbyhealthresearchers.Thepurposeofthisarticleistobroadenthediscussionofhealthresearchethics,particularlytheethicalprincipleofjustice,toincludesocietalconsiderationswhoandwhatarestudiedandwhy?andtocritiquecurrentapplicationsofethicalprincipleswithinthisbroaderview.Wewilluseafeministintersectionalapproachinthecontextofhealthdisparitiesresearchtofirmlyestablishinseparablelinksbetweenhealthresearchethics,socialaction,andsocialjustice.Theaimistoprovideanethicalapproachtohealthdisparitiesresearchthatsimultaneouslydescribesandseekstoeliminatehealthdisparities.


Document22AlbisserSchleger,HeidiOehninger,NicoleRReiterTheil,StellaAvoidingbiasinmedicalethicaldecisionmaking.Lessonstobelearntfrompsychologyresearch.Medicine,healthcare,andphilosophy2011May14(2):15562Abstract:Whenethicaldecisionshavetobetakenincritical,complexmedicalsituations,theyofteninvolvedecisionsthatsetthecoursefororagainstlifesustainingtreatments.Thereforethedecisionshavefarreachingconsequencesforthepatients,theirrelatives,andoftenfortheclinicalstaff.Althoughtherichpsychologyliteratureprovidesevidencethatreasoningmaybeaffectedbyundesiredinfluencesthatmayunderminethequalityofthedecisionoutcome,notmuchattentionhasbeengiventothisphenomenoninhealthcareorethicsconsultation.Inthispaper,weaimtocontributetothesensitizationoftheproblemofsystematicreasoningbiasesbyshowinghowexemplaryindividualandgroupbiasescanaffectthequalityofdecisionmakingonanindividualandgrouplevel.Weareaddressingclinicalethicistsaswellasclinicianswhoguidecomplexdecisionmakingprocessesofethicalsignificance.Knowledgeregardingexemplarygrouppsychologicalbiases(e.g.conformitybias),andindividualbiases(e.g.stereotypes),willbetakenfromthedisciplinesofsocialpsychologyandcognitivedecisionscienceandconsideredinthefieldofethicaldecisionmaking.Finallywediscusstheinfluenceofintuitiveversusanalytical(systematical)reasoningonthevalidityofethicaldecisionmaking.



Document23Gordijn,BertTenHave,HenkPrioritisationinhealthcarestillmuddlingthrough.Medicine,healthcare,andphilosophy2011May14(2):10910


Document24Hofmann,PaulB7factorscomplicateethicalresourceallocationdecisions:weshouldbemoreawareoftheissuesmostlikelytoproduceconflicts.Healthcareexecutive2011MayJun26(3):623


Document25Tandon,AshutoshAilingmedicalservicesinIndia.Indianjournalofmedicalethics2011AprJun8(2):1289


Document26GoodyearSmith,FelicityTherelativistic,naturalisticnatureofethicsandotherissues.Journalofprimaryhealthcare2011March13(1):23


Document27Turner,NikkiWeshouldgivetheinfluenzavaccinetoelderlypatientsinresthomeswhoaresufferingfromseveredementia:No.[debate]Journalofprimaryhealthcare2011March13(1):601


Document28Skirbekk,HelgeNortvedt,PerMakingadifference:aqualitativestudyoncareandprioritysettinginhealthcare.Healthcareanalysis:HCA:journalofhealthphilosophyandpolicy2011Mar19(1):7788Abstract:Thefocusofthestudyistheconflictbetweencareandconcernforparticularpatients,versusconsiderationsthattakeimpartialconsiderationsofjusticetobecentraltomoraldeliberations.ToexaminethesequestionswehaveconductedqualitativeinterviewswithhealthprofessionalsinNorwegianhospitals.Wefoundavaluenormthatimplicitlyseemedtooverruleallothers,thenormof'makingadifferenceforthepatients'.Wewillexaminewhatsuchastatementimplies,aimingtoshedsomelightovermoraldilemmasinterwoveninbedside

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rationing.


Document29Mikochik,StephenLRationinghumanlife:healthcarereformandpeoplewithdisabilities.Issuesinlaw&medicine2011Spring26(3):199205Abstract:PeterSingerhasproposedhealthcarerationingthatincludesaninvidiousdiscriminationagainstpeoplewithdisabilities.Unfortunately,Congresshascodifiedthepotentialforsuchdiscriminationinthe2010PatientProtectionandAffordableCareAct.Butwhyshouldanypublicofficialhavethediscretiontotreatthelivesofpeoplewithdisabilitiesasof"lowervalue"thanthelivesofanyoneelse.Theremustbeacomprehensivelimitationinthelawagainstthemisuseofcomparativeclinicaleffectivenessresearchtosupporttherationingofhumanlife.


Document30VelascoGarrido,MarcialZentner,AnnetteBusse,ReinhardTheeffectsofgatekeeping:asystematicreviewoftheliterature.Scandinavianjournalofprimaryhealthcare2011Mar29(1):2838Abstract:Toassesstheeffectsofphysiciancentredgatekeepingonhealth,healthcareutilization,andcostsbyconductingasystematicreviewoftheliterature.


Document31Callahan,DanielRationing:theory,politics,andpassions.TheHastingsCenterreport2011MarApr41(2):237


Document32Frangenberg,ElmarHAGoodSamaritaninspiredfoundationforafairhealthcaresystem.Medicine,healthcare,andphilosophy2011Feb14(1):739Abstract:Distributivejusticeontheincomeandontheserviceaspectsisthemostvexingmoderndayproblemforthecreationandmaintenanceofanallinclusivehealthcaresystem.Apervasiveproblemofallcurrentschemesisthelackofeffectivecostcontrol,whichcontinuestoresultinincreasingburdensforallpublicandprivatestakeholders.Thisproposalpositsthattheresponsibilityandfinancialobligationtoachieveanidealoutcomeofequalandaffordableaccessandbenefitsforallcitizensismisplaced.TheGoodSamaritandemonstratedbasicethicalprinciples,whicharerevisited,elaboratedandintegratedintoanewapproachtohealthcare.Theparticipantsarelimitedtoindividualcontributorsandbeneficiariesandorganizedasacitizencarried,closed,independent,andselfsufficientselfgoverningcooperativefortheirownandthebenefitofaminorityofdisadvantagedhealthcareconsumers.Thegovernmentassumesoversight,providesarbitration,enforcesdemocraticdecisionmaking,aschemeofprogressivetaxation,aseparateandtransparentaccountingsystem,andabalancebetweenincomeandreinvestmentinhealthcare.Theresultsareafairdistributionofcost,itseffectivecontrol,andincreasedindividualmotivationtotakeonresponsibilityforpersonalhealthasaprivategoodandasharpenedfocustowardscommunityhealth.Atthesociopoliticallevelthegovernmentaswellasemployersarereleasedfromtheinappropriateburdenofcateringtoindividualhealth.



Document33Emmerich,NathanAntitheoryinaction?Planningforpandemics,triageandICUor:hownottobiteabullet.Medicine,healthcare,andphilosophy2011Feb14(1):91100Abstract:Antitheoryisamultifacetedcritiqueofmoraltheorywhich,itappears,isundergoingsomethingofreassessment.InarecentpaperHmlinendiscussestherelevanceofanantitheoreticalperspectivefortheactivityofappliedethics.Thispaperexploresherviewofantitheory.InparticularIexamineitsrelevanceforunderstandingtheformalguidanceonpandemicfluplanningissuesbytheDepartmentofHealth(DoH)intheUKandsomesubsequentdiscussionsaroundtriageandreversetriagedecisionswhichmaybeconsideredbybothPrimaryandSecondaryCareTrusts(PCTsandSCTs)(OnthedivisionbetweenPrimaryandSecondaryCareTrustsintheUKNationalHealthServicesee:http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx[AccessedAugust2010]).insettingtheirownpoliciesandwhichmayfacecliniciansintheeventualityofapandemic.FollowingHmlinenincontrastingreflectiveequilibriumwithherantitheoryinspiredsuggestionofaninstrumentalapproachtomoraltheoryinpracticeIdemonstratehowthisunderstandingcomplementsthediversityofourintuitivemoraljudgements.ConsequentiallyIsuggestthatthisantitheoreticalinstrumentalapproachisingreateraccordwiththeconditionsunderwhichsuchpolicyplanninganddecisionmakingis,orwillbe,made.Furthermore,onthegroundsofkeepingopentheethicaldimensionsofmedicalpracticeinconditionsofuncertainty,i.e.duringapandemic,Isuggestthattheantitheoreticalinstrumentalperspectiveis,ethically,thepreferableapproachtoproducingsuchpoliciesandguidelines.


Document34Buyx,AlenaMFriedrich,DanielRSchneSeifert,BettinaEthicsandeffectiveness:rationinghealthcarebythresholdsofminimumeffectiveness.BMJ(Clinicalresearched.)2011January17342:d54


Document35Huilgol,NagrajDistributivejusticeandpublicprivateparticipation.Journalofcancerresearchandtherapeutics2011JanMar7(1):12


Document36Latham,StephenRThe"reallife"deathpanel,reformed.TheHastingsCenterreport2011JanFeb41(1):1pfollowing52


Document37Iserson,KennethV


Therapidethicaldecisionmakingmodel:criticalmedicalinterventionsinresourcepoorenvironments.Cambridgequarterlyofhealthcareethics:CQ:theinternationaljournalofhealthcareethicscommittees2011Jan20(1):10814


Document38Porz,RZimmermann,HExadaktylos,AK[Ethics,empiricismanduncertainty].=Ethik,EmpirikundUnsicherheit.DeutschemedizinischeWochenschrift(1946)2011Jan136(12):456Abstract:Accidentscanleadtodifficultboundarysituations.Suchsituationsoftentakeplaceintheemergencyunits.Themedicalteamthusoftenandinevitablyfacesprofessionaluncertaintyintheirdecisionmaking.Itisessentialtocommunicatetheseuncertaintieswithinthemedicalteam,insteadofdownplayingoroverridingexistentialhurdlesindecisionmaking.Acknowledginguncertaintiesmightleadtoalertandprudentdecisions.Thusuncertaintycanhaveethicalvalueintreatmentorwithdrawaloftreatment.Itdoesnotneedtobecoveredinevidencebasedarguments,especiallyassomesingularsituationsofindividualtragediescannotbegraspedintermsofevidencebasedmedicine.


Document39UnitedStates.CongressVAHEALTHCARE:NEEDFORMORETRANSPARENCYINNEWRESOURCEALLOCATIONPROCESSANDFORWRITTENPOLICIESONMONITORINGRESOURCES:REPORTTOCONGRESSIONALREQUESTERSWashington,DC:U.S.GovernmentAccountabilityOffice,2011.23p.[Online].Accessed:http://www.gao.gov/new.items/d11426.pdf[2011November7]

http://www.gao.gov/new.items/d11426.pdf(linkmaybeoutdated)

Document40CRispel,LaetitiaPadarath,AshnieWalt,GillStrengtheninghealthsystemsforequityandsocialjusticeinSouthAfrica:the24thanniversaryoftheCentreforHealthPolicy.Journalofpublichealthpolicy201132Suppl1:S19


Document41Anderson,MalcolmRichardson,JeffMcKie,JohnIezzi,AngeloKhan,MunirTherelevanceofpersonalcharacteristicsinhealthcarerationing:whattheAustralianpublicthinksandwhy.Americanjournalofeconomicsandsociology201170(1):13151Abstract:ThisarticleexaminesthepreferencesofthegeneralpublicinAustraliaregardinghealthcareresourceallocation.Whilepreviousstudieshaverevealedthatthepubliciswillingtogiveprioritytoparticulargroupsofpatientsbasedontheirpersonalcharacteristics,thepresentarticlegoesbeyondpreviouseffortsinattemptingtoexplaintheseresults.Inthepresentstudy,therewasstrongsupportamongrespondentsforgiving?equalpriority?topeopleregardlessoftheirpersonalcharacteristics.However,respondentsdidrevealapreferenceformarriedpatientsoversingle,forchildrenoveradults,forcarersofchildrenandtheelderly,solebreadwinners,andgoodcommunitycontributors.Further,theywouldgivealowerprioritytothoseperceivedas?selfharmers??smokers,individualswithunhealthydiets,andthosewhorarelyexercise.Variationintheanswersaccordingtobroadeconomicandsocialbeliefsacrosssevendifferentcategories(?factors?)influencedthepatternofthepublic'sattitudestowardsrationing.

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ThePrincipalComponentsAnalysis(PCA)indicatedthatmostoftheitemsinoursurveyareassociatedwithsevenfactorsthatexplainorcapturemuchofthevariation.Theserelatetoapatient'savoidanceofselfharmbehaviors(SafeLiving),theirLifeStyle(diet,exercise,etc.),theircontributiontothecommunitythroughcaringforothers(Caring),theirtalents(Gifted),theirsexualbehavior(Sexuality),theirageandmaritalstatus(Family),andwhethertheyareanAustraliancitizenoremployed(Citizen).Thestrengthofsocialpreferences?e.g.,howstronglyrespondentswould?discriminate?againstarecreationaldruguserorpreferenceapersonwithahealthydiet?isrelatedtotheparticularclassofpreferences.


Document42Jonas,MoniqueObesity,autonomyandtheharmprinciple.Journalofprimaryhealthcare2010December12(4):3436


Document43Kotalik,JaroExaminingthesuitabilityoftheprincipleofsubsidiarityforbioethics.KennedyInstituteofEthicsjournal2010Dec20(4):37190Abstract:Thepoliticalandsocialprincipleofsubsidiaritycanbeusefulasageneralprincipleofbioethics.Theprinciplestatesthatonlythosedecisionsandtasksthatcannotbeeffectivelydecideduponorperformedbyasupportedorsubsidizedlowerlevelauthorityoughttoberelegatedtoamorecentralorhigherauthority.TheconceptofsubsidiarityhasbeenembeddedtacitlyinWesternpoliticalthoughtfortwomillennia,butithasbeenarticulatedexpresslyonlyinthetwentiethcentury.Theprinciplehasuniquestrengths:itistheonlyprinciplethataddressestheissueoflocusofdecisionmakingitisstronglylinkedtohumandignity,democracy,andsolidarityanditcanassistinreachingagreementsonthecommongood.Therearealsopotentialdrawbacksthatneedtobetakenintoaccountwhendevelopingrulesandguidelinesfortheprinciple'sapplicationinbioethics.Theprincipleisparticularlyhelpfulinpublichealthethics,butitisalsoofuseintheethicsofpersonalcareandhumanresearchethics.


Document44Furnham,AdrianLoganathan,NirooshaMcClelland,AlastairAllocatingscarcemedicalresourcestotheoverweight.TheJournalofclinicalethics2010Winter21(4):34656Abstract:Aprogrammaticresearcheffortinvestigatedhowlaypeopleweighinformationonhypotheticalpatientswhenmakingdecisionsregardingtheallocationofscarcemedicalresources.Thisstudyispartlyreplicativeandpartlyinnovative,andlooksparticularlyatwhetheroverweightpatientswouldbediscriminatedagainstinallocatingresources.


Document45Armstrong,RussellFairnessandequityintheprovisionofantiretroviraltherapy:somereflectionsfromLesotho.Developingworldbioethics2010Dec10(3):12940Abstract:Thenumberofpeopleinimmediateneedofantiretroviraltreatment(ART)inthesouthernAfricanregioncontinuestosignificantlyexceedthecapacityofhealthsystemstheretoprovideit.Approachestothiscomplexrationingdilemmahaveevolvedindifferentdirections.Theethicalconceptsoffairnessandequityhavebeen


suggestedasabasistoguidethedevelopmentofapproachestoselectpatientsforART.ThisarticlereportstheresultsofacasestudyonpatientselectionataruralARTclinicinLesotho.ThepurposeofthestudywastoexaminewhetherornotsuchconceptshadrelevanceoroperativevalueforatreatmentteamprovidingARTinruralLesotho.Thestudyfoundthatwhileconceptsoffairnessandequitywererelevanttotheworkofthetreatmentteam,patientselectionpracticesdidnotnecessarilyreflectwhattheseconceptsentail.Theideaoffairnessasastructured,formalizedselectionprocessdidnotfigureintheapproachtoARTprovisionatthesite.Alessformal,'firstcomefirstserved'approachwasadopted.Whiletherewasknowledgeamongsometeammembersthatsocial,economicorgeographicconditionsinhibitindividualsandgroupsfromgainingaccesstoARTandthatthiswasinequitable,itwasfeltthattherewaslittletheycoulddototrytomediatetheimpactoftheseconditions.Thestudy'sfindingsposeimportancequestionsabouttheapproachtoARTprogramminginresourceconstrainedsettings.Thefindingsalsoquestiontherelevanceoftryingtoachievefairnessandequitywhenthegapbetweenneedforcareandcapacitytoprovideitremainssolarge.


Document46Shebaya,SirineSutherland,AndreaLevine,OrinFaden,RuthAlternativestonationalaverageincomedataaseligibilitycriteriaforinternationalsubsidies:asocialjusticeperspective.Developingworldbioethics2010Dec10(3):1419Abstract:Currentstrategiestoaddressglobalinequitiesinaccesstolifesavingvaccinesuseaveragednationalincomedatatodetermineeligibility.Whilelargelysuccessfulinthelowestincomecountries,wearguethatthisapproachcouldleadtosignificantinefficienciesfromthestandpointofjusticeifappliedtomiddleincomecountries,whereincomeinequalitiesarelargeandleadtonationalaveragesthatobscuretrulyneedypopulations.Instead,wesuggestalternativeindicatorsmoresensitivetosocialjusticeconcernsthatmeritconsiderationbypolicymakersdevelopingnewinitiativestoredresshealthinequitiesinmiddleincomecountries.


Document47Tuba,MarySandoy,IngvildFBloch,PaulByskov,JensFairnessandlegitimacyofdecisionsduringdeliveryofmalariaservicesandITN[insecticidetreatednet]interventionsinZambia.Malariajournal2010November19:309Abstract:MalariaistheleadingcauseofmorbidityandthesecondleadingcauseofmortalityinZambia.PerceptionsoffairnessandlegitimacyofdecisionsrelatingtotreatmentofmalariacaseswithinpublichealthfacilitiesanddistributionofITNswereassessedinadistrictinZambia.ThestudywasconductedwithintheframeworkofREsponsetoACcountableprioritysettingforTrustinhealthsystems(REACT),anorthsouthcollaborativeactionresearchstudy,whichevaluatestheAccountabilityforReasonableness(AFR)approachtoprioritysettinginZambia,TanzaniaandKenya.


Document48Condit,DonaldP.HealthcarecounterreformTheLinacreQuarterly2010November77(4):426444


Document49


Hope,TonyOsterdal,LarsPeterHasman,AndreasAninquiryintotheprinciplesofneedsbasedallocationofhealthcare.Bioethics2010Nov24(9):47080Abstract:Theconceptofneedisoftenproposedasprovidinganadditionaloralternativecriteriontocosteffectivenessinmakingallocationdecisionsinhealthcare.Ifitistobeofpracticalvalueitmustbesufficientlypreciselycharacterizedtobeusefultodecisionmakers.Thiswillrequirebothanaccountofhowdegreeofneedforaninterventionistobedeterminedandaprioritizationrulethatclarifieshowdegreeofneedandthecostoftheinterventioninteractindeterminingtherelativepriorityoftheintervention.Threecommonfeaturesofhealthcareinterventionsmustbeaccommodatedinacomprehensivetheoryofneed:theprobabilisticnatureofprognosis(withandwithouttheintervention)thetimecourseofeffectsandthefactthatthemosteffectivetreatmentsoftencombinemorethanoneintervention.Thesecommonfeaturesareproblematicfortheconceptofneed.Weoutlinevariousapproachestoprioritizationonthebasisofneedandarguethatsomeapproachesaremorepromisingthanothers.


Document50Sharkey,KerithGillam,LynnShouldpatientswithselfinflictedillnessreceivelowerpriorityinaccesstohealthcareresources?Mappingoutthedebate.Journalofmedicalethics2010Nov36(11):6615Abstract:Thedistributionofscarcehealthcareresourcesisanincreasinglyimportantissueduetofactorssuchasexpensive'hightech'medicine,longerlifeexpectanciesandtherisingprevalenceofchronicillness.Furthermore,inthecurrenthealthcarecontextlifestylerelatedfactorssuchashighbloodpressure,tobaccouseandobesityarebelievedtocontributesignificantlytotheglobalburdenofdisease.Assuch,thispaperfocusesonanongoingdebateintheacademicliteratureregardingtheroleofresponsibilityforillnessinhealthcareresourceallocation:shouldpatientswithselfcausedillnessreceivelowerpriorityinaccesstohealthcareresources?Thispapercriticallydescribesthelowerprioritydebate's12keyargumentsandmapsouttheirrelationships.Thisanalysisrevealsthatmostargumentshavebeenrefutedandthatthedebatehasstalledandremainsunresolved.Inconclusion,wesuggestprogressioncouldbeachievedbyinvitingmultidisciplinaryinputfromarangeofstakeholdersforthedevelopmentofevidencebasedcriticalevaluationsofexistingargumentsandthedevelopmentofnovelarguments,includingtheoutstandingrebuttals.


Document51Hope,Tonysterdal,LarsPeterHasman,AndreasAninquiryintotheprinciplesofneedsbasedallocationofhealthcareBioethics2010November24(9):470480


Document52Peacock,StuartJMitton,CraigRuta,DannyDonaldson,CamBate,AngelaHedden,LindsayPrioritysettinginhealthcare:towardsguidelinesfortheprogrambudgetingandmarginalanalysisframework.Expertreviewofpharmacoeconomics&outcomesresearch2010Oct10(5):53952Abstract:Economists'approachestoprioritysettingfocusontheprinciplesofopportunitycost,marginalanalysisandchoiceunderscarcity.Theseapproachesarebasedonthepremisethatitispossibletodesignarationalprioritysettingsystemthatwillproducelegitimatechangesinresourceallocation.However,beyondissuingguidanceatthenationallevel,economicapproachestoprioritysettinghavehadonlyamoderateimpactinpractice.Inparticular,localhealthserviceorganizationssuchashealthauthorities,healthmaintenanceorganizations,hospitalsandhealthcaretrustshavehaddifficultyimplementingevidencefromeconomicappraisals.Yet,inthecontextof

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makingdecisionsbetweencompetingclaimsonscarcehealthserviceresources,economictoolsandthinkinghavemuchtooffer.Thepurposeofthisarticleistodescribeanddiscusstenevidencebasedguidelinesforthesuccessfuldesignandimplementationofaprogrambudgetingandmarginalanalysis(PBMA)prioritysettingexercise.PBMAisaframeworkthatexplicitlyrecognizestheneedtobalancepragmaticandethicalconsiderationswitheconomicrationalitywhenmakingresourceallocationdecisions.WhilethetenguidelinesaredrawnfromthePBMAframework,theymaybegeneralizedacrossarangeofeconomicapproachestoprioritysetting.


Document53Pauker,StephenGWong,JohnBHow(should)physiciansthink?:ajourneyfrombehavioraleconomicstothebedside.JAMA:thejournaloftheAmericanMedicalAssociation2010Sep15304(11):12335


Document54Rosenthal,MSaraEthicalissuesinradioisotopeshortages:rationingandprioritysetting.Journalofnuclearmedicinetechnology2010Sep38(3):11720Abstract:Inrecentyears,shortagesofradioisotopesthatcannotbestockpiledhavecreatedascenarioinwhichtheymaybeconsidered,periodically,ascarcemedicalresource.Thisdiscussionfocusesonthejustallocationofmedicalradioisotopesandpresentsthedominantethicalframeworksforrationingandprioritysettinginthepatientpopulationsmostaffected.Prioritysettingisnecessarywhendemandforascarceresourceexceedssupply.Oncompletionofthisarticle,thereaderwillbeabletodescribetheoriginsofrationingandprioritysettinginmedicine,aswellasethicallysoundframeworksforrationing.Finally,theprocessforprioritysettingandtheneedfortransparencyofthisprocessinthenuclearmedicinesettingareoutlined.


Document55Marckmann,G[Ethicalbasisofprioritysettinginhealthcare].=EthischeGrundlagenderPriorisierungimGesundheitswesen.Bundesgesundheitsblatt,Gesundheitsforschung,Gesundheitsschutz2010Sep53(9):86773Abstract:ThedebateaboutprioritiesinhealthcarehasalsostartedinGermany.Becauseofthespecialmoralsignificanceofhealthandhealthcare,prioritysettinginhealthcarealsoinvolvesethicalissues.Afterclarifyingtherelationshipbetweenprioritysettingandrationing,Ifirstdiscusswhetheritisethicallyacceptableorevenmandatedtosetprioritiesinhealthcare.Ifthisfirstquestionisansweredwith"yes",thefollowingquestionishowtheprioritiescanbedeterminedinanethicallydefensibleway.Iwilltrytoshowthatitisimpossibletojustifyprioritiesinhealthcarewithinaliberaltheoryofjusticethatisneutraltowardssubstantiveconceptionsofthegoodlife.Weratherneedadeliberativedecisionprocessabouthowwewanttoliveinthefaceofillness,suffering,anddeath.Onlybyreferencetoasubstantialconceptofagoodlifeisitpossibletodefineandjustifyhealthcarepriorities.AnationalprioritysettingcommissioncouldplayanimportantroleinstimulatingthisdeliberationanddevelopinggeneralrecommendationsaccordingtowhichcriteriaandproceduresprioritiesshouldbesetintheGermanhealthcaresystem.Theapplicationofthisgeneralframeworkrequiresthecooperationofmedicalscientificandphysicianorganizations.


Document56


Raspe,H[Priorizationinhealthcare.Animportantduty,anunnecessaryluxury,orplayingwithfire?Asociomedicalpointofview].=PriorisierungindermedizinischenVersorgung.UnabweisbareAufgabe,unntzerLuxusoderSpielmitdemFeuer?EinesozialmedizinischePosition.Bundesgesundheitsblatt,Gesundheitsforschung,Gesundheitsschutz2010Sep53(9):87481Abstract:Whilesettingprioritiesinhealthcarehasbeendiscussedinternationallyforabout25years,attemptstoevenstartadiscussioninGermanyhavefailedformorethanadecade.Onthecontrary,thetopicwasandstillisactivelysuppressed.Inthisrespect,onehelpfulmechanismistodeliberatelyorcarelesslyconfuseprioritizationwithrationing,aGermantabooword.ThenationalhealthcaredebateagainandagainneglectsthequestiononwhattospendGermany'sstillveryconsiderableresources.Thishelpsourhealthpoliticianstocontinuetolivethepostulatethateverybodyshouldhaveimmediate,unrestrictedaccesstoallmedicallyindicatedhealthcare.AttemptstodistinguishbetweenprioritysettingandrationingastwoentirelydistinctprogramsbasedonprioritizationmodelsfromSweden,England,andOregon/USAarepresented.Whilediscussingpossibleobjects,levels,criteria,ethics,andnormativeimplicationsofprioritysettinginhealthcare,recentrecommendationsofapermanentvaccinationcommittee(STIKO)areusedasanexample.


Document57Diederich,ASchreier,M[Theacceptanceofpersonalresponsibilityasacriterioninassigninghealthcarebenefits.Anempiricalstudy].=ZurAkzeptanzvonEigenverantwortungalsPosteriorisierungskriterium.EineempirischeUntersuchung.Bundesgesundheitsblatt,Gesundheitsforschung,Gesundheitsschutz2010Sep53(9):896902Abstract:Inordertoaccomplishbroadacceptanceofprioritysettinginhealthcare,apublicdebateseemsessential,inparticular,includingthepreferencesofthegeneralpublic.InGermany,objectionstopublicinvolvementaretosomeextentbasedontheperceptionthatindividualshaveaninherentpersonalbiasandcannotrepresentinterestsotherthantheirown.Thefollowingexcerptfromamorecomprehensivestudyreportsontheacceptanceofpersonalresponsibilityasacriterionforprioritizing.AmixedmethodsdesignisusedforcombiningaqualitativeinterviewstudyandaquantitativesurveyrepresentativeoftheGermanpublic.Boththeinterviewstudyandthesurveydemonstratethatbehaviorthatisharmfultoone'shealthisgenerallyacceptedasacriterionforposteriorizingpatients,mostlyregardlessofselfinterest.Inaddition,theinterviewstudyshowsreasonsforacceptanceorrefusaloftheselfinflictedbehaviorcriterion.


Document58Metz,JohnPWinter,RobinOMasscriticalcareethics:blackandwhite,orgrey?Familymedicine2010Sep42(8):5878


Document59Strech,DanielHurst,SamiaDanis,MarionTheroleofethicscommitteesandethicsconsultationinallocationdecisions:a4stageprocess.Medicalcare2010Sep48(9):8216Abstract:BACKGROUND:Decisionsabouttheallocationandrationingofmedicalinterventionslikelyoccurinallhealthcaresystemsworldwide.Sofarverylittleattentionhasbeengiventothequestionofwhatroleethicsconsultationandethicscommitteescouldorshouldplayinquestionsofallocationatthehospitallevel.OBJECTIVESANDMETHODS:Thisarticlearguesfortheneedforethicsconsultationinrationingdecisionsusingempiricaldataaboutthestatusquoandtheinherentnatureofbedsiderationing.Subsequently,itintroducesa4stageprocessforestablishingandconductingethicsconsultationinrationingquestionswithsystematicreferenceto


coreelementsofproceduraljustice.RESULTS:Qualitativeandquantitativefindingsshowasignificantdemandforethicsconsultationexpresseddirectlybydoctors,aswellasadditionalindirectevidenceofsuchaneedasindicatedbyethicallychallengingcircumstancesofinconsistentandstructurallydisadvantagingrationingdecisions.Toaddressthisneed,wesuggest4stagesforestablishingandconductingethicsconsultationinrationingquestionswerecommend:(1)training,(2)identifyingactualscarcityrelatedproblemsatclinics,(3)supportingdecisionmaking,and(4)evaluation.CONCLUSION:Thisprocessofethicsconsultationregardingrationingdecisionswouldfacilitatetheachievementofseveralpracticalgoals:(i)encouragementofanawarenessandunderstandingofethicalproblemsinbedsiderationing,(ii)encouragementofachievingefficiencyalongwithrationing,(iii)reinforcementofconsistencyininterandintraindividualdecisionmaking,(iv)encouragementofexplicitreflectionandjustificationoftheprioritizationcriteriatakenintoconsideration,(v)improvementininternal(inhouse)andexternaltransparency,and(vi)preventionofthemisuseofthecorrespondingconsultingstructures.


Document60LippertRasmussen,KasperLauridsen,SigurdJusticeandtheallocationofhealthcareresources:shouldindirect,nonhealtheffectscount?Medicine,healthcare,andphilosophy2010Aug13(3):23746Abstract:Alternativeallocationsofafixedbundleofhealthcareresourcesofteninvolvesignificantlydifferentindirect,nonhealtheffects.Thequestionariseswhethertheseeffectsmustfigureinaccountsoftheconditionsunderwhichadistributionofhealthcareresourcesismorallyjustifiable.InthisarticlewedefendaScanlonian,affirmativeanswertothisquestion:healthcareresourcemanagersshouldsometimesselectanallocationwhichhasworsedirect,healthrelatedeffectsbutbetterindirect,nonhealtheffectstheyshoulddothiswhentheinterestsservedbysuchapolicyaremoreurgentthanthehealthcareinterestsbetterservedbyanalternativeallocation.Wenotethatthereisaprimafaciecasefortheclaimthatsuchbenefits(andcosts)arerelevanti.e.theyarerealbenefits,andinothercontextsourdecisionscanpermissiblybeguidedbythem.Wethenproceedtorebutthreelinesofargumentthatmightbethoughttodefeatthisprimafaciecase:theyappealtofairness,theKantianFormulaofHumanityasanEndinItself,andtheequalmoralworthofpersons,respectively.


Document61Nelson,MarkTYandZarenotoffthehook:thesurvivallotterymadefairer.TheJournalofmedicineandphilosophy2010Aug35(4):396401Abstract:InthisarticleIshowthattheargumentinJohnHarris'sfamous"SurvivalLottery"papercannotberight.EvenifwegrantHarris'sassumptionsofthejustifiabilityofsuchalottery,thecorrectnessofmaximizingconsequentialism,theindistinguishabilitybetweenkillingandlettingdie,thepracticalandpoliticalfeasibilityofsuchaschemetheargumentstillwillnotyieldtheconclusionthatHarriswants.Onhisownterms,themedicallyneedyshouldbelessfavored(andmorevulnerabletobeingkilled),thanHarrissuggests.


Document62Sachs,BenjaminLingeringproblemsofcurrencyandscopeinDaniels'sargumentforasocietalobligationtomeethealthneeds.TheJournalofmedicineandphilosophy2010Aug35(4):40214Abstract:NormanDaniels'snewbook,JustHealth,bringstogetherhisdecadesofworkontheproblemofjusticeandhealth.Itimprovesonearlierwritingsbydiscussinghowwecanmeethealthneedsfairlywhenwecannotmeetthemallandbyattendingtotheimplicationsofthesocioeconomicdeterminantsofhealth.InthisarticleIreturntothecoreideaaroundwhichtheentiretheoryisbuilt:thattheprincipleofequalityofopportunitygroundsasocietalobligationtomeethealthneeds.Ipoint,first,thatnowheredoesDanielssayjustwhatversionofthatprinciplehe


accepts.Ithenproceedtoconstructaprincipleonhisbehalf,basedonafaithfulreadingofJustHealth.Onceweactuallynaildowntheprinciple,Iargue,wewillfindthattherearetwoproblems:itisimplausibleinitself,anditfailstogroundasocietalobligationtomeethealthneeds.


Document63Lindemann,HildeRiskybusiness.TheHastingsCenterreport2010JulAug40(4):4


Document64Siegel,MarkDPrigerson,HollyGTheperceptiongap:race,religion,andprognosisintheICU.Chest2010Jul138(1):89


Document65Eastman,NigelPhilips,BarbaraRhodes,AndrewTriagingforadultcriticalcareintheeventofoverwhelmingneed.Intensivecaremedicine2010Jun36(6):107682Abstract:INTRODUCTION:PredictionsoftheneedforcriticalcarewithintheH1N1influenzapandemicsuggestedoverwhelmingneedbeyondpotentialresources,necessitatingrationingofcareviatriaging.METHOD:ThetriagemodeldescribedwasderivedfrominformeddiscoursewithinaconjoinedNHSandUniversityClinicalEthicsCommittee,supplementedbyspecialistsinintensivecareandinfectiousdiseases.THEMODEL:Thetriagemethodologydescribedisjustifiedethicallyprimarilyupon'utilitarian'principleswithinanaggregatepublichealthmodel,withadditionalreferenceto'fairness'.Advantagesofsuchamodel,whichpartiallysuspendsusualclinicaljudgmentappliedtoindividualsinfavourofalsoutilizingorganfailurescores,includeminimizationofaggregateinfluenzamorbidityandmortality,andminimizationofpsychologicalstressuponstaffmakingtriagingdecisions.Legally,inEnglandandWales,themodelisuncontentiousasregardsrationingofadmissiontocriticalcarehowever,thelawadopts'futility'asthecorejustificationforwithdrawaloftreatment,appliedtotheindividual,thusfailingtoallowforrationingthroughtriagingindividualsoutofcriticalcareintheinterestofotherpatientswithbetterchancesofsurvival.Thereisthereforeamismatchbetweenaclinicallyandethicallyacceptablemodeloftriaging,baseduponapublichealthapproach,andthelaw,basedupontheparadigmoftheindividualpatient.CONCLUSION:ThegoodfortunethattheH1N1pandemicwaslessseverethanpredicted,allowingtimeforcalmconsideration,debateanddecisionmakingaboutwhatmodeloftriagingshouldbeadoptedwheneveritmightbenecessaryinthefuture.Itisintheinterestofthehealthofthenation,andgovernment,todecideuponacriticalcaretriagingmodelwhilethereisnotanimminenthealthservicecrisis.


Document66Reynolds,LRaymondRosenthal,MSaraAreweprovidingethicalcarefortheseverelyobese?Southernmedicaljournal2010Jun103(6):4989



Document67Collier,RogerNewYorkenactssurrogatedecisionmakinglegislationforincapacitatedpatients.CMAJ:CanadianMedicalAssociationjournal=journaldel'Associationmedicalecanadienne2010May18182(8):E3312


* Document68Bhattacharya,DhrubajyotiHodge,JamesG.,Jr.Courtney,BrookePublichealthemergenciesandlegalstandardsofcare.[letterandreply]JAMA:TheJournaloftheAmericanMedicalAssociation2010May12303(18):1811authorreply18111812


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Document69Petrini,CarloTriageinpublichealthemergencies:ethicalissues.Internalandemergencymedicine2010Apr5(2):13744Abstract:Generalconceptsaboutmedicaldisasters,publichealthandtriageareoutlined.Triageisdescribedinthecontextofpublichealthemergenciesanddisastersettings,andthemainethicalvaluesatstakeintriagearediscussed.Possibleconflictsbetweencompetingvaluesareoutlined.Specialattentionisgiventopossibleconflictsbetweentheprotectionofindividualinterests(typicalofclinicalethics),andthepursuitofcollectiveinterests(typicalofpublichealthandtriage).Hippocraticethicsiscomparedtoutilitarianethicsandtoperspectivesthatemphasizetheprincipleofjustice.Threeethicalattitudesaresuggestedthatmaycontributetoaresolutionofcompetingvalues:protectionofhumandignity,precautionand,especially,solidarity.Personalismpromotesthecollectivegoodbysafeguardingandgivingvaluetothewellbeingofeachindividual.Apersonalisticperspectiveissuggestedasawaytodeepentheconceptofsolidarityasapillarbothofclinicalandpublichealthethics.


Document70Wolfensberger,WolfHowtocomportourselvesinaneraofshrinkingresources.Intellectualanddevelopmentaldisabilities2010Apr48(2):14862


* Document71Kerstein,SamuelJ.Bognar,GregCompletelivesinthebalance.AmericanJournalofBioethics2010April10(4):3745Abstract:Theallocationofscarcehealthcareresourcessuchasflutreatmentororgansfortransplantpresentsstarkproblemsofdistributivejustice.Persad,Wertheimer,andEmanuelhaverecentlyproposedanovelsystemforsuchallocation.Their"completelivessystem"incorporatesseveralprinciples,includingonesthatprescribesavingthemostlives,preservingthemostlifeyears,andgivingprioritytopersonsbetween15and40yearsold.Thispaperarguesthatthesystemlacksadequatemoralfoundations.Persadandcolleagues'defenseofgivingprioritytothose

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between15and40leavesthemopentothechargethattheydiscriminateunfairlyagainstchildren.Second,thepapercontendsthatthecompletelivessystemfailstoprovidemeaningfulpracticalguidanceincentralcases,sinceitcontainsnomethodforbalancingitsprincipleswhentheyconflict.Finally,thepaperproposesanewmethodforbalancingprinciplesofsavingthemostlivesandmaximizinglifeyears.


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* Document72Persad,GovindC.Wertheimer,AlanEmanuel,EzekielJ.Standingbyourprinciples:meaningfulguidance,moralfoundations,andmultiprinciplemethodologyinmedicalscarcity.AmericanJournalofBioethics2010April10(4):4648



* Document73McMillan,JohnHope,TonyBalancingprinciples,QALYs,andthestrawmenofresourceallocation.AmericanJournalofBioethics2010April10(4):4850



* Document74Menzel,PaulT.Completelives,shortlives,andthechallengeoflegitimacy.AmericanJournalofBioethics2010April10(4):5052



* Document75Sayeed,SadathA.Assessingthemodifiedyoungestfirstprincipleandtheideaofnonpersonsatthebedside:aclinicalperspective.AmericanJournalofBioethics2010April10(4):5254



* Document76

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Vawter,DorothyE.Garrett,J.ElineGervais,KarenG.Prehn,AngelaWittDeBruin,DebraA.Duelingethicalframeworksforallocatinghealthresources.AmericanJournalofBioethics2010April10(4):5456



* Document77Nord,ErikBalancingrelevantcriteriainallocatingscarcelifesavinginterventions.AmericanJournalofBioethics2010April10(4):5658



* Document78Friedman,AlexanderCompletelives,incompletetheories.AmericanJournalofBioethics2010April10(4):5860



* Document79Norheim,OleFrithjofPrioritytotheyoungortothosewithleastlifetimehealth?AmericanJournalofBioethics2010April10(4):6061



* Document80Kirsch,ThomasD.Moon,MargaretR.Apieceofmymind.Theline.JAMA:TheJournaloftheAmericanMedicalAssociation2010March10303(10):921922


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* Document81Brock,DanRehmannSutter,ChristophTambyah,PaulAnanthRepublication:InThatCase:DistributingscarceoseltamivirinanAvianflupandemic[casestudyandresponses]

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JournalofBioethicalInquiry2010March7(1):133138


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Document82AndrnSandberg,AkePermert,Johan[Today'smedicalethicschallenge]=Dagensmedicinskaetikutmaning.Lkartidningen2010February1723107(7):412413


Document83Akhtar,JamshedAframeworkforadvancingequityinhealthforPakistan[editorial]JournaloftheCollegeofPhysiciansandSurgeonsPakistan2010February20(2):7173[Online].Accessed:http://www.cpsp.edu.pk/jcpsp/archive/2010/Feb2010/1.pdf[2011August3]


http://www.cpsp.edu.pk/index.php?code=MXxUb3B8aW5kZXgucGhwfDA=(linkmaybeoutdated)

* Document84OwenSmith,AmandaCoast,JoannaDonovan,JennyArepatientsreceivingenoughinformationabouthealthcarerationing?Aqualitativestudy.JournalofMedicalEthics2010February36(2):8892Abstract:BACKGROUND:Thereisbroadinternationalagreementfromcliniciansandacademicsthathealthcarerationingshouldbeundertakenasexplicitlyaspossible,andtheBMAhavepubliclysupportedthecallformoreaccountableprioritysettingforsometime.However,studiesintheUKandelsewheresuggestthatcliniciansexperienceanumberofbarrierstorationingopenly,andtheinformationneedsofpatientsatthepointofprovisionarelargelyunknown.METHODOLOGY:IndepthinterviewswereundertakenwithNHSprofessionalsworkingatthecommunitylevelofprovision,andwithpatientsandprofessionalsreceivingorprovidingtreatmentformorbidobesityandbreastcancer(n=52).RESULTS:Nearlyallpatientswantedtoknowabouthealthcarerationingandhadhighexpectationsoftheirclinicalprofessionalstoprovideallrelevantinformationabouttreatmentoptions.However,professionalsdidnotalwaysunderstandtheseinformationrequirements,andcasesofimplicitrationingwerecommon.Theexistenceofrelevantnationalguidancewasnotalwaysknownabout,meaningthatpatientswereoftenreliantonothersourcesofinformationabouttreatmentoptions,whichincludedthepopularmedia,theinternet,patientadvocacygroupsandinformalnetworksofsupport.DISCUSSION:Clinicalprofessionalsneedtounderstandpatients'needfordetailedinformationwhenitcomestorationing,andtounderstandthattheyarethemaingatewayforthistobeprovided.However,disclosurecouldbedistressingforbothpatientsandprofessionals,andthusthemostsensitiveandacceptablewaystomakethisinformationavailablerequiresfurtherinvestigation.


Document85OwenSmith,AmandaCoast,JoannaDonovan,JennyArepatientsreceivingenoughinformationabouthealthcarerationing?Aqualitativestudy.JournalofMedicalEthics2010February36(2):8892Abstract:BACKGROUND:Thereisbroadinternationalagreementfromcliniciansandacademicsthathealthcarerationingshouldbeundertakenasexplicitlyaspossible,andtheBMAhavepubliclysupportedthecallformore

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accountableprioritysettingforsometime.However,studiesintheUKandelsewheresuggestthatcliniciansexperienceanumberofbarrierstorationingopenly,andtheinformationneedsofpatientsatthepointofprovisionarelargelyunknown.METHODOLOGY:IndepthinterviewswereundertakenwithNHSprofessionalsworkingatthecommunitylevelofprovision,andwithpatientsandprofessionalsreceivingorprovidingtreatmentformorbidobesityandbreastcancer(n=52).RESULTS:Nearlyallpatientswantedtoknowabouthealthcarerationingandhadhighexpectationsoftheirclinicalprofessionalstoprovideallrelevantinformationabouttreatmentoptions.However,professionalsdidnotalwaysunderstandtheseinformationrequirements,andcasesofimplicitrationingwerecommon.Theexistenceofrelevantnationalguidancewasnotalwaysknownabout,meaningthatpatientswereoftenreliantonothersourcesofinformationabouttreatmentoptions,whichincludedthepopularmedia,theinternet,patientadvocacygroupsandinformalnetworksofsupport.DISCUSSION:Clinicalprofessionalsneedtounderstandpatients'needfordetailedinformationwhenitcomestorationing,andtounderstandthattheyarethemaingatewayforthistobeprovided.However,disclosurecouldbedistressingforbothpatientsandprofessionals,andthusthemostsensitiveandacceptablewaystomakethisinformationavailablerequiresfurtherinvestigation.


http://jme.bmj.com/content/36/2.toc(linkmaybeoutdated)

Document86Buijsen,Martin.JustCaring.HealthCareRationingandDemocraticDeliberation,byF.Fleck[bookreview]Medicine,HealthCare,andPhilosophy2010February13(1):9798


* Document87Macauley,RobertConflictsindutycausedbyexpensivedrugsMedicalEthicsNewsletter[LaheyClinic]2010Winter17(1):3


http://www.lahey.org/Ethics/(linkmaybeoutdated)

Document88Ersoy,NerminAkpinar,AslihanTurkishnurses'decisionmakinginthedistributionofintensivecarebeds.NursingEthics2010January17(1):8798Abstract:Theaimofthisstudywastoassesstheopinionsandroleofintensivecareunit(ICU)nursesregardingthedistributionofICUbeds.Weconductedthisresearchamong30%oftheattendeesattwoICUcongressesinTurkey.Aselfadministeredquestionnairewasused,whichincluded13casesandallocationcriteria.Ofthetotal(136nurses),53.7%participatedinadmission/dischargedecisions.Themostimportantcriterionwasqualityoflifeasviewedbythephysiciantheleastimportantwasthepatient'ssocialstatus.Accordingtothefindings,thenursesthoughtthatmedicalbenefitandavoidingdiscriminationwereimportant.Ontheotherhandtheirignoranceofpatients'autonomouspreferencesarousessuspicionsaboutthesenurses'roleinadvocatingforpatients'rights.Forthisreason,nurses'roleinallocationdecisionsshouldbeclearlydescribedandshouldalsobethebasisonwhichintensivecarenurses'dutiesinallocationdecisionsshouldbedetermined.


Document89

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Browne,AlisterTheethicsofaggressivedischargeplanning.CambridgeQuarterlyofHealthcareEthics2010January19(1):7585


Document90Farrar,JocelynA.Pandemicinfluenza:allocatingscarcecriticalcareresources.JournalofNursingAdministration2010January40(1):13


Document91Jones,TerryL.Yoder,LindaEconomictheoryandnursingadministrationresearchisthisagoodcombination?NursingForum2010January45(1):4053Abstract:TOPIC:Economictheoryisusedtodescribeandexplaindecisionmakinginthecontextofscarceresources.PURPOSE:Thispaperpresentstwoapplicationsofeconomictheorytothedeliveryofnursingservicesinacutecarehospitalsandevaluatesitsusefulnessinguidingnursingadministrationresearch.SOURCESOFINFORMATION:Thedescriptionofeconomictheoryandtheproposedapplicationsfornursingarebasedoncurrentnursing,healthcare,andeconomicliterature.EvaluationofthepotentialusefulnessofeconomictheoryinguidingnursingadministrationresearchisbasedonthecriteriaofsignificanceandtestabilityasdescribedbyFawcettandDowns.CONCLUSIONS:Whileeconomictheorycanbeveryusefulinexplaininghowdecisionsaboutnursingtimeallocationandnursingcareproductionaremade,itwillnotaddresstheissueofhowtheyshouldbemade.Normativetheoriesandethicalframeworksalsomustbeincorporatedinthedecisionmakingprocessaroundtheseissues.Economictheoryandnursingadministrationareagoodfitwhenbalancedwiththevaluesandgoalsofnursing.


Document92OwenSmith,AmandaCoast,JoannaDonovan,JennyThedesirabilityofbeingopenabouthealthcarerationingdecisions:findingsfromaqualitativestudyofpatientsandclinicalprofessionals.JournalofHealthServicesResearch&Policy2010January15(1):1420Abstract:OBJECTIVE:Tounderstandtheviewsofpatientsandprofessionalsabouthowfeasibleandappropriateitistomakehealthcarerationingdecisionsopenlyattheconsultationlevel.METHODS:Thirtyonepatientsand21healthcareprofessionalswereaskedabouttheirexperiencesofimplicitandexplicitrationingduringindepthinterviewsstructuredaroundtwoclinicalcasestudies(morbidobesityandbreastcancer).Samplingwasundertakentheoreticallyanddataanalysiswascarriedoutusingconstantcomparison.RESULTS:Patientshadabroadawarenessofhealthcarerationingandnearlyallsaidtheywantedtoknowhowfinancialfactorsaffectedtheprovisionoftheirhealthcare.However,theexperienceofexplicitrationingcouldbedistressingandonepatientregrettedhavingbeentold.Despiteafirmcommitmenttotheidealofbeingopenwithpatientsaboutrationing,inpractice,clinicalprofessionalsencounteredanumberofethicalandpracticalbarrierstomakingsuchdecisionsexplicitly,meaningthatimplicitmethodswerefrequentlyadopted.CONCLUSIONS:TheresultssuggestthatmovesintheUKandelsewheretoundertakerationingmoreexplicitlyareinlinewiththepreferencesofthemajorityofpatientsandprofessionals.However,thepotentialfordistresscausedthroughrationingopenlymeansthatfurtherresearchisneededtounderstandwhetherexplicitnessisalwaysthebestapproachattheconsultationlevel,andprofessionalsneedfurthertrainingandsupporttodealwiththestressfulnatureofmakingrationingdecisionsopenly.



* Document93Hirose,IwaoShouldweselectpeoplerandomly?Bioethics2010January24(1):4546


http://www3.interscience.wiley.com/journal/123210643/issue(linkmaybeoutdated)

Document94Ubel,PeterA.andDaniels,NormanDeVosMedicalEthicsColloquyGrandValleyStateUniversity[and]RichardandHelenDeVosFoundationRATIONINGVS.RATIONALIZINGHEALTHCARE:DEVOSMEDICALETHICSCOLLOQUYGrandRapids,MI:[GrandValleyStateUniversity,2010].83p.

Document95UnitedStates.GovernmentAccountabilityOfficeEMERGENCYPREPAREDNESS:STATEEFFORTSTOPLANFORMEDICALSURGECOULDBENEFITFROMSHAREDGUIDANCEFORALLOCATINGSCARCEMEDICALRESOURCES:TESTIMONYBEFORETHESUBCOMMITTEEONMANAGEMENT,INVESTIGATIONS,ANDOVERSIGHT,COMMITTEEONHOMELANDSECURITY,HOUSEOFREPRESENTATIVESWashington,DC:U.S.GovernmentAccountabilityOffice,2010.16p.[Online.]Accessed:http://www.gao.gov/new.items/d10381t.pdf[16June2011]

http://www.gao.gov/new.items/d10381t.pdf(linkmaybeoutdated)

* Document96Segall,SchlomiHEALTH,LUCK,ANDJUSTICEPrinceton,NJ:PrincetonUniversityPress,2010.239p.Callnumber:RA418.S4122010

Document97Petrini,CEthicalapproachestotriageinpublichealthemergencies.LaClinicaterapeutica2010161(5):4714Abstract:Generalconceptsandaboutmedicaldisasters,publichealthandtriageareoutlined.Ethicalvaluesatstakearesummarized.Aspecialattentionisgiventoconflictsbetweenprotectionofindividualinterests(typicalofclinicalethics)andcollectiveinterests(typicalofpublichealthandtriage).Hippocraticethicsiscomparedtoutilitarianethicsandtoperspectivesthatemphasizetheprincipleofjustice.Threeattitudesaresuggested:protectionofhumandignity,precaution,solidarity.Apersonalisticperspectiveissuggestedtodeepensolidarityasapillarbothofclinicalandpublichealthethics.


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Document98Zydziunaite,VilmaSuominen,TarjaAstedtKurki,PiviLepaite,DaivaEthicaldilemmasconcerningdecisionmakingwithinhealthcareleadership:asystematicliteraturereview.Medicina(Kaunas,Lithuania)201046(9):595603Abstract:Theobjectivewastodescribetheresearchmethodsandresearchfocusesonethicaldilemmasconcerningdecisionmakingwithinhealthcareleadership.


Document99Kapp,MarshallBHealthcaretechnology,healthcarerationing,andolderAmericans:enoughalready!Caremanagementjournals:JournalofcasemanagementThejournaloflongtermhomehealthcare201011(4):2458


Document100Hurst,SamiaAClinicalindicationasanethicalappraisal:theexampleofimagingbeforemiddleearsurgery.ORLjournalforotorhinolaryngologyanditsrelatedspecialties201072(3):13843discussion144Abstract:Askingwhetherimagingisindicatedbeforemiddleearsurgeryrequiresustoexaminethequestionofindicationmoregenerally.


Document101Hurst,SamiaAGeneralcommentsonthisissue:howmuchgooddoesittaketomakearealdifference?ORLjournalforotorhinolaryngologyanditsrelatedspecialties201072(3):1789


Document102SchneSeifert,Bettina[Dealingwithbottlenecksinhealthcareethicalissues].=EngpssemedizinischerVersorgungEthischeAspekte.ZeitschriftfrEvidenz,FortbildungundQualittimGesundheitswesen2010104(5):3604Abstract:Duetotheageingofoursocietyandtheenduringprogressofmedicineitwillnolongerbepossibletoprovideuniversalaccesstoeverythinghealthcareproviderscouldpotentiallyoffer.Therefore,weneedadebateonlegitimatehealthcareclaimsandfairdistributionofmedicalresourcesunderconditionsofscarcityhenceonmattersofsocialjustice.Thispaperwilllookatsomegeneralethicalaspectsandsomespecificproposalsforfaircriteriaofrationinginhealthcare.



Document103Hffe,Otfried[Shouldtheaffluentsocietybeallowedtorationhealth?]=DarfeineberflussgesellschaftGesundheitrationieren?ZeitschriftfrEvidenz,FortbildungundQualittimGesundheitswesen2010104(3):196202Abstract:Thetitleofthispaperisnot,asitmightsuggestatfirstglance,justarhetoricalquestion.Itis,rather,aseriousone,whichIwillexamineinfivesteps:(1)Nomatterhowaffluentasocietymaybe,itwillnevermanagetoovercomewhatIcall"theanthropologicallawofscarcity".(2)Becauseofthisanthropologicallawsocietieshavetodecidehowtorespondtoit.Thisimpliesquestionsaboutthewhereandwhatofrationingonepossiblecandidateisthehealthcaresystem.(3)Areasonablewayofdealingwiththeseissues,Ipropose,isbasedonthemoralattitudeofprudence.(4)Whereverthethreatofunboundcovetousness(pleonexia)arisesprudencestimulatescounterforces.(5)Finally,Iconsiderthequestionofhowasocietyshoulddealwithscarcityfromthenormativeperspectiveofjustice.


Document104Katz,MeirTowardsanewmoralparadigminhealthcaredelivery:accountingforindividuals.Americanjournaloflaw&medicine201036(1):78135Abstract:Foryears,commentatorshavedebatedhowtomostappropriatelyallocatescarcemedicalresourcesoverlargepopulations.Inthispaper,Iabstractthemajorrationingschemaintothreegeneralapproaches:rationingbyprice,quantity,andprioritization.Eachhasbothnormativeappealandconsiderableweakness.Afterexploringthem,Ipresentwhatsomecommentatorshavetermedthe"moralparadigm"asanalternativetobroaderphilosophiesdesignedtoencapsulatetheuniverseofoptionsavailabletoallocators(oftentermedthemarket,professional,andpoliticalparadigms).Whilenotitselfanabstractionofanyspecificviablerationingscheme,itprovidesastrongbasisforthedevelopmentofanewschemethatoffersconsiderablemoralandpoliticalappealoftenabsentfromtraditionallyemployedrationingschema.AsIexplain,themoralparadigm,initsstrong,absolute,anduncompromisingversion,iseconomicallyuntenable.Thispaperarticulatesamodifiedversionofthemoralparadigmthatispluralistinnatureratherthanabsolute.Itappealstothemoral,emotional,andirrationalsensibilitiesofeachindividualperson.Themoralparadigm,soarticulated,cancomplementanyhealthcaredeliverysystemthatpolicymakersadopt.Itfunctionsbygrantingindividualstheabilitytoappealtoanadministrativeadjudicatoryboarddesignatedforthispurpose.Theadjudicatoryboardwouldhavetheexpertiseandpowertoactinresponsetothecomplaintsofindividualaggrievedpatients,includingthosecomplaintsthatstemfromthemoral,religious,ethical,emotional,irrational,orothersubjectivepositionsofthepatient,andwouldhaveplenarypowertoaffirmthedenialofaccesstomedicalcareortomandatetheprovisionofsuchcare.Theboardmustbedesignedtofacilitateitsintendedfunctionwhilecreatingstructurallimitationsonabuseofpowerandotherexcess.Imakesomespecificsuggestionsonmattersofstructureandfunctioninthehopeofdemonstratingboththatthisadjudicatorymodelcanfunctionandthatitcandosoimmediately,regardlessoftheunderlyinghealthcaredeliverysystemoritstheoreticalunderpinnings.


* Document105Menzel,PaulT.JustaccesstohealthcareandpharmaceuticalsIn:Brenkert,GeorgeG.Beauchamp,TomL.,eds.TheOxfordHandbookofBusinessEthics.OxfordNewYork:OxfordUniversityPress,2010:202232Callnumber:HF5387.O952010

Document106Moran,MichaelD

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Justsay'No'toSoylentGreenmedicineyou'llbegladyoudid.TheAmericanhearthospitaljournal2009Winter7(2):E1068


* Document107Blinderman,CraigPalliativecare,publichealthandjustice:settingprioritiesinresourcepoorcountries.DevelopingWorldBioethics2009December9(3):105110Abstract:Manycountrieshavenotconsideredpalliativecareapublichealthproblem.Withlimitedresources,diseaseorientedtherapiesandpreventionmeasurestakepriority.Inthispaper,Iintendtodescribethemoralframeworkforconsideringpalliativecareasapublichealthpriorityinresourcepoorcountries.Adistributivetheoryofjusticeforhealthcareshouldconsiderintegrativepalliativecareasmorallyrequiredasitcontributestoimprovingnormalfunctioningandpreservingopportunitiesfortheindividual.Forpatientsrequiringterminalcare,weareguidedlessbyprinciplesofjusticeandmorebythedutytorelievesufferingandsociety'scommitmenttoprotectingtheprofessional'sobligationtoupholdprinciplesofbeneficence,compassionandnonabandonment.Afairdeliberationprocessisnecessarytoallowthesestrongmoralcommitmentstoserveasreasonswhensettingprioritiesinresourcepoorcountries.


http://www3.interscience.wiley.com/journal/117981440/home(linkmaybeoutdated)

Document108Marshall,JohnL.FightingasmarterwaroncancerWashingtonPost2009November29p.B1,B2

http://www.washingtonpost.com(linkmaybeoutdated)

Document109McNeil,DonaldG.,Jr.ShiftingvaccineforflutoelderlyNewYorkTimes2009November24p.D1,D6

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* Document110McNeil,DonaldG.,Jr.65?Backoftheline,palNewYorkTimes2009November22lp.WK5


* Document111

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Alvarez,AllenAndrewA.Thecrossculturalimportanceofsatisfyingvitalneeds.Bioethics2009November23(9):486496Abstract:Ethicalbeliefsmayvaryacrossculturesbuttherearethingsthatmustbevaluedaspreconditionstoanyculturalpractice.Physicalandmentalabilitiesvitaltobelieving,valuingandpractisingaculturearesuchpreconditionsanditisalwaysimportanttoprotectthem.Ifoneistopractiseadistinctculture,shemustatleasthavethesebasicabilities.Accesstobasichealthcareisonewaytoensurethatvitalabilitiesareprotected.JohnRawlsarguedthataccesstoallpurposeprimarygoodsmustbeensured.AmartyaSenandMarthaNussbaumclaimthatuniversalcapabilitiesarewhatresourcesaremeanttoenable.LenDoyalandIanGoughidentifyphysicalhealthandautonomyasbasicneedsofeverypersonineveryculture.Whenwedisagreeonwhattoprioritize,whenresourcestosatisfycompetingdemandsarescarce,ourcommonneedscanprovideapointofnormativeconvergence.Needbasedrationing,however,hasbeencriticizedforbeingtooindeterminatetogiveguidancefordecidingwhichhealthcareservicestoprioritizeandfortendingtocreateabottomlesspitproblem.Butthereisadifferencebetweenneedingsomething(firstorderneed)andneedingtohavetheabilitytoneed(secondorderneed).Evenifwedisagreeaboutwhichfirstorderneedtoprioritize,wemustaccepttheimportanceofsatisfyingoursecondorderneedtohavetheabilitytovaluethings.Weallhaveasecondorderneedforbasichealthcareasameanstoprotectourvitalabilitiesevenifwedifferinwhatourculturesconsidertobeparticularfirstorderneeds.


http://www3.interscience.wiley.com/journal/122612825/issue(linkmaybeoutdated)

Document112Watson,RoryEuropeancommissionseekstotacklehealthinequalities[news]BritishMedicalJournal2009October31339(7728):995


http://www.bmj.com(linkmaybeoutdated)

Document113Klein,SabraL.Greenberger,PhyllisDowomenneedsuchbigflushots?[oped]NewYorkTimes2009October28p.A33


* Document114Steinhauer,JenniferAnxiouscrowdsmeetadhocswineflupoliceNewYorkTimes2009October28p.A1,A4

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Document115Shenson,DouglasOneperson,onedose[oped]NewYorkTimes2009October26p.A23

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* Document116Fink,SheriWorstcase:choosingwhogetsthebreathoflifeNewYorkTimes2009October25p.WK3


Document117ParkerPope,TaraBenefitsandrisksofcancerscreeningarenotalwaysclear,expertssayNewYorkTimes2009October22p.A26


Document118Kolata,GinaCancergrouphasconcernsonscreeningsanalysisfindsbenefittobeoverstatedNewYorkTimes2009October21p.A1,A22


Document119Kristof,NichoasD.Dad'slifeoryours?Youchoose.[oped]NewYorkTimes2009October4p.WK9


Document120Kaufman,SharonRMakinglongevityinanagingsociety:linkingethicalsensibilityandMedicarespending.Medicalanthropology2009Oct28(4):31725Abstract:Anagingsociety,agrowingarrayoflifeextendingmedicalinterventions,Medicarepolicy,andanethicofindividualdecisionmakingtogethercontributetothedeepeningsocietaltensionintheUnitedStatesbetweencontrollinghealthcarecostsandenablinghealthconsumeruseoflifesustainingtechnologies.Theactivitiesthatconstitutelongevitymaking,likesomanyothersociomedicalpractices,compriseasiteforthegoverningoflifeandtheemergenceofnewformsofethicalcomportmentandsocialparticipation.Thoseactivitiesincludingthenecessityoftreatingrisk,thedifficultyofsaying"no"toevidencebasedinterventions,andtheresponsibilityofchoosingamongclinicaloptionsalsolieattheheartofdebatesabouthealthcarerationingandreform.Cardiacprocedures,organtransplantation,andcancertreatmentsarethreeexamplesofmedicine'ssuccessinextendinglife

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andareemblematicoftheexistentialandsocietalquandariesthatresult.Aperspectivefrommedicalanthropologyshowsthewaysinwhichthemakingoflifeislinkedtohealthcarespendingandtheongoingdebatesaboutagebasedrationing.


Document121Mankiw,N.GregoryWhyhealthcarewillneverbeequalNewYorkTimes2009September20p.BU5


Document122Cressey,DanielLifeinthebalance[newsfeature]Nature2009September17461(7262):336339


http://www.nature.com/nature/(linkmaybeoutdated)

Document123Rubino,FrancescoPurnell,JonathanQ.Flum,DavidR.Accesstobariatricsurgeryandpatientswithdiabetes.[letterandreply]JAMA:TheJournaloftheAmericanMedicalAssociation2009September9302(10):10551056authorreply10561057


http://jama.amaassn.org/content/vol302/issue10/(linkmaybeoutdated)

* Document124Wall,AnjiE.Solidarity:analternativejusticeinhealthcarepolicydebateHealthCareEthicsUSA[electronic]2009Fall17(4):25


http://www.chausa.org/Pub/MainNav/News/HCEthics/(linkmaybeoutdated)

* Document125Norheim,OleFrithjofAnoteonBrock:prioritarianism,egalitarianismandthedistributionoflifeyears.JournalofMedicalEthics2009September35(9):565569Abstract:ThemoralphilosopherDanBrockhasarguedthatequalityofhealthoutcomes"evenifachievable"isproblematicasagoalinitsownrightbecauseitisopentothelevellingdownobjection.Thelevellingdownobjection

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toegalitarianismhasreceivedsurprisinglylittleattentioninthebioethicsliteratureondistributionofhealthandhealthcareanddeservesmoreattention.ThispaperdiscussesandacceptsanexamplegivenbyBrockshowingthatprioritarianismandegalitarianismmayjudgedistributionsofhealthoutcomesdifferently.Weshouldacceptthatlevellingdownisneveragoodthing,allthingsconsidered,butthatequalityoftenis.BydiscussingvariantsofBrock'sexample,itisdemonstratedthatifequality,prioritarianismandaggregationarecombined,asinapopulationwidesummarymeasureofhealth,suchasthehealthachievementindex,thiscombinedsetofprinciplesisnotopentolevellingdown.Thepapersuggestsalthoughamorethoroughinvestigationofthepropertiesoftheachievementindexisneededthatthismeasure(a)isalwayssensitivetoinequalityinhealth,(b)isalwayssensitivetoaveragehealth,(c)canassignprioritytothosewithlowesthealthoutcomesand(d)isnotsensitivetolevellingdown.Levellingdownisnotanembarrassmentforegalitariansiftheyadoptapluralisttheorythatintegratesfairnesswithgoodness.Equalityisnottheonlyvalueegalitarianspromote.Butequalityissoimportantthatweshouldnotrejectit.


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Document126McCaughey,BetsyObama'shealthrationerinchief[editorial]WallStreetJournal2009August27p.A15

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Document127Buntin,JohnLiveordie?ThatwasforthepaneltodecideWashingtonPost2009August23p.B3

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Document128Wheeler,RobertPrioritypatientsinapandemoniumBMJ:BritishMedicalJournal2009August22339(7718):461



* Document129Meier,barryWhenonesizedoesn'tfitall:foradiabetestreatment,aguidelinebecameapitfallNewYorkTimes2009August18p.B1,B4


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Document130Douthat,RossTellinggrandma"no"[oped]NewYorkTimes2009August17p.A19


Document131Coombes,RebeccaDoctorscallforguidanceonprioritisingA/H1N1criticallyill[news]BMJ:BritishMedicalJournal2009August1339(7715):257



* Document132Halvorsen,K.Frde,R.Nortvedt,P.Theprincipleofjusticeinpatientprioritiesintheintensivecareunit:theroleofsignificantothers.JournalofMedicalEthics2009August35(8):483487Abstract:BACKGROUND:Theoretically,theprincipleofjusticeisstronginhealthcareprioritiesbothnationallyandinternationally.Research,however,hasindicatedthatquestionscanberaisedastohowthisprincipleisdealtwithinclinicalintensivecare.OBJECTIVE:Theobjectiveofthisarticleistoexaminehowsignificantothersmayaffecttheprincipleofjusticeinthemedicaltreatmentandnursingcareofintensivecarepatients.METHOD:Fieldobservationsandindepthinterviewswithphysiciansandnursesinintensivecareunits(ICU).Emphas