In Debate Over Health Policy, Some Words Are Seldom Spoken

New York Times, Beliefs, By PETER STEINFELS, August 15, 2009
Read complete article: http://www.nytimes.com/2009/08/15/he...tml?ref=health

What has bioethics contributed to the current national debate over health care reform? The question was put to Daniel Callahan in an interview this week.

Mr. Callahan, a philosopher, has been there from the beginning. In 1969, along with Dr. Willard Gaylin, a psychiatrist, he founded the Institute of Society, Ethics and the Life Sciences, now the Hastings Center. (This writer worked there for part of the 1970s.) Two years later, the Kennedy Institute of Ethics was founded at Georgetown University, and a host of similar interdisciplinary institutions followed.

In the early years, broad changes in health care of the sort now roiling the United States were not on the bioethics agenda. To be sure, there was a sense that the new ethical questions posed by dramatic advances in biology and medicine were fundamental to the future of humankind; yet these questions were usually framed in terms of choices facing individual patients, physicians and researchers:

Were terminally ill patients owed the full truth about their condition? What constituted genuinely informed consent for human experimentation? Who should be screened for genetic conditions, and how should they be counseled? When could patients refuse life-sustaining medical care — and what if they could not decide for themselves? Should organ donors be paid? What rewards and penalties could governments use to slow population growth? What principles should govern the allocation of scarce medical resources like (at that time) dialysis machines?

Those last three questions obviously pointed toward issues of social policy, scarcity and equity, and scholars in the field soon recognized that few issues in bioethics could be isolated from the larger framework of how health care was delivered and who had access to it.

The publication in 1971 of “A Theory of Justice”,by the political philosopher John Rawls, had a major impact on the contribution of bioethics to the health care debate, Mr. Callahan said. The ensuing discussion made justice one of the governing themes in bioethical discourse, and most of that discussion ended up criticizing the current unequal access of Americans to health care.