Michael Green   Manuel Vargas   phone, office information Additional information on moral philosophy Additional Reading on Abortion Additional Reading on Euthanasia Euthanasia   Assisted suicide in general   Oregon guide for physician-assisted suicide   Physician-assisted suicide in Oregon   Physician-assisted suicide survey, NYT, April 1998   Physician-assisted suicide survey, WP, April 1998   Timothy Quill Rationing   Criteria for rationing organs   Prisoners' organs for sale   Viagra in France		Medical Ethics: Additional Reading on Rationing Is rationing just for meanies? Americans can be forgiven for thinking that rationing is the province of those who believe above all in the virtues of the free market. Part of the reason why HMOs succeed in lowering costs is that they ration care. They do that, of course, because they want to keep the excess money as profit. Not that there's anything wrong with that. Still, rationing has respectable left wing roots. Some who want a more equitable distribution of health care resources favor rationing as a way of moving resources away from expensive treatments and research into programs that help more people; typically, the beneficiaries are the poor. For example, Ronald Dworkin is a passionate advocate of greater economic equality in general and specifically in health care. He rolls the case for rationing into a more general argument for an egalitarian distribution of health care in an article in the McGill Law Journal 38 (1993): 883-898. The Stanford Law library probably doesn't have this article. If you're curious, I would be happy to let you have a look at my copy. Oregon employs a rationing plan in distributing public money for health care. They've managed to increase the amount of money going to the poor. See the Economist, 25 April, 1998, article on John Kitzhaber. For that matter, HMOs may not be so bad either. The Economist (7 March, 1998, pp. 15, 23-26) also reports that HMOs are improving the health of their subscribers by favoring preventive care such as screening and vaccination while holding down costs so that health insurance remains affordable for many. Inessential treatments Medicine isn't just for saving life, it's for enhancing it as well. But how much value should we put on life enhancing treatments in our rationing decisions? Here's one opinion on one class of treatments: the French have put their collective foot down over viagra and the Italians are sticking up for natural aging. At least, editorial writers and government officials in these countries are doing so. Organ Transplants Organs are a scarce medical resource. How should they be distributed? Recently, the Department of Health and Human Services decided to change the rules governing organ transplants so that geographical proximity to an organ donor no longer matters. Here's an article from the New York Times about some of the competing criteria for distributing organs. Here's another one about a disturbing news item: the sale of organs from Chinese prisoners. Are the people who buy these organs doing something wrong? My inclination is to say they are. But, they might say, the Chinese government is going to kill these prisoners anyway. Even if the prisoners are innocent and the Chinese government is absolutely wrong in killing them, what is wrong about using the organs to save lives? Is that a good question or a monstrous one? Can it be wrong to sell organs but not wrong to buy them? This page was originally posted on 5/28/98; 10:11:37 AM and was last built on 5/28/98; 10:11:43 AM with BBEdit and Frontier 5 on a Macintosh running System 8.0.