Health Care Policy in an Age of New

Revolutionary advances in biomedical research and information systems technology pose new and difficult issues for American health care policy, especially in the context of managed care. Health Care Policy in an Age of New Technologies takes on this challenging array of issues, where the dignity of individual life meets the imperatives of the national-level health care system: the right to die, rationing of care, organ transplants, experiments with human embryos, genetic research, confidentiality of medical records, and other ethical dilemmas.

Chapters on a patient's bill of rights, and on medical education and physician training, link the book to policy issues of direct concern to the public and practitioners. Throughout the book, the authors place critical questions in their political, legal, social, economic, and ethical context. Each chapter ends with discussion points, and a multimedia bibliography directs readers to relevant films, documentaries, and case studies.

Kant Patel (Ph.D., University of Houston, 1976) is Professor of Political Science at Southwest Missouri State University Mark Rushefsky (Ph.D., State University of New York at Binghamton, 1977) is professor of political science at Southwest Missouri State University

List of Tables

xi

Foreword

xiii

Preface

xvii

Technology, Values, and Health Care Policy in the New Millennium

3

(25)

Medicine in the Twentieth Century

3

(1)

Health Care in the New Millennium

4

(7)

Virtual Medicine

5

(1)

Telemedicine

6

(1)

E-Health and E-Commerce

6

(1)

Electronic Information

7

(1)

Organ Transplants

8

(1)

Genetic Research

9

(1)

Cloning

10

(1)

The Value of Biomedical Technology in Health Care

11

(1)

Health Care and Values

12

(6)

Professional Domination and the Value of Paternalism

13

(1)

The Individual Rights Perspective

14

(2)

The Communitarian Perspective: Community/Common Good

16

(2)

Health Care, Values, and Public Policy in the New Millennium

18

(7)

Organization of the Book

25

(2)

Study Questions

27

(1)

The Right to Die

28

(38)

Right to Die: International Perspective

31

(9)

Right to Die in the United States

40

(8)

Life-Sustaining Treatment and the Courts: 1970--1980s

41

(1)

Karen Ann Quinlan Case (New Jersey)

41

(1)

Elizabeth Bouvia Case (California)

42

(1)

Nancy Cruzan Case (Missouri)

43

(1)

Physician-Assisted Suicide: 1990s

44

(1)

Physician-Assisted Suicide and the Courts

45

(1)

Oregon's Physician-Assisted Suicide Law

46

(1)

Physician-Assisted Suicide and Congress

47

(1)

State Governments, Right to Die, and Public Policy

48

(9)

Advance Directives

48

(1)

Living Wills

49

(2)

Durable Power of Attorney (Health Care Agent or Surrogate)

51

(1)

Criticisms of Health Care Advance Directives

52

(1)

Euthanasia and Physician-Assisted Suicide

53

(1)

State of Oregon and Physician-Assisted Suicide

54

(2)

Physician-Assisted Suicide and Other States

56

(1)

Arguments For and Against Physician-Assisted Suicide

57

(4)

Arguments in Favor of Physician-Assisted Suicide

57

(3)

Arguments Against Physician-Assisted Suicide

60

(1)

Right to Die, Values, and Public Policy

61

(4)

Study Questions

65

(1)

Organ Transplants

66

(45)

Organ Donations and Transplants: International Perspective

68

(4)

Brief History of Organ Transplants

72

(2)

Organ Transplants and Organ Donations in the United States

74

(3)

National Government and Public Policy

77

(5)

State Governments and Public Policy

82

(5)

Courts and Public Policy

87

(4)

Property Rights and the Dead Body

87

(2)

Property Rights in Living Organs and Tissues

89

(2)

Organ Procurement and Allocation: Problems

91

(2)

Policy Proposals to Address the Problem of Organ Shortages

93

(9)

Conscription

94

(1)

Mandated Choice

94

(1)

Rationing

95

(1)

Organ Swapping/Trading

96

(1)

Change Definition of ``Brain Dead''

97

(2)

Presumed Consent

99

(2)

Financial Incentives

101

(1)

Future of Organ Transplants: Human Cloning and Xenotransplantation

102

(7)

Human Cloning

102

(1)

Xenotransplantation

103

(1)

Organ Transplants, Values, and Public Policy

104

(5)

Study Questions

109

(2)

Genetic Research and Health Care

111

(45)

Defining Terms

112

(1)

History of Genetic Research

113

(2)

Genetic Research: An International Perspective

115

(2)

Applications of Genetic Research

117

(10)

Genetic Medicine

117

(3)

Genetic Therapy

120

(2)

Genetic Testing and Counseling

122

(3)

Stem Cell Research

125

(1)

Cloning

126

(1)

Arguments Against Genetic Research

127

(7)

Genetic Medicine: Problems of Access

127

(1)

Gene Therapy

128

(2)

Insurance and Eugenics

130

(1)

The Storm over Stem Cell Research

131

(2)

Arguing over Cloning

133

(1)

Genetic Research and Public Policy

134

(14)

Policy at the National Level

134

(1)

Gene Therapy

134

(1)

Stem Cell Research

135

(7)

Cloning

142

(1)

Public Opinion and Cloning

143

(1)

The Courts: Whose Genes Are They?

144

(2)

The States: Genetic Testing and Counseling

146

(2)

Genetic Research, Values and Public Policy

148

(5)

Notes

153

(1)

Study Questions

153

(3)

Privacy of Medical Records and Confidentiality

156

(39)

Privacy in Other Countries

159

(2)

Privacy in the U.S. Constitution

161

(3)

Understanding Privacy

164

(12)

A Right to Privacy

166

(1)

Confidentiality

167

(1)

Health Information Technology

168

(1)

The Internet

169

(1)

Genetics

170

(2)

Insurance

172

(1)

Horror Stories

173

(1)

Public Opinion

174

(1)

Criticisms of Privacy

175

(1)

Privacy, Confidentiality, and Public Policy in the United States

176

(12)

National Government

176

(1)

Federal Legislation

176

(4)

Executive Branch

180

(6)

State Governments

186

(1)

State Constitutions

186

(1)

State Legislation and Medical Privacy

187

(1)

A Model Health Privacy Policy

188

(1)

Privacy and Confidentiality of Medical Records, Values, and Public Policy

189

(4)

Notes

193

(1)

Study Questions

194

(1)

Health Care Rationing

195

(49)

Rationing Defined

197

(2)

Rationing and Rights

199

(3)

How to Ration

202

(21)

Analytical Techniques for Rationing

203

(1)

Evidence-Based Medicine

203

(3)

Cost-Effectiveness Analysis

206

(1)

Technology Assessment

207

(3)

Rationing and Ethical Perspectives

210

(2)

Health Care Rationing: International Perspectives

212

(1)

Great Britain

212

(5)

Canada

217

(2)

Denmark (Scandinavia)

219

(3)

Rationing in Other Countries

222

(1)

National Government and Public Policy

223

(13)

The Private Sector and Managed Care

225

(3)

Courts and Health Care Rationing

228

(2)

The Federal Government

230

(6)

State Governments and Public Policy: Oregon and Beyond

236

(4)

The Oregon Plan

238

(2)

Health Care Rationing, Values, and Public Policy

240

(2)

Notes

242

(1)

Study Questions

242

(2)

Patients' Bill of Rights

244

(44)

Patients' Bill of Rights: International Perspective

246

(4)

History of Patients' Bill of Rights in the United States

250

(6)

Defining Managed Care

252

(1)

Development of Managed Care

252

(1)

Managed Care in the Public and Private Sectors

253

(2)

The Successes of Managed Care

255

(1)

Problems of Managed Care

256

(5)

Managed Care and Narratives

258

(2)

Public Opinion

260

(1)

Regulating Managed Care

261

(2)

National Government and Patients' Bill of Rights

263

(8)

Putting Patients First?

266

(2)

Congressional Action

268

(1)

Provisions of Bills

269

(1)

The Importance of ERISA

270

(1)

Enterprise Liability

271

(8)

A Communitarian View of Enterprise Liability

273

(3)

Class Action Suits

276

(1)

Criticizing Enterprise Liability

277

(2)

State Governments and Patients' Bill of Rights

279

(4)

The Cost of Enterprise Liability

281

(2)

Outlook for the Future

283

(1)

Patients' Bill of Rights, Values, and Public Policy

284

(2)

Note

286

(1)

Study Questions

287

(1)

Medical Education and Physician Training

288

(38)

History of Medical Education in the United States

291

(19)

Early Colonial Period: The Seventeenth Century

291

(1)

The Eighteenth Century

292

(4)

The Nineteenth Century

296

(6)

The Twentieth Century: 1900s to 1970s

302

(6)

Medical Education in the 1980s and 1990s

308

(2)

Medical Education and Training: Criticisms and Proposed Reforms

310

(1)

Criticisms and Reforms

311

(11)

Physicians for the New Century: Medical Education, Values, and Health Care Policies

322

(3)

Study Questions

325

(1)

Conclusion

326

(11)

Transformation of the U.S. Health Care System

326

(4)

Health Care Policy in an Age of New Technologies

330

(5)

Study Question

335

(2)

Appendix A: Web Sites

337

(8)

Appendix B: Films and Videos

345

(8)

References

353

(48)

Index

401

(40)

About the Authors

441

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Health Care Policy in an Age of New Technologies

Summary

Author Biography

Table of Contents

Supplemental Materials