Comprehensive Health Care Reform and Biomedical Innovation

Considers ways to control the costs of development, adoption, and diffusion of new technologies as part of comprehensive healthcare reform. Discusses how cost control interventions might affect coverage, physician payments, and care processes

The Obligation to Participate in Biomedical Research

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived

The Shared Ethical Framework to Allocate Scarce Medical Resources: A Lesson from COVID-19

The COVID-19 pandemic has helped to clarify the fair and equitable allocation of scarce medical resources, both within and among countries. The ethical allocation of such resources entails a three-step process: (1) elucidating the fundamental ethical values for allocation, (2) using these values to delineate priority tiers for scarce resources, and (3) implementing the prioritisation to faithfully realise the fundamental values. Myriad reports and assessments have elucidated five core substantive values for ethical allocation: maximising benefits and minimising harms, mitigating unfair disadvantage, equal moral concern, reciprocity, and instrumental value. These values are universal. None of the values are sufficient alone, and their relative weight and application will vary by context. In addition, there are procedural principles such as transparency, engagement, and evidence-responsiveness. Prioritising instrumental value and minimising harms during the COVID-19 pandemic led to widespread agreement on priority tiers to include health-care workers, first responders, people living in congregate housing, and people with an increased risk of death, such as older adults and individuals with medical conditions. However, the pandemic also revealed problems with the implementation of these values and priority tiers, such as allocation on the basis of population rather than COVID-19 burden, and passive allocation that exacerbated disparities by requiring recipients to spend time booking and travelling to appointments. This ethical framework should be the starting point for the allocation of scarce medical resources in future pandemics and other public health conditions. For instance, allocation of the new malaria vaccine among sub-Saharan African countries should be based not on reciprocity to countries that participated in research, but on maximally reducing serious illness and deaths, especially among infants and children

What are the potential cost savings from legalizing physician-assisted suicide?

Journal ArticleIN the Washington v. Glucksberg and Vacco v. Quill decisions rejecting a constitutional right to physician-assisted suicide, the Supreme Court allowed each state to decide whether to legalize the intervention.1 In state legislatures rather than courtrooms, factual claims about the probable extent and implications of permitting physician-assisted suicide assume a preeminent role in the debate about legalization.2 Particularly sensitive in these discussions will be the issue of the potential cost savings from legalizing physician-assisted suicide, and how the savings might influence decision making by health care institutions, physicians, families, and terminally ill patients. 3-6 Although we do not agree with each other about the ethics or optimal social policy regarding physician- assisted suicide and euthanasia, we do agree that the claims of cost savings distort the debate. Within the limits of available data, we offer an assessment of the potential cost savings from legalizing physician- assisted suicide, demonstrating that the savings can be predicted to be very small - less than 0.1 percent of both total health care spending in the United States and an individual managed-care plan's budget