3_7_05_216j_rev - 21A.216J Dilemmas in Bio-Medical Ethics...

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21A.216J Dilemmas in Bio-Medical Ethics 2005/3/7 (M), Week 6, Class 10 Readings Howard Hiatt, “Protecting the Medical Commons: Who is Responsible,” New England Journal of Medicine , Vol 293, No 5 (July 31, 1975): 235-241 Howard Hiatt, MC Weinstein, “Will Disease Prevention Spare the Medical Commons?” Ciba Found Symp. , Vol 110 (1985): 218-35. Laurie Zoloth-Dorfman, Susan B Rubin, “The Patient as Commodity: Managed Care and the Question of Ethics,” Journal of Clinical Ethics , Winter 6, No 4(1995): 339-357. Class Business Short Paper 1 handout. Blackboard Percent of GDP spent on healthcare, 1998: US-42; Canada-75; Australia-70%; Sweden-90%; Japan-75%; Italy 79% (down from 84% in 1980); UK-84%; US spends the most but leaves out undocumented workers, immigrants; many children of immigrants are citizens but have no care Managed care enrollments in US: 1985-7%; 1995-75% Student presentation: “Protecting the Medical Commons: Who is Responsible?” Background: Hiatt, BIDMC, HMS, health disparities studied through education, training Introduction: Medical commons – uses a metaphor of sheep grazing, overgrazing on available resources; freedom in commons brings ruin to all. Are we destined to problems and what kind of precautions that we can take? Question: Page 1. The principle that doctors should do everything possible for the individual patient—a luxury for all patients. Gawande—doing everything they can to avoid cutting off her leg vs. most patients lucky to even be alive. Was it right of them to use those resources and time for the patients? Quality of life of patient vs the individual doctor worried about distribution of resources Luxury of a hierarchy of how many patients, etc., as decided by managed care Concierge/Retainer/Boutique medicine—flat fee to the patients and a new way of paying for health care, the doctor is responsible for providing or limiting care. An overall hierarchy to distributing care. How does that differ from fee for service? Flat amount per year vs fee for service; a whole other tier of care © 2005 MIT OCW 1
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o How resources differ for the rich vs poor? Extreme hierarchy of access increasingly refined o Discussion on social security Is health care privilege or a right? Should health insurance be linked to work? What individuals need, what society needs— Monetary value of life; cost-effective ratios – save for second article How can you make sure that medical practices are effective? And clinical stage. Posits more clinical testing and trials before entering medicine. But will cost more for it to reach the market, and is that good for patients? Regulation over drugs—realm of medical liability, litigation, doing no harm
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This note was uploaded on 11/06/2011 for the course ANTHRO 216 taught by Professor James during the Fall '05 term at MIT.

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3_7_05_216j_rev - 21A.216J Dilemmas in Bio-Medical Ethics...

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