Patient autonomy and social fairness

Cambridge Quarterly of Healthcare Ethics

Volumn 9, Issue 3, 2000, Pages 391-399

  Cohen, Joshua ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0034196050     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0963180100903116     Document Type: Review

References (33)

1. 1. See Sen A. Commodities and Capabilities. Dordrecht: North Holland, 1985.
2. 2. Cotton P. Providers to advise of medical miranda. JAMA 1991;265:306.
3. 3. See Sen A. On Ethics and Economics. Oxford: Oxford University Press, 1987:56.
4. 4. Unlike negative rights such as refusal of treatment, positive rights do not establish "correlative duties" on the part of the healthcare provider. See Munby J. Rhetoric and reality: the limitations of patient self-determination in contemporary English law. Journal of Contemporary Health Law and Policy 1999;14:315-34.
5. 5. "Informed" suggests that consent must be based on truthful, adequate, and confidential information.
6. 6. See Brock D. Quality of life measures in health care and medical ethics. In: Sen A, Nussbaum M, eds. The Quality of Life. Oxford: Clarendon Press 1993:98-113, 106.
7. 7. Levinsky N. The purpose of advance medical planning-autonomy for patients or limitation of care. New England Journal of Medicine 1996;336:532-5.
8. 8. Hellinger F. The expanding scope of state legislation. JAMA 1996;276:1065-71.
9. 9. State freedom of choice laws proclaim patients' freedom to choose without protecting patients from the financial consequences of exercising their freedom. If a patient decides to choose a provider outside her health plan's network of so-called preferred providers she will probably have to incur higher out-of-pocket costs.
10. 10. See Rowley C, Peacock A. Welfare Economics: A Liberal Restatement. London: Martin Robertson, 1973:84.
11. 11. Wilson MS. Patients' rights in England and the United States of America. Journal of Medical Ethics 1997;23:213-20.
12. 12. Regulators such as the Food and Drug Administration also place restrictions on both suppliers and purchasers of healthcare services.
13. 13. Mill JS. Utilitarianism. London: Williams Collins & Sons, 1962.
14. 14. See note 1, Sen 1985.
15. 15. See note 3, Sen 1987.
16. 16. See also Sen A, Dreze J. World Hunger and Public Action. Oxford: Oxford University Press, 1989.
17. 17. It is acknowledged here that a person's voluntary choice of desired functionings will often be mediated by factors outside the person's control. Furthermore, certain functionings will be relatively easier to "choose" than others. For example, provided there is enough food, choosing to be well nourished would seem easier to achieve than choosing to be happy.
18. 18. The capabilities approach recognizes interpersonal variability in terms of naturally endowed traits, and thus the need to focus on an individual or group's ability to achieve functionings with the quantities of commodities and services available to them, rather than focusing strictly on the quantities of commodities and services per se.
19. 19. Daniels N. Justice, fair procedures, and the goals of medicine. Hastings Center Report 1996;26(6):10-12.
20. 20. Undoubtedly, other services such as housing, education, and infrastructure also contribute to an individual's or population's health.
21. 21. Torrance G, Boyle B, Horwood S. Applications of multi-attribute utility theory to measure social preferences for health states. Operations Research 1982;30:1043-69.
22. 22. If we disregard possible interdependence problems, the degree of overall health-related functioning, "being healthy," can be considered a sum of the degrees of separate health-related functionings.
23. 23. Establishing "minimally adequate levels of quality of life" is a difficult task. However, a parallel can be drawn between the kind of research needed to accomplish this task and the kind of research that has been carried out to establish federal and state "poverty lines."
24. 24. Cantor J, Long S, Marquis M. Private employment-based insurance in ten states. Health Affairs 1998;14:199-211.
25. 25. See note 19, Daniels 1996:10.
26. 26. See for example the introduction to President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Securing Access to Health Care. Washington, D.C.: U.S. Government Printing Office, 1983.
27. 27. From a Pareto perspective, the shift toward a socially fair healthcare system is seen as suboptimal because improvement in the welfare of some comes at the expense of the welfare of others.
28. 28. Streeten P. Development Perspectives. London: Macmillan Press, 1981.
29. 29. As was seen above, the utilitarian Mill is an exception to this rule in that he asserts the role autonomy plays as a fundamental value of humanity.
30. 30. See Korsgaard C. Commentary on A. Sen's capability and well-being In: Sen A, Nussbaum M, eds. The Quality of Life. Oxford: Clarendon Press, 1993; Cohen G. Equality of what? On welfare, goods and capabilities. In: Sen A, Nussbaum M, eds. The Quality of Life. Oxford: Clarendon Press, 1993.
31. 30. See Korsgaard C. Commentary on A. Sen's capability and well-being In: Sen A, Nussbaum M, eds. The Quality of Life. Oxford: Clarendon Press, 1993; Cohen G. Equality of what? On welfare, goods and capabilities. In: Sen A, Nussbaum M, eds. The Quality of Life. Oxford: Clarendon Press, 1993.
32. 31. Quality First: Better Health Care for all Americans. Washington, D.C.: U.S. Government Printing Office, 1998.
33. 32. Moreover, the Clinton bill is not even legally binding, so even the fortunate consumers presently enrolled in health plans are not guaranteed the various freedoms laid out in the bill. And, the bill specifically opposes state freedom of choice laws, in apparent contradiction of the bill's stated purpose.