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Buzz words or principles: ethics & health-care reform.


In June 1990, when I was lining up the witness list for a Senate Finance Committee hearing on the Patient Self-Determination Act Patient Self-Determination Act An act that requiring health professionals reimbursed by Medicare/Medicaid to inform Pts of their legal rights to refuse treatment and prepare advance directives. , a prominent medical ethicist eth·i·cist   also e·thi·cian
n.
A specialist in ethics.

Noun 1. ethicist - a philosopher who specializes in ethics
ethician

philosopher - a specialist in philosophy
 declined to testify for fear of having his views distorted and manipulated by the political process. The bill, which became law that fall and which required medical facilities to distribute information about living wills and durable powers of attorney, was the first piece of federal legislation to deal explicitly with end-of-life decision making--a major ethical issue. Yet this respected ethicist expressed skepticism about the capacity of a political forum, such as a congressional hearing Congressional hearings are the principal formal method by which committees collect and analyze information in the early stages of legislative policymaking. Whether confirmation hearings — a procedure unique to the Senate — legislative, oversight, investigative, or a , to capture adequately the nuances and complexities of the issue. Only two years out of divinity school Divinity School may be:
  • The generic term for divinity school
  • The Divinity School at the University of Oxford



See also Divinity School, Oxford.
 and convinced of the political relevance of ethics, I argued with him that ethicists have a responsibility to engage in the public dialogue about health-care issues to ensure that the human and ethical dimensions be addressed along with economic factors.

Three years later, watching the national health-care debate, I think this bioethicist may have made a salient point about the relationship between ethics and politics.

As the Clinton administration Noun 1. Clinton administration - the executive under President Clinton
executive - persons who administer the law
 begins to unveil its plan for our ailing system, the feasibility of marrying ethics and politics remains an open question. Of the four hundred or so members of the President's Task Force on National Health Reform, a small number were engaged in the discussion of ethical matters. Although the ethics group did not convene until many of the other "clusters" and "subgroups" were well underway, one of its tasks was to articulate the principles underlying the effort to reform health care. Thus, the parameters of the new health-care system were set before the ethics group ever met, and participants in groups constructing basic aspects of the plan said they had little or no exposure at all to the "ethics people." In one sense, that isolation might have been positive because each group was free to function without outside pressures. But then, we have to ask, what contribution did the ethics group make? And what relevance did its deliberations have in the formation of the Clinton health-care policy?

There is no question that in the realm of health-care reform, critical ethical choices must be made. One of the most politically difficult--medical rationing--wasn't even touched. In the view of an aide to Hillary Rodham Rodham is an English surname which may refer to a number of persons or places. People
Family of Hillary Rodham Clinton
  • Hillary Rodham Clinton, 2008 presidential candidate and current junior U.S.
 Clinton, the administration needs to prove its credibility in containing overall health-care costs before even discussing whether some forms of medical care are worth the limited benefits they provide. And although Mrs. Clinton's aide was under the impression that the ethics task force made thoughtful contributions and recommendations with respect to end-of-life decision making, participants in the ethics task force said these were not the kinds of issues they discussed. Even the volatile issue of including abortion in the basic benefits package was not on the group's agenda.

But as two participants admitted, they were under no illusions that their work was in any way intended to form the ethical foundation of the new system or that policy choices to be made turned on ethical considerations. Rather, their work would be used as justification for the plan. Thus, consultants working on the basic benefits package, the structure of the purchasing cooperatives purchasing cooperative,
n a group of dental professionals pooling their financial resources to purchase large quantities of supplies and equipment for the purpose of obtaining a discount.
, and other central components of the system, were not waiting for the ethics group to conclude their deliberations.

The ethics group did, however, articulate a broad range of principles that should motivate any new health-care system, and these contributions have apparently helped the Clintons frame a philosophical approach to the complex issue of health-care reform. When it comes time to sell the health-care program, the rhetoric will most likely be gleaned from the values and principles articulated by the ethics task force. The preamble A clause at the beginning of a constitution or statute explaining the reasons for its enactment and the objectives it seeks to attain.

Generally a preamble is a declaration by the legislature of the reasons for the passage of the statute, and it aids in the interpretation of
 to the bill will be loaded with words such as security, choice, quality, access, and efficiency that signal valued principles. A trial balloon raised by the administration in August used many of these buzz words buzz word
Noun

Informal a word, originally from a particular jargon, which becomes a popular vogue word

buzz word npalabra que está de moda

.

Nonetheless, the ethics participants hope that as the program is put forward, their contribution will not only be part of a public relations public relations, activities and policies used to create public interest in a person, idea, product, institution, or business establishment. By its nature, public relations is devoted to serving particular interests by presenting them to the public in the most  campaign, but will also be used as a standard by which to measure the ultimate product. Arthur Caplan Arthur L. Caplan PhD, is Emanuel and Robert Hart Professor of Bioethics and director of the Center for Bioethics at the University of Pennsylvania. Prior to coming to Penn in 1994, Caplan taught at the University of Minnesota, the University of Pittsburgh, and Columbia University. , who led the "values framework" subgroup sub·group  
n.
1. A distinct group within a group; a subdivision of a group.

2. A subordinate group.

3. Mathematics A group that is a subset of a group.

tr.v.
 of the ethics cluster, says he would be happy to see the health-care reform plan sold in terms of certain ethical standards, and told Ira Magaziner Ira Magaziner (born November 8, 1947 [1]) Ira Magaziner was born in New York City, NY in 1947. After earning notoriety as a student activist and business consultant, Magaziner became the senior advisor for policy development for President Clinton and later served as his , head of the task force, as much. Caplan believes that these standards would serve to hold the plan accountable.

But remembering the words of my reluctant witness of three years ago, I worry that participation of the ethicists gives the appearance that the plan has an ethical stamp of approval, though none of the hard ethical questions has been addressed. Of course, these are not easy questions nor is the relationship between ethical deliberations and practical policy outcomes clear-cut. But it seems to me that the professional ethicists have missed the opportunity--a rare one--of contributing to the public debate without being used by the process.
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Author:McCloskey, Liz Leibold
Publication:Commonweal
Date:Sep 24, 1993
Words:836
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