Markkula Center of Applied Ethics

Unhealthy Dilemmas

Medical technology and research in the U.S. ranks with the best in the world. Americans have pioneered some of the boldest and most promising cancer treatments, surgical procedures, and pharmacological breakthroughs. Advanced genetic research in American laboratories has brought the medical world to a new frontier, where an understanding of the fundamental causes of some of the most vexing medical conditions from AIDS to cystic fibrosis are now within grasp, some inherited conditions may soon be prevented or reversed, and recently introduced genetically engineered drugs are already saving lives.

That is the good news. Unfortunately, there is a great deal of bad news. The same technology that offers hope for ever-increasing life expectancy is also leading to increased demands on the health care system from a growing population of senior citizens. Ethicists and health professionals alike are now raising questions about when and from whom treatments should be withheld, as competition for the scarce medical resources of the health care system grows beyond the system's capacity to provide care for everyone. Already, some forms of rationing have been implemented, and more rationing of health care resources may be inevitable.

The system, too, is burdened by costs that have spiralled wildly out of control. In 20 years, the total cost of medical care for the nation has increased from less than $50 billion a year to over $500 billion. The average cost of a one-day stay in a hospital has now risen to over $500, the total cost of a coronary bypass operation and follow-up treatment has reached $37,300, and the average cost of delivering a baby now exceeds $2500. As costs have increased, fewer people have been able to afford the medical care they need. Over 37 million Americans -- including over 12 million children carry no health insurance at all. Unable to afford private health care, they must rely on a public health system that cannot deal with such a burden. Others simply do without. Rising costs and shrinking allocations for public health programs have led to an increase in infant mortality, reductions in life expectancy among lower income groups, and outbreaks of such preventable diseases as measles.

As if these problems were not already severe enough, we now confront the crisis of AIDS as well. As the death toll from AIDS approaches 100,000 (86,339 through July 1990), fear about the spread of the epidemic, and concerns about the cost of controlling it and treating its victims have resulted in proposals -- such as those for mandatory blood tests and the quarantine of infected individuals -- that could threaten individual liberties, and that raise serious ethical issues.

All of these developments pose difficult moral questions for society. How, for example, should society balance the demands for access to health care for the poor against the potential dilution of health care resources for the majority that might result from reforms in the system? Do we dare to introduce rationing as a means of controlling the growing medical costs of treating our nation's elderly population? As we confront the AIDS epidemic, what sort of testing program should we implement? Who do we test, who has access to test results, and where should we draw the line between assuring the health of the public, and protecting individual rights?

In this newsletter, we can only begin to address these issues, but we hope that the questions that we raise will stimulate our readers to further reflection.

Featured Materials

Issues in Ethics - V. 3, N. 3 Summer 1990
issue abstract
Arrow Unhealthy Dilemmas
thinking ethically
Arrow Age-Based Health Care Rationing
Arrow AIDS, Privacy, & the Community
ethics brief
Arrow System Overload: The Ethics of America's Health Care System
readers respond
Arrow Letters From Our Readers
issues in ethics tools
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