This book takes the conversation between bioethics and health policy to a new level. Moving beyond principles and normative frameworks, bioethicists writing in the volume consider the actual policy problems faced by health care systems, while policy-makers reflect on the moral values inherent in both the process and content of health policy. The result is a vigorous dialogue with some of the nation's leading experts at the interface of ethics and health policy. the book provides a history of the values implicit in U.S. health policy, a discussion of the federal and state roles in policy making, an ethical examination of the social goals expressed through various policies, an analysis of the role of public opinion in the creation of health policy, and an exploration of the value of the private sector in health policy. In addition, the authors examine some of the major ethical controversies in health policy, such as the challenge of balancing ethical concerns with economic realities, the need to allocate scarce health resources, the call for heightened accountability, and the impact of various policies on vulnerable populations. The book concludes with an examination of the ethical issues in health services research, including the threats to privacy that arise in such research. To a greater extent than any previous volume, it establishes a strong connection between the disciplines of medical ethics and health policy.
Reviewer:Ruth B. Purtilo, Ph.D.(Creighton University)
Description:This collection of 18 articles is designed to contribute to interdisciplinary scholarship at the intersection of U.S. bioethics and health policy. Part 1 identifies goals of healthcare; Part 2 is devoted to making connections between ethical values and the policy-making process; Part 3 addresses how various stakeholders influence policy mechanisms and their relative effectiveness; and in Part 4 several current health policy controversies are analyzed according to ethical approaches.
Purpose:The book meets the editors' purpose of contributing scholarly material for a dialogue between ethicists and policy makers.
Audience:The book remains somewhat unfocused overall, leaving the reader to wonder exactly who the target audience is. The majority of contributors are bioethicists, outcomes researchers, and clinicians who have served in policy positions at national levels or directed their scholarship to policy concerns. Perhaps their familiarity with the policy process is mistaken for a lack of attention to basics that could assist novices in the dialogue.
Features:Part 2 is the strongest section, particularly Churchill's essential chapter in which he analyzes what ethics can contribute to the health policy process. Also notable are the later chapters on accountability and the topic of vulnerable populations, each of which help the reader focus attention on why and how ethical concerns serve to shape policy.
Assessment:This book will be of interest to ethicists and other thinkers who want to become more relevant in the policy-making arena. It will also appeal to some of the more reflective policy wonks who are interested in why and how societal values influence their bottom line of policy. Fortunately, the book is eminently readable, having avoided the pitfall of technical language.