Health Policy and Ethics: A Critical Examination of Values from a Global Perspective

Almost 2 years ago, our national debate about changing the American health care system devolved into a war of words over whether these changes would enable the creation of " death panels, " an extreme euphemism for rationing. In Health Policy and Ethics: A Critical Examination of Values from a Global Perspective, Roger Wor-thington and Robert Rohrbaugh have compiled a number of essays addressing how ethics can and should influence rationing , the relationship between pharmaceutical companies and doctors, and the determination of appropriate treatments. The authors argue not only that ethics is influenced by a number of variables and should be an important consideration in determining health care policy, but that health care itself provides insights into the ethical standards and priorities of a given society. The book is divided into three sections of contributions. The first focuses on ethics, law, and health, primarily in the context of the British health care system. The second section broadens this outlook by considering the health care systems and associated challenges in China, India, and Malaysia. The final section links all of the earlier case studies and identifies universally shared ethical concerns. Unfortunately, the ethical analysis of rationing is both revealing and too brief. One of the contributors offers a framework for using rationing to make health care determinations, but subsequently presents a rather weak hypothetical case to illustrate the challenges of rationing: What is more deserving of funding: mental health services or assisted reproduction treatments? While this hypothetical case is presented as a genuine dilemma, it is unclear whether most readers would actually see it that way. Public opinion data on this type of question or others would have been useful — especially since several contributors present public opinion as a valuable consideration in ethics. There seems to be a slight bias against centralization in health care throughout the book, and although this is certainly a valid opinion, some of the arguments presented are superficial. For example, one contributor suggests that, in the wake of the measles-mumps-rubella (MMR) vaccine controversy, the public could be trusted to determine whether vaccination is necessary because medical professionals have done a poor job of providing information. While the latter point is a concern, the contributor was too dismissive of the potential ramifications of eliminating mandatory vaccinations , namely, the loss of herd immunity. It seems far more risky to allow the poorly informed public to …