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Cover -- Title -- Copyright -- Contents -- Preface -- Dedication -- Introduction -- I. The question -- II. The history of the problem -- III. Ethics and the law -- IV. Ethics and public policy analysis -- V. The method -- VI. The plan -- Part one Theory -- Competence and incompetence -- I. The concept of competence -- II. Capacities needed for competence -- III. Competence as a threshold concept, not a comparative one -- IV. Standards of competence: Underlying values -- V. Contrast with a single value foundation - individual self-determination as sovereign -- VI. Deciding on standards of competence -- VII. Different standards of competence -- VIII. Relation of the process standard of competence to expected harms and benefits -- IX. Relation of refusal of treatment to determination of incompetence -- X. Contrast with a fixed minimum threshold conception of competence -- XI. A two-step model of patient decision-making authority - the competence of the decisionmaker and the rationality of his or her choice -- XII. Operational measures in the medical setting -- XIII. Competence determinations in nonmedical settings -- XIV. Varying standards of competence -- XV. The need for institutional policies for the determination of competence -- XVI. Summary of conclusions concerning competence -- The primary ethical framework: patient-centered principles -- I. The need for an ethical framework -- II. Underlying ethical values -- III. Guidance principles -- IV. Conflicts among guidance principles -- V. The advance directive principle -- VI. The substituted judgment standard -- VII. Scope and limits of the moral authority of substituted judgment -- VIII. The best interest principle -- IX. Authority principles: Who should decide? -- X. Intervention principles: Attempts to specify conditions that rebut the presumptive authority of the family.

In Uniting America, some of the country's most prominent social thinkers-among them Francis Fukuyama, Daniel Yankelovich, Amitai Etzioni, Alan Wolfe, Uwe Reinhardt, and Thomas E. Mann-reject the myth of polarization. On topics ranging from the war on terrorism, health care, economic policy, and Social Security to religion, diversity, and immigration, the authors argue that there are sensible, centrist solutions that are more in keeping with prevailing public sentiment and that would better serve the national interest. On issue after issue, the authors show how the conventional framing of the debate in Washington has misled Americans, creating a series of false dilemmas and forcing choices between two extremes-at the expense of more balanced and pragmatic policy solutions based on enduring American values.Uniting America provides a blueprint for a fresh approach to American politics, grounded in moderation, pragmatism, and the shared values that unite Americans

Through Canadian and international perspectives, Bending the Cost Curve in Health Care explores the management of growing health costs in an extraordinarily complex arena. The book moves beyond previous debates, agreeing that while efficiencies and better value for money may yet be found, more fundamental reforms to the management and delivery of health services are essential prerequisites to bending the cost curve in the long run. While there is considerable controversy over direction and details of change, there also remains the challenge of getting agreement on the values or principles that would guide the reshaping of the policies, the structures, and the regulatory environment of health care in Canada. Leading experts from around the world representing a range of disciplines and professional backgrounds come together to organize and define the problems faced by policy-makers. Case studies from the United States, the United Kingdom, Australia, the Nordic countries, and industrialized Asian countries such as Taiwan offer useful reform experiences for provincial governments in Canada. Finally, common Canadian cost factors, such as pharmaceuticals and technology, and paying the health workforce, are explored. This book is the first volume in The Johnson-Shoyama Series on Public Policy, published by the University of Toronto Press in association with the Johnson-Shoyama Graduate School of Public Policy, an interdisciplinary centre for research, teaching, and executive training with campuses at the Universities of Regina and Saskatchewan

Frontmatter -- Contents -- Preface to the Second Edition -- Introduction -- Part I The Uninsured, Health Care Costs, and Public Programs -- The U.S. Health Care System: On a Road to Nowhere? -- Wanted: A Clearly Articulated Social Ethic for American Health Care -- From Bismarck to Medicare—A Brief History of Medical Care Payment in America -- The Sad History of Health Care Cost Containment as Told in One Chart -- The Unsurprising Surprise of Renewed Health Care Cost Inflation -- The Not-So-Sad History of Medicare Cost Containment as Told in One Chart -- Medicaid and Medicare: The Unanticipated Politics of Public Insurance Programs -- PART II Managed Care, Markets, and Rationing -- Bedside Manna -- Must Good HMOs Go Bad? The Commercialization of Prepaid Group Health Care -- Defending My Life -- Business vs. Medical Ethics: Conflicting Standards for Managed Care -- The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation -- Ethics of Queuing for Coronary Artery Bypass Grafting in Canada -- Rationing in Practice: The Case of In Vitro Fertilization -- PART III International Perspectives and Emerging Issues -- Reforming the Health Care System: The Universal Dilemma -- Health Care in Four Nations -- Keeping Quality on the Policy Agenda -- What's Ahead for Health Insurance in the United States? -- Luxury Primary Care— Market Innovation or Threat to Access? -- Correspondence: Response to ''Luxury Primary Care'' -- Limiting Health Care for the Old -- Scapegoating the Aged: Intergenerational Equity and Age-Based Rationing -- Index to Authors -- About the Editors