Peter A. Ubel
There is a notable change in professional debates about how to better control health care costs. Discussion of health care rationing has become much more muted. "I contend that debates about health care rationing have waned not because the need to ration has dwindled nor because ethical debates about how or whether to ration have been resolved," writes Peter A. Ubel. They have declined because the word "rationing" has been replaced by terms such as "value" that "are not burdened by emotional and historical baggage." The author applauds this change of language, concluding that the best way to promote healthy moral debate is to turn to new words that don't carry the burden of past debates. Ubel is the Madge and Dennis T. McLawhorn University Professor in the Fuqua School of Business at Duke University.
Jonathan Kimmelman and Alex John London
The so-called drug pipeline is widely regarded as being rife with waste and inefficiency. To reduce these problems, the authors propose the first explicit model of clinical translation. They conclude that any attempt to improve clinical translation will require a shift in perception--recognizing that the principal output is not only new drugs, vaccines, devices, and diagnostics but also information. Key information is whether the translation process furnishes clinicians with what they need to know to treat patients who differ from the participants in drug trials. Jonathan Kimmelman is associate professor of biomedical ethics at McGill University. Alex John London is a professor of philosophy and the director of the Center for Ethics and Policy at Carnegie Mellon University.
The male sexual partner often has no voice in the decision about whether to go forward with a pregnancy, and the standard view in bioethics is that he ought not to have. But the author disagrees, arguing that this position is based exclusively on the limited experience of pregnancy itself and not on the enduring role of parenting. Because "the burden of an unplanned pregnancy or even of an unavoidable childbirth . . . is only a small part of the burden of being a parent, then it is no longer clear why the decision about having a child should be [the woman's] alone," writes the author, a professor emeritus of philosophy at the University of Tennessee, Knoxville.
Also in this issue:
Case Study: Temporizing after Spinal Cord Injury
Mr. C is a twenty-two-year-old who was flown to a trauma center after diving headfirst into shallow water. At the scene, he had been conscious but was paralyzed. The emergency medical services team intubated him for airway protection before transport. Mr. C expressed a desire for extubation, but it was not clear that he had the capacity to make this (or any other) decision. What does it mean to respect his autonomy?
Commentaries are by Rebecca L. Volpe and Joshua S. Crites of Pennsylvania State College of Medicine, and Kristi L. Kirschner, University of Illinois at Chicago.
Lawrence O. Gostin
Ebola represents an infection point requiring fundamental reform for the World Health Organization. A failure of leadership will impact its status and legitimacy for a generation. Lawrence O. Gostin offers five reforms that would transform it and ensure that it fulfills its constitutional missions as "the directing and coordinating authority on international health work." Gostin is University Professor and faculty director of the O'Neill Institute for National and Global Health Law at Georgetown University. He directs the World Health Organization Collaborating Center on Public Health Law and Human Rights.