Refining research on access to gynecologic cancer care: The DIMeS framework.

BACKGROUND: Despite its importance, there is no consensus definition of access to care, and several fundamental philosophical questions about access remain unanswered. Lack of clarity impedes interventional research designed to develop and test methods of correcting barriers to access. To help remedy this problem, we propose a conceptual framework to help guide empirical research about access to gynecologic cancer care. METHODS: Relevant philosophical and empirical literature was reviewed and analyzed to highlight key elements needed to refine research on access to care. RESULTS: The DIMeS framework involves 1) choice and justification of a Definition of access to cancer care that will guide research; 2) Identification of essential gynecologic cancer care services for which access disparities are ethically unacceptable; 3) quantitative MEasurement of specific parameters that affect access to care; and 4) Selection of a target threshold on measured parameters above which access is acceptable. CONCLUSIONS: The DIMeS framework provides clarity and reproducibility for investigators seeking to develop and test interventions to improve cancer health equity. This framework should be considered for use in research on access to gynecologic cancer care.

The University of California Crisis Standards of Care: Public Reasoning for Socially Responsible Medicine.

During the Covid-19 pandemic, the University of California convened the University of California Critical Care Bioethics Working Group, a team of twenty individuals tasked with developing a set of triage procedures. This article highlights several crucial components of the UC procedures and describes the reasoning behind them. The recommendations and the reasoning in the UC protocol are distinctive because of the emphasis the working group placed on grounding its decisions on the public's preferences for triage protocols. To highlight the distinctiveness of the recommendations and reasoning, this article contrasts the UC procedures with the triage procedures known as the "Pittsburgh framework." Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resources, and triage priority for pregnant patients.

Liberalism and Public Health Ethics.

Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that (i) liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; (2) there are special reasons for hard paternalism in public health; and (3) liberalism is incompatible with proper protection of the community good. The article argues that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health.

Wait times and national health policy.

Many arguments against US healthcare reform appeal to facts about wait times, and wait times are also discussed in debates about national health policy in other industrialised countries. This paper points out that there are several different ways to measure wait times. We currently measure them in one way, and this paper describes an alternative. The most reasonable assessments of US and international health reforms need to rely on the alternative method, and so when critics of health reform rely on the standard method, their arguments are unsound.

One danger of biomedical enhancements.

In the near future, our society may develop a vast array of medical enhancements. There is a large debate about enhancements, and that debate has identified many possible harms. This paper describes a harm that has so far been overlooked. Because of some particular features of enhancements, we could come to place more value on them than we actually should. This over-valuation would lead us to devote time, energy, and resources to enhancements that could be better spent somewhere else. That mistake might not be trivial. By spending too much time, energy, and resources on enhancements, we could set back our pursuit of our deepest goals such as living happily and leading ethical lives.

A critique of the innovation argument against a national health program.

President Bush and his Council of Economic Advisors have claimed that the US shouldn't adopt a national health program because doing so would slow innovation in health care. Some have attacked this argument by challenging its moral claim that innovativeness is a good ground for choosing between health care systems. This reply is misguided. If we want to refute the argument from innovation, we have to undercut the premise that seems least controversial--the premise that our current system produces more innovation than a national health program would. I argue that this premise is false. The argument requires clarifying the concept 'national health program' and examining various theories of human well-being.

Making risk-benefit assessments of medical research protocols.

It is commonly assumed that medical experiments are ethical only if they have favorable "risk-benefit ratios". In this paper it is argued that "risk-benefit ratios" often cannot be calculated, even roughly; and that even if they could, ethical experiments don't need to have favorable "risk-benefit ratios". In addition, a new method of assessing an experiment's risk and benefits is proposed-a method grounded in the principles of liberal government.