Rawlsian Justice and Palliative Care.

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive.

[Would you mind a little bit less? Methodological and ethical challenges posed by the reduction of overtreatment]. / Darf es auch weniger sein? Methodische und ethische Herausforderungen bei der Verringerung von Überversorgung.

The present paper outlines two central challenges that should be taken into account when making a concerted effort to reduce excessive medical care (overdiagnosis and overtreatment): first, the inevitability of value judgements in the risk-benefit assessment of medical treatment measures in conjunction with the need to go beyond the individual doctor-patient relationship and make these value judgements while, at least in part, assuming the role of acting deputy; and second, the need for a sufficient level of competence and trust in evidence-based medicine on the part of both physicians and patients. The paper will explain how one can say in a methodologically reasonable and ethically acceptable manner that a certain medical measure - in the context of the regular care setting - will objectively cause a "net harm" to the patient. Relevant institutions in the German healthcare system will be described that are currently conducting risk-benefit assessments (by different means and with different purposes). Taking the known entity of clinical guidelines as an example, the paper will demonstrate that the subjects of overdiagnosis and overtreatment as well as shortage of medical care can be more explicitly communicated by employing certain additional methodological tools. Finally, some central implementation barriers to a successful application of "Less is more!" will be presented and critically discussed. (As supplied by publisher).

Is there a problem with enhancement?

This article examines arguments concerning enhancement of human persons recently presented by Michael Sandel (2004). In the first section, I briefly describe some of his arguments. In section two, I consider whether, as Sandel claims, the desire for mastery motivates enhancement and whether such a desire could be grounds for its impermissibility. Section three considers how Sandel draws the distinction between treatment and enhancement, and the relation to nature that he thinks each expresses. The fourth section examines Sandel's views about parent/child relations and also how enhancement would affect distributive justice and the duty to aid. In conclusion, I briefly offer an alternative suggestion as to why enhancement may be troubling and consider what we could safely enhance.

Are patents for methods of medical treatment contrary to the ordre public and morality or "generally inconvenient"?

"No one has advanced a just and logical reason why reward for service to the public should be extended to the inventor of a mechanical toy and denied to the genius whose patience, foresight, and effort have given a valuable new [discovery] to mankind" (Katopis CJ. Patents v patents: policy implications of recent patent legislation. St John's Law Review 1997;71:329). The law around the world permits the granting of patents for drugs, medical devices, and cosmetic treatment of the human body. At the same time, patentability for a method of treatment of the same body is denied in some countries on various public policy grounds. Is there any logical justification for this distinction? Are methods of medical treatment not as vital to the health or even to the life of a patient as drugs or medical devices? Why is a cosmetic result patentable and a curative result not?