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This paper distinguishes four major types of futility (physiological, imminent demise, lethal condition, and qualitative) that have been advocated in the literature either in a patient dependent or a patient independent fashion. It proposes five criteria (precision, prospective, social acceptability, significant number, and non-agreement) that any definition of futility must satisfy if it is to serve as the basis for unilaterally limiting futile care. It then argues that none of the definitions that have been advocated meet the criteria, primarily because their proponents have not paid sufficient attention to the problematic nature of the data supporting the use of their definitions.

This paper argues, contrary to what has sometimes been claimed, that public commissions need to be more philosophical than they have been in analyzing crucial bioethical issues. It argues (a) that the failure of the President's Commission to develop and use even simple distinctions between life and personhood led to flaws in both its discussion of death and its discussion of persistent vegetative patients, and (b) that its treatment of access to health care fails to develop a coherent approach precisely because it is based on no serious philosophical reflections about justice in health care.

In this paper questions are raised about the use of Halakhic material in discussions of medical ethics. Three ways in which one might use Halakhic material in such discussions are distinguished: (a) as a source for ideas about medical ethics which can be defended independently of their origin; (b) as a basis for mandating certain forms of behavior for members of the Jewish faith; (c) as the basis for claims about the Jewish view on disputed topics in medical ethics. The first two raise no methodological problems. The third use raises a number of theoretical and practical issues, with which the paper is concerned. The problems stem from the fact that Halakhah distinguishes between obligations, the fulfillment of which is required of the Jewish people, and obligations, the fulfillment of which is required of all people. With rare exceptions, the obligations imposed upon the Jewish people are more stringent. The pitfall lurking in the third of the three uses is that authors using Halakhic material may incorrectly conclude that obligations that are supposed to fall only upon the Jewish people fall upon all people. An analysis of this problem follows, along with a plea for a responsible use of Halakhic material in the third way, so as to avoid certain real pitfalls.Brody, who is Director of the Center for Ethics, Medicine, and Public Issues at Baylor College of Medicine, considers several theoretical and practical issues in applying Jewish religious law (Halakhah) to problems in medical ethics. According to Halakhah, certain obligations are demanded only of Jews while others are incumbent upon all people. Brody suggests ways of avoiding the pitfalls of inappropriately applying principles derived from Halakhah to general medical ethics.

This essay challenges the view that the provision of health care must take place within a competitive-free system. The author argues that, presuming that there is a requirement to meet the demands of those who cannot pay for health care, a competitive market provides a good way to deal with injustices within the health care system. The author concludes that the demands for justice are best met when indigent individuals use some portion of the funds they receive from the government to purchase one of the many competing forms of health care. This scheme requires a competitive market in the delivery of health care.