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The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidence-based guidelines. We can do this and still continue to respect the primacy of patient welfare and the right of patients to act in their own self-interest. However, as evidenced by the use of high-volume centers of excellence, each strategy adapted to control costs must be vetted and must be monitored for its unintended ethical consequences.The solution to this complex problem must involve the input of all of the health-care stakeholders, including the patients, payers, and providers. Physicians ought to play a role in designing and executing a remedy. After all, we are the ones who best understand medicine and whose moral obligation is to the welfare of our patients., (Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.)

Parents of school-age children are increasingly claiming nonmedical exemptions to refuse vaccinations required for school entry. The resultant unvaccinated pockets in many areas of the country have been linked with outbreaks of vaccine-preventable diseases. Many states are now focused on reducing rates of nonmedical exemptions by making exemption processes more restrictive or burdensome for the exemptor. These strategies, however, pose ethical problems and may ultimately be inadequate. A shift to strategies that raise the financial liabilities of exemptors may lead to better success and prove ethically more sound. Potential areas of reform include tax law, health insurance, and private school funding programs. We advocate an approach that combines this type of incentive with more effective vaccination education., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Competing visions for health reform in the United States and renewed interest in health technology assessment (HTA) have led to fierce national debates about the appropriateness of rationing. Because of a limited supply of organs, kidney transplantation has always required rationing and overt discussion of the ethics that guide it, but the field of transplantation has also contended recently with internal calls for a new rationing system. The aim of the Life Years from Transplantation (LYFT) proposal is to allocate kidneys to patients who obtain the greatest survival benefit from transplantation, which would lengthen the lives of kidney transplant recipients but restrict the ability of older Americans to obtain a transplant. The debate around the LYFT proposal reveals the ethical and policy challenges of identifying which patients should receive a treatment based on the results of cost-effectiveness and other HTA studies. This article argues that attempts to use HTA for healthcare rationing are likely to disadvantage older patients. Guiding principles to help ensure that resources such as kidneys are justly allocated across the life span are proposed., (© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.)

Solid organ transplant (SOT) candidates and recipients were not included in the COVID‐19 vaccine trials that have justified vaccine administration to millions worldwide and will be critical to ending the pandemic. The risks of COVID‐19 for SOT candidates and recipients combined with data about this population's response to other vaccines has led to transplant centers recommending vaccination for their candidates and recipients in accordance with guidance from major transplant organizations. Relevant ethics considerations include: weighing the low risk of vaccination causing transplant complications against potentially limited antibody response of vaccines for transplant recipients; the equitable distribution of vaccines among vulnerable populations; the duty to steward and respect organs as limited resources; the duty to support vaccination; and patient autonomy. Vaccinated transplant patients and candidates should also consider participating in research studies to better understand the efficacy and potential long‐term risks in this patient population. There are difficult scenarios, like timing transplant after second vaccine dose, when to administer the second dose to a partially vaccinated candidate who gets an organ match, whether to vaccinate a recent transplant recipient with low exposure risk and which vaccine to use. Here we provide ethics considerations for vaccinating different groups within the transplant population. [ABSTRACT FROM AUTHOR]

In Tyranny of the Gene: Personalized Medicine and Its Threat to Public Health (Knopf, 2023), James Tabery traces the ascendance of personalized or precision medicine in America, arguing that America's emphasis on genetics offers more hype than transformational power. In his examination of the power struggles, social relationships, and technological advances that centered the gene in American health policy, Tabery demonstrates how an intensive focus on genetics draws attention away from both the fundamental causes of health disparities and more‐effective changes that could be made to developmental, physical, and social environments. American policy‐makers, health care institutions, funders, and bioethicists should not let the technological shine and attractive politics of personalized medicine continue to replace the hard but necessary work of addressing sociopolitical causes of disease and illness. [ABSTRACT FROM AUTHOR]

In the U.S., there is no requirement for research sponsors to compensate human research subjects who experience injuries as a result of their participation. In this article, we review the moral justifications that compel the establishment of a better research-related injury compensation system. We explore how other countries and certain institutions within the U.S. have adopted various systems of compensation. The existence of these systems demonstrates both that the U.S. lags behind other nations in its protection of human research subjects and that the establishment of a compensation system is both practical and feasible. We then examine factors which have prevented the U.S. from establishing its own compensation system. We consider possible alternatives for the U.S. by examining the advantages and disadvantages of both established and proposed systems. We offer a new proposal that addresses the justice concerns which compel the establishment of a national compensation system, distributes the burdens of such a system on multiple stakeholders that benefit from research, and has the additional advantage of minimizing the administrative and logistical challenges associated with initiating such a system. [ABSTRACT FROM AUTHOR]

The author talks about the electronic long-form COI disclosure statement (ELFCOI) issued by the School of Medicine Division of Medical Ethics of the New York University (NYU). Topics discussed include the internal Conflict of Interest Disclosure Policy of NYU; the encouragement of detailed personal COI disclosure statements by NYU; and the role of financial relationships in COI.

Rates of nonmedical exemptions from school immunizations are increasing and have been associated with resurfacing clusters of vaccine-preventable diseases, such as measles. Historically, state-level school immunization policies successfully suppressed such diseases. We examined state immunization exemption regulations across the United States. We assessed procedures for exempting schoolchildren and whether exemption rates were associated with the complexity of the procedures. We also analyzed legal definitions of religious objections and state legislatures' recent modifications to exemption policies. We found that states with simpler immunization exemption procedures had nonmedical exemption rates that were more than twice as high as those in states with more-complex procedures. We also found that the stringency of legal definitions of religious exemptions was not associated with exemption procedure complexity. Finally, we found that although there were more attempts by state legislatures to broaden exemptions than to tighten them in 2011-13, only bills tightening exemptions passed. Policy makers seeking to control exemption rates to achieve public health goals should consider tightening nonmedical exemption procedures and should add vaccine education components to the procedures by either mandating or encouraging yearly educational sessions in schools for parents reluctant to have their children vaccinated. [ABSTRACT FROM AUTHOR]

Ethical issues are present at each stage in the vaccine product life cycle, the period extending from the earliest stages of research through the eventual design and implementation of global vaccination programs. Recent developments highlight fundamental principles of vaccine ethics and raise unique issues for ongoing vaccination activities worldwide. These include the 2009–10 H1N1 pandemic influenza vaccination campaign, renewed attention to the potential global eradication of polio, and the ongoing evaluation of vaccine risk controversies, most notably the alleged link between childhood vaccines and autism. These cases present ethical challenges for public health policy-makers, scientists, physicians, and other stakeholders in their efforts to improve the health of individuals, communities, and nations through vaccination. [ABSTRACT FROM AUTHOR]

Information is presented about several subjects which were discussed at a round table discussion meeting on U.S. health policy and health coverage which was organized by the Massachusetts Medical Society and held ion May 10, 2008. Topics included important challenges to the U.S. health care system and possible solutions to the challenges. The meeting featured several physicians, academicians and business and political leaders, including Arthur Kaplan and Charles Baker.

The article focuses on the formulation of a health care system that would provide greater equity and greater efficiency to the people in the U.S. It has been stated that the American health care system is in crisis due to several factors including the rise in health expenditures, as well as the government financing through Medicare and Medicaid. However, the article stresses that the Americans should have access to the full range of important health care services. Accordingly, a new and just health care system or health insurance protection that would address the needs of the people should be developed whereby, moral priority is being emphasized and people could have equal access to all medical facilities.

The article discusses the policy of requiring health care personnel to be vaccinated against influenza as an employment mandate in the U.S. and states that at presents, there are more than 200 health care centers that have mandated influenza vaccine for its employees. It discusses the failure of voluntary vaccination strategies in the country and code of ethics for employment mandates for health care workers. It states that health workers should understand moral issues behind the requirement.

The article discusses U.S. government policies regarding access to health care for migrants (illegal immigrants) as of 2017, and it provides a response to the article "Effect of U.S. Health Policies on Health Care Access for Marshallese Migrants" by P.A. McElfish, E. Hallgren, and S. Yamada which appears in a 2015 issue of the journal. Deportation risk, fear, and stress are examined, along with the moral aspects of medical care in the U.S.

The authors comment on solutions for meeting the increasing U.S. demand for transplants. Topics covered include the failure of the U.S. policy on organ recovery to meet the demand, the neglect by the country's organ donation system of potential donors who could provide organs following unexpected death outside an intensive care unit and a proposed approach to uncontrolled donation after circulatory determination of death (UDCDD).

The authors discuss issues related to a regulation in New York which goes into effect with the 2013-2014 flu season that requires unvaccinated health care personnel in regulated settings to wear surgical masks in areas where patients may be present. According to the authors, the privacy of those who choose to mask must be respected and that the use of a mask should be explained to patients. They mention that the moral case for masking or vaccination is indisputable.

The article offers the author's insights on the new law in Pennsylvania which restricts on what doctors can say about the chemicals that were used in natural gas drilling that might affect the health of people. The author mentions that the law allows doctors to get access to information regarding the identity of the trade-secret chemicals but they cannot them to anyone. The author relates the efforts of doctors in doing invasive tests and on reporting women who are seeking for abortion.

In this article, the author offers views concerning the need of health care reform in the U.S. He suggests that if the expansion of health care coverage to uninsured people is the key reason to reform the country's health care system, all of those promoting reform must consider that health care reform is in the ethics. He relates that the ethical position of health reform will only occur if those who promote it can win the fight in recognizing a right to health care.

The article discusses the distribution of liver transplants by geographic and medical criteria. Donna Shalala, secretary of the U.S. Department of Health and Human Services, has proposed regulations governing allocation of liver transplants that would eliminate geographic criteria and focus on medical urgency. Many have criticized national waiting lists for liver transplantation on the grounds that large transplantation centers may gain an unfair advantage. The United Network for Organ Sharing maintains a list of patients awaiting transplants. The author comments that preservation techniques make geographic favoritism in organ allocation unethical. Some believe regulation of organ transplants will discourage donation of organs.

Abstract: Aim: Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). Scope: Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009–10. Results: 1388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). Conclusions: Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility. [Copyright &y& Elsevier]