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Biomedical subjects

Nancy S Jecker

Publications and source records attributed to Nancy S Jecker.

18 recordsLinked to original sources
PubMed2005

Health care reform: what history doesn't teach.

The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician's role in managed care take root in medicine's past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives can function as "master narratives" that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform.

American Medical Association↗
PubMed2002

Taking care of one's own: justice and family caregiving.

This paper asks whether adult children have a duty of justice to act as caregivers for their frail, elderly parents. I begin (Sections I. and II.) by locating the historical reasons why relationships within families were not thought to raise issues of justice. I argue that these reasons are misguided. The paper next presents specific examples showing the relevance of justice to family relationships. I point out that in the United States today, the burden of caregiving for dependent parents falls disproportionately on women (Sections III. and IV.). The paper goes on to use Rawls' theoretical tool of the veil of ignorance to argue that caring for parents should not be linked to a person's sex and more generally, that there is no duty of justice to assume the role of caregiver for dependent parents (Sections V.). Although justice does not provide the moral foundations for parent care, I show that it nonetheless places important limits on the instinct to care. I conclude that the voice of justice should be audible, and is intrinsically present, within families.

Adult↗
PubMed1993

Genetic testing and the social responsibility of private health insurance companies.

In this paper, I have pressed the general question, "Are private health insurers responsible for preventing the problems of equity and access that genetic discrimination would pose?" I have argued that socially responsible insurance companies will avoid genetic discrimination, even if they conceive of their social responsibility in narrow terms. The significance of this point extends beyond the specific question of genetic testing, and bears relevance to broader debates about reforming the nation's health care system. Ultimately, society's attraction to retaining a private health insurance market depends upon private health insurers affirming and meeting responsibilities to the wider society. How society and the insurance industry respond in the face of new genetic testing capabilities will be a moral guidepost indicating how we as a society should devise and implement health care reform.

Delivery of Health Care↗
PubMed1993

Can an employer-based health insurance system be just?

It is America's distinctive practice to tie private health insurance to employment, and recent proposals have tried to retain this link through mandating that all employers provide health insurance to their employees. My primary approach to these issues is neither economic, nor historical, nor political but ethical. After a brief historical overview, I outline a general approach to evaluating the ethical significance of linking the distributions of distinct goods. I examine whether an unjust distribution of jobs spoils justice in the distribution of health insurance, taking as a central example gender inequities in employment and exploring their impact on job-based health insurance. Second, I explore the possibility that justly awarding jobs guarantees justice in employment-sponsored insurance. However, linking the distributions of different goods remains problematic, because such links inevitably undermine equality by enabling the same individuals to enjoy advantages in many different distributive areas. Finally, I examine recent proposals to reform America's health care system by requiring all employers to provide health insurance to their employees. I argue that such proposals lend themselves to the same ethical problems that the current system does and urge greater attention to alternative reform options.

Coercion↗