Health literacy, health inequality and a just healthcare system

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.     

Understanding equality in health care: a Christian free-market approach.

This paper examines the arguments presented by the Roman Catholic Bishops in their 1993 Pastoral Resolution, Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good, concerning health care reform. Focusing on the meaning of equality in health care and traditional Roman Catholic doctrine, it is argued that the Bishops fail to grasp the force of the differences among persons, the value of the market, and traditional scholastic arguments concerning obligatory and extraordinary health care. To attempt to equalize the distribution of health care would be ruinous. A more traditional understanding of Christian thought reveals an acceptance of inequality in health care distribution and a bias against using the secular state to coerce a solution to such concerns for social justice.     

The responsiveness and equality of mental health care to Chicanos and Native Americans

An examination was made of the services received by Chicano and Native American clients in 17 community mental health facilities. Although these minority clients differed from Anglos in demographic variables, there was no evidence that they were rendered inferior or discriminatory services. However, failure to return for therapy was much higher among minority clients. Possible reasons for this failure to return are discussed. It is suggested that for ethnic group clients, equality of services may not mean responsive services.     

Subjective equality and just noticeable differences in body-size judgments by obese persons

Body-size estimates by obese and normal-weight subjects were compared using two different procedures with a TV-video methodology. In the continuous method subjects adjusted an image larger or smaller until they judged a correct TV-image had been achieved. In the second procedure the method of constant stimuli was used wherein values corresponding to the point of subjective equality (PSE) and difference threshold (DL) were determined. No differences between obese and normal-weight subjects were obtained with these procedures. On the continuous task subjects slightly underestimated body size and were more accurate on descending trials where they adjusted the size of the image downwards. With the second procedure, an average PSE of -.62% was obtained, with an average DL = 7.27%. Different PSE values were obtained when subjects were judging whether their image was distorted too wide or too thin. Data from the two procedures are compared and ramifications for the study of body size are discussed.     

Rationing just medical care

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for--as though health care is a commodity that needs no examination--or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with "health care," the terminology used in the current debate, but with the more modest and limited topic of medical care. Integral to this rationing proposal--which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society--is a definition of a "decent minimum," the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span.     

Psychology,health and health care

This article traces the development of the World Health Organization's emphasis on psychological and behavioural factors in health and notes its encouragement of recognition of these factors by member states. The article further outlines the reasons for this increasing recognition and stresses the important role of psychological and behavioural factors in the maintenance of health and prevention of illness.     

Health care, equality, and inequality: Christian perspectives and moral disagreements.

Equality is a concept that is often used in health care discussions about the allocation of resources and the design of health care systems. In secular discussions and debates the concept of equality is highly controverted and can take on many different specifications. One might think that Christians hold a common understanding of equality. A more careful study, though, makes it clear that equality is just as controversial among different Christian communities as it is in the secular world.     

Welfare,Autonomy, and the Autonomy Fallacy

In this article, I subject the claim that autonomous choice is an intrinsic welfare benefit to critical scrutiny. My argument begins by discussing perhaps the most influential argument in favor of the intrinsic value of autonomy: the argument from deference. In response, I hold that this argument displays what I call the ‘Autonomy Fallacy’: the argument from deference has no power to support the intrinsic value of autonomy in comparison to the important evaluative significance of bare self‐direction (autonomous or not) or what I call ‘self‐direction tout court’. I defend the claim that the Autonomy Fallacy really is a fallacy, and show that my examination of the argument from deference has wider reverberations. Once we clearly distinguish between autonomy and self‐direction tout court, it becomes much less plausible to say that autonomy of itself is an intrinsic welfare benefit.     

Personal privacy in the health care system: employer-sponsored insurance, managed care, and integrated delivery systems

Widespread collection and use of identifiable information can promote social goods while, at the same time, infringing on personal privacy. Information systems are developing within the context of a fundamental transformation in the organization, delivery, and financing of health care. Changes in the health care system include rapid development of employer-sponsored health coverage, managed care organizations, and integrated delivery systems. These complex, multifaceted arrangements for delivering and paying for health care require ever-more-sophisticated information systems that facilitate extensive sharing of personal data. Systemic flows of sensitive health information occur both vertically and horizontally among employers, hospitals, insurers, laboratories, and suppliers. Beyond this complex web of vertical and horizontal sharing are the multiple demands for information management, quality assurance, research, governmental regulation, and public health. Theoretical problems exist with the law and ethics of informational privacy. The traditional method of exercising control over personal health information is through informed consent. Informed consent, however, within a modern health information infrastructure becomes highly complex. In this kind of environment, the doctrine of informed consent is flawed and does not provide sufficient control over personal information to assure adequate protection of privacy.     

Universal health care, American style: a single fund approach to health care reform

With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.     

Autonomy,Experience, and Reflection. On a Neglected Aspect of Personal Autonomy

The aim of this paper is to suggest that a necessary condition of autonomy has not been sufficiently recognized in the literature: the capacity to critically reflect on one’s practical attitudes (desires, preferences, values, etc.) in the light of new experiences. It will be argued that most prominent accounts of autonomy—ahistorical as well as history-sensitive—have either altogether failed to recognize this condition or at least failed to give an explicit account of it.     

Spirituality,health care,and bioethics

This article explores the relationship of spirituality to health care and bioethics in terms of the need and efforts of people to make sense of their lives in the face of illness, injury, or impending death. Moving beyond earlier associations with specific religious traditions, spirituality has come to designate the way in which people can integrate their experiences with their sense of ultimate meaning and related values. The holistic model of health care also affirms that one should not simply treat a body in pain, but respond to the suffering of the whole person within his or her full life. A narrative emphasis in ethics also maintains that ethical decisions occur within the framework of interacting life-stories, each of which embodies a certain core vision and set of values. In each instance it is the life stories of people, their lived narratives, that provide a common thread. The telling of these stories and the discernment of the lived spirituality they contain may assist persons in the process of achieving understanding, making decisions, and finding purpose in the experience of illness, injury, or disability.Maureen Muldoon, Ph.D., is Associate Professor in the Department of Religious Studies, University of Windsor, Windsor, Ontario, and Norman King, Ph.D., is Professor in the same department.     

Killing, wrongness, and equality

This paper examines accounts of the moral wrongness of killing persons in addition to determining what conclusions, if any, can be drawn from the morality of killing persons about the (in)equality of persons, and vice versa. I will argue that a plausible way of thinking about the moral wrongness of killing implies that the permissibility of killing innocent, nonthreatening persons depends on a person’s age. I address objections to this conclusion and discuss some potential implications of the view.     

Kant,health care and justification

An argument based on Kant for access to health-care for all is a most helpful addition to prior discussions. My paper argues that while such a point of view is helpful it fails to be persuasive. What is needed, in addition to a notion of the legislative will, is a viewpoint of community which sees justice as originating not merely from considerations of reason alone but from a notion of community and from a framework of common human experiences and capabilities.