Daniel Callahan - Böcker

Daniel Callahan---whose cofounding of The Hastings Center in 1969 was one of the most important milestones in the history of bioethics--has written on an uncommonly wide range of issues over a long career. They have moved back and forth between clinical care of individual patients and the ethical problems of health care research and delivery. Through his many writings, four core problems have recurred in all of his work, and influence each of the others. What is health and how has its understanding been shaped by medical progress and the culture of medicine and society? What is progress, a deep value in modern health care and how should we judge it? What kinds of technological innovations that come out of the drive for progress are really good for us-and what do we do when there is a clash between individual good and social good in the use of expensive technologies, a problem now evident in the unsustainable high costs of health care? How should our understanding of the place of an inevitable death in all our lives, and its place in medicine, help us to better think of the goals of medicine and the goals of our life in seeking a good death? Those four questions have been with bioethics from its beginning and will remain with it for the indefinite future. They are the roots of bioethics.

In recent decades, we have seen five perilous and interlocking trends dominate global discourse: irreversible climate change, extreme food and water shortages, rising chronic illnesses, and rampant obesity. Why can't we make any progress in counteracting these problems despite vast expenditures of intellectual, institutional, and social capital? What makes these global emergencies the "wicked problems" that resist our best efforts and only grow more daunting? Daniel Callahan, noted author and the nation's preeminent scholar in bioethics, examines these global problems and shines a light on the institutions, practices, and actors that block major change. We see partisan political and ideological forces, old-fashioned hucksters, and trumped-up scientific disagreements but also the problem of modern progress itself. Obesity, anthropogenic climate change, degenerative diseases, ecological degradation, and global famine are often the unintended consequences of unchecked industrial growth, insatiable eating habits, and technologically extended life spans.Only through well-crafted political, regulatory, industrial, and cultural counterstrategies can we change enough minds to check these threats. With big thinking on issues that are usually evaluated separately, this book is sure to scramble partisan divides and provoke unusual, heated debate.

The idea that we have an unlimited moral imperative to pursue medical research is deeply rooted in American society and medicine. In this provocative work, Daniel Callahan exposes the ways in which such a seemingly high and humane ideal can be corrupted and distorted into a harmful practice. Medical research, with its power to attract money and political support, and its promise of cures for a wide range of medical burdens, has good and bad sides - which are often indistinguishable. In "What Price Better Health?", Callahan teases out the distinctions and differences, revealing the difficulties that result when the research imperative is suffused with excessive zeal, adulterated by the profit motive, or used to justify cutting moral corners. Exploring the National Institutes of Health's annual budget, the inflated estimates of health care cost savings that result from research, the high prices charged by drug companies, the use and misuse of human subjects for medical testing, and the controversies surrounding human cloning and stem cell research, Callahan clarifies the fine line between doing good and doing harm in the name of medical progress.His work shows that medical research must be understood in light of other social and economic needs and how even the research imperative, dedicated to the highest human good, has its limits.

Technological innovation is deeply woven into the fabric of American culture, and is no less a basic feature of American health care. Medical technology saves lives and relieves suffering, and is enormously popular with the public, profitable for doctors, and a source of great wealth for industry. Yet its costs are rising at a dangerously unsustainable rate. The control of technology costs poses a terrible ethical and policy dilemma. How can we deny people what they may need to live and flourish? Yet is it not also harmful to let rising costs strangle our health care system, eventually harming everyone? In Taming the Beloved Beast, esteemed medical ethicist Daniel Callahan confronts this dilemma head-on. He argues that we can't escape it by organizational changes alone. Nothing less than a fundamental transformation of our thinking about health care is needed to achieve lasting and economically sustainable reform. The technology bubble, he contends, is beginning to burst.Callahan weighs the ethical arguments for and against limiting the use of medical technologies, and he argues that reining in health care costs requires us to change entrenched values about progress and technological innovation. Taming the Beloved Beast shows that the cost crisis is as great as that of the uninsured. Only a government-regulated universal health care system can offer the hope of managing technology and making it affordable for all.

Much has been written about medicine and the market in recent years. This book is the first to include an assessment of market influence in both developed and developing countries, and among the very few that have tried to evaluate the actual health and economic impact of market theory and practices in a wide range of national settings. Tracing the path that market practices have taken from Adam Smith in the eighteenth century into twenty-first-century health care, Daniel Callahan and Angela A. Wasunna add a fresh dimension: they compare the different approaches taken in the market debate by health care economists, conservative market advocates, and liberal supporters of single-payer or government-regulated systems. In addition to laying out the market-versus-government struggle around the world-from Canada and the United States to Western Europe, Latin America, and many African and Asian countries-they assess the leading market practices, such as competition, physician incentives, and co-payments, for their economic and health efficacy to determine whether they work as advertised.This timely and necessary book engages new dimensions of a development that has urgent consequences for the delivery of health care worldwide.

Regardless of the fate of national health care reform, public policy makers will have to make difficult and tragic choices about which health services are more or less important. This volume, the first comprehensive examination of setting mental health services priorities, systematically explores the history, ethics, and politics of setting priorities for public mental health services. Because mental health services have traditionally been given lower priority and less generous benefits than general health services, they form a striking case study for priority setting. Written by mental health care practitioners and scholars, "What Price Mental Health?" explores the social factors that most influence attempts to set priorities; offers case studies at the state level; illustrates priorities at the federal level and in the private sector; and, identifies the ethical criteria that must be applied in any attempt to set priorities. This volume is conceptionally rich for those familiar with mental health care research, but written in a style understandable to the general reader. Policy makers will find the book useful in the on-going debates about mental health care.Psychologists, public health professionals, researchers and students of psychology, public policy and public health will find this study an absorbing and informative addition to the mental health field.

This is a provocative call to rethink America's values in health care.

This is a provocative call to rethink America's values in health care.

For much of the developed world, health care for a surging elderly population looms as one of the most daunting problems of the coming decade. In this book, contributors from diverse disciplinary backgrounds and countries discuss resource allocation for the elderly and debate plans for the years ahead. Essays focus on five general issues: the meaning of old age, the goals of medicine and health care for the elderly, the balance between the needs of the young and old, the pressures of other social priorities, and the role of families, especially the burden on women, in long-term care. In consideration of the difficult moral and practical issues involved, the editors conclude the volume with a special report containing policy recommendations from representatives of eight countries (the United States, Belgium, the Czech Republic, Germany, Hungary, the Netherlands, Sweden, and the United Kingdom). This important volume will be of interest to policymakers and a broad spectrum of health care professionals, as well as to anyone interested in the fate of the elderly or in coming health care challenges.

Drawing on his own experience, and on literature, philosophy, and medicine, Daniel Callahan offers great insight into how to deal with the rewards of modern medicine without upsetting our perception of death. He examines how we view death and the care of the critically ill or dying, and he suggests ways of understanding death that can lead to a peaceful acceptance. Callahan's thoughtful perspective notably enhances the legal and moral discussions about end-of-life issues. This title is originally published in 1993 by Simon and Schuster.

The government, the media, HMOs, and individual Americans have all embraced programs to promote disease prevention. Yet obesity is up, exercise is down, teenagers continue to smoke, and sexually transmitted disease is rampant. Why? These intriguing essays examine the ethical and social problems that create subtle obstacles to changing Americans' unhealthy behavior. The contributors raise profound questions about the role of the state or employers in trying to change health-related behavior, about the actual health and economic benefits of even trying, and about the freedom and responsibility of those of us who, as citizens, will be the target of such efforts. They ask, for instance, whether we are all equally free to live healthy lives or whether social and economic conditions make a difference. Do disease prevention programs actually save money, as is commonly argued? What is the moral legitimacy of using economic and other incentives to change people's behavior, especially when (as with HMOs) the goal is to control costs?One key issue explored throughout the book is the fundamental ambivalence of traditionally libertarian Americans about health promotion programs: we like the idea of good health, but we do not want government or others posing threats to our personal lifestyle choices. The contributors argue that such programs will continue to prove less than wholly successful without a fuller examination of their place in our national values.

SIDNEY CALLAHAN AND DANIEL CALLAHAN This book, like many other things to do with abortion, is a product of long controversy. Though carried out with cooperation, it was conceived in conflict. The conflict between the coeditors has per­ sisted for years-in fact, for at least half of their thirty-year marriage. One, Sidney, is prolife; the other, Daniel, is prochoice. Ever since the topic of abortion became of professional interest to us, in the 1960s, we have disagreed. At one time, while Daniel was writing a book on the subject, Abortion: Law, Choice and Morality (1970), we talked about the subject every day for the four years of the book's gestation. On many occasions during the 1970s, prolife articles writ­ ten by Sidney were passed out at Daniel's lectures in order to refute his pro choice views. Over the years, every argument, every statistic, every historical example cited in the literature has been discussed by the two of us. As Eliza Doolittle says about "words" in My Fair Lady, "There's nota one I haven't heard. " And yet we still disagree. How can it be, we ask ourselves, that intelligent people of goodwill who know all the same facts and all the same arguments still come down on different sides of the con­ troversy? As we well know, it is possible to agree about many things and have great love and respect for an opponent, and still differ.

A concern for the ethical instruction and formation of students has always been a part of American higher education. Yet that concern has by no means been uniform or free from controversy. The centrality of moral philosophy in the undergraduate curriculum during the mid-19th Century gave way later during that era to the first signs of increasing specialization of the disciplines. By the middle of the 20th Century, instruction in ethics had, by and large, become confined almost exclusively to departments of philosophy and religion. Efforts to introduce ethics teaching in the professional schools and elsewhere in the university often met with indifference or outright hostility. The past decade has seen a remarkable resurgence of the interest in the teaching of ethics, at both the undergraduate and the professional school levels. Beginning in 1977, The Hastings Center, with the support of the Rockefeller Brothers Fund and the Carnegie Corporation of New York, undertook a system­ atic study of the state of the teaching of ethics in American higher education.

OUR AGE IS CHARACTERIZED by an uncertainty about the na­ ture of moral obligations, about what one can hope for in an afterlife, and about the limits of human knowledge. These uncertainties were captured by Immanuel Kant in his Critique of Pure Reason, where he noted three basic human questions: what can we know, what ought we to do, and what can we hope for. Those questions and the uncer­ tainties about their answers still in great part define our cultural per­ spective. In particular, we are not clear about the foundations of ethics, or about their relationship to religion and to science. This volume brings together previously published essays that focus on these inter­ relationships and their uncertainties. It offers an attempt to sketch the interrelationship among three major intellectual efforts: determining moral obligations, the ultimate purpose and goals of man and the cosmos, and the nature of empirical reality. Though imperfect, it is an effort to frame the unity of the human condition, which is captured in part by ethics, in part by religion, and in part by the sciences. Put another way, this collection of essays springs from an attempt to see the unity of humans who engage in the diverse roles of valuers, be­ lievers, and knowers, while still remaining single, individual humans.

The social sciences playa variety of multifaceted roles in the policymaking process. So varied are these roles, indeed, that it is futile to talk in the singular about the use of social science in policymaking, as if there were one constant relationship between two fixed and stable entities. Instead, to address this issue sensibly one must talk in the plural about uses of dif­ ferent modes of social scientific inquiry for different kinds of policies under various circumstances. In some cases, the influence of social scientific research is direct and tangible, and the connection between the find­ ings and the policy is easy to see. In other cases, perhaps most, its influence is indirect-one small piece in a larger mosaic of politics, bargaining, and compromise. Occasionally the findings of social scientific studies are explicitly drawn upon by policymakers in the formation, implementation, or evaluation of particular policies. More often, the categories and theoretical models of social science provide a general background orientation within which policymakers concep­ tualize problems and frame policy options. At times, the in­ fluence of social scientific work is cognitive and informational in nature; in other instances, policymakers use social science primarily for symbolic and political purposes in order to le­ gitimate preestablished goals and strategies. Nonetheless, amid this diversity and variety, troubling general questions persistently arise.

At the center of the debate over complementary and alternative medicine - from acupuncture and chiropractic treatments to homeopathy and nutritional supplements - is how to scientifically measure the effectiveness of a particular treatment. Fourteen scholars from the fields of medicine, philosophy, sociology, and cultural and folklore studies examine that debate, and the clash between growing public support and the often hostile stance of clinicians and medical researchers. Proponents and critics have different methodologies and standards of evidence - raising the question of how much pluralism is acceptable in a medical context - particularly in light of differing worldviews and the struggle to define medicine in the modern world. The contributors address both the methodological problems of assessment and the conflicting cultural perspectives at work in a patient's choice of treatment. Sympathetic to CAM, the contributors nonetheless offer careful critiques of its claims, and suggest a variety of ways it can be taken seriously, yet subject to careful scrutiny.