The Ethics of Healthcare and Medical Research

general
January 1, 2001
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Dear President Bush,

Congratulations on your election to office. I hope that the United States thrives under your leadership.

Although I know that your responsibilities range over a broad spectrum, I would like to ask you to consider one particular area as you plan your work for the next four years: health care and medical research. We are all, on the one hand, immensely blessed by the advances in medical knowledge to date, and we eagerly anticipate cures for cancer, AIDS, Parkinson’s, and a series of other diseases. We even have reason to hope that genetic engineering will enable us to eventually prevent many of these diseases.

On the other hand, many of the breakthroughs in medicine are available only to the wealthy. Thus, the blessing of medicine has turned into another source of division in our society along economic and social lines. Over 40 million Americans do not even have health insurance to cover the more standard forms of care. We simply should not allow that situation to continue. It does not speak well of us as a community. It is not even financially smart, for people without insurance ultimately get help in the emergency room, the most expensive way possible. With the aging of the American population, the need for health insurance and the inability to obtain it will undoubtedly only increase. For social, moral, and practical reasons, then, please devote considerable time and energy to creating a plan for guaranteeing health care for all Americans.

Immanuel Kant pointed out that if you cannot do x, you never have to ask whether you should, but as soon as you can do x, you must ask whether you should. As we become more able to treat diseases, the question of whether we should engage in treatment becomes more acute. When should we treat, and when should we alleviate pain but let nature take its course? The financial cost of some treatment is only one concern; another is the degree to which a given treatment aids the patient as a whole rather than merely responding to one particular ailment. As the American population grows older, these questions will become all the more acute. Moreover, as you enter office, the United States is the undisputed leader in medical research, but genetic engineering and stem cell research have already raised serious moral questions. I would urge that, in cooperation with Congress and state governments, you continue and expand the work of the President’s National Bioethics Advisory Commission. The Commission not only addresses these questions but also opens these moral issues to a national discussion.

As we stretch our medical and scientific abilities, our moral and - dare I say it - religious sensitivities need to be developed all the more. We will all need to marshal our abilities and resources to take advantage of the great promise that medicine, science, and technology hold for us at this time in human history. Simultaneously, we must garner as much moral wisdom and religious insight as possible to decide how and when to push forward.

Jewish tradition mandates that when seeing a political leader, we say a blessing thanking God “who has given of His glory to flesh and blood.” When seeing a scholar, the required blessing has us thank God “who has given of His wisdom to flesh and blood.” For the sake of us all, may you find it possible to combine the power of your office with wisdom; may you call upon your fellow Americans to provide health care for us all, and may you know when and how to push the envelope of scientific research.

Sincerely,
Rabbi Elliot N. Dorff
Rector and Distinguished Professor of Philosophy
University of Judaism, Los Angeles

Dear President Bush,

The single most important thing you can do is to demonstrate that the creation of wealth through the vigorous expansion of the free market can be accompanied by public policies that enhance the quality of our lives and provide some measure of fairness.

Three engines drive our strong recent economic record: globalization, technological change, and deregulation. But while globalization and technological change have created wealth, they have also exacerbated inequality. Falling unemployment has only recently kept the gap between wealthy Americans and those in the lower-middle-class and below from widening. For people who participate in the new economy, the world is their market, and they prosper. For Americans who cannot join this prosperity, the world is their lower cost competitor, and their economic position erodes.

The pressures of global competition also work against our quality of life. Countries that invite manufacturers to ignore environmental guidelines, use child labor, and provide terrible working conditions for employees have a competitive advantage. One example is global warming: Conservatives tell us that America cannot seek to reduce global warming because we would be at a competitive disadvantage with such nations as China and India who do not share this commitment. But our efforts to make that commitment a condition to open access to our economy are blocked. Globalization is a fact, and it can be an extremely beneficial one. But if it continues to exacerbate inequality and be used against efforts to improve the quality of our lives, it will generate even greater opposition than it now faces.

This is precisely what Franklin Roosevelt confronted in 1933 when he sought to rescue the current system from its own defects. He worked, uncertainly at first but ultimately successfully, to preserve a free market system with public policies that dealt with economic fairness and quality-of-life issues.

A similar synthesis is required with regard to deregulation. We have drastically reduced regulations of telecommunications, financial institutions, the shipment of goods, and air travel. This is one reason why we are now more efficient as a nation. But, like globalization, this phenomenon has a good general effect, along with negative side effects. Many Americans encounter deregulation negatively because they experience the day-to-day disruptions in their lives without directly experiencing the broader beneficial effects. Just as globalization produces greater wealth with greater inequality, deregulation often brings macro economic efficiency and micro consumer inconvenience.

It is not simply inconvenience that troubles people in the deregulatory era. Increasingly there are privacy concerns from citizens who worry that the combination of extremely sophisticated new technology with an absence of any regulatory barriers leaves them vulnerable to an uncomfortable degree of intrusion. The answer is not to stop deregulating, but to make sure that deregulation is accompanied with a full understanding of the negative side effects it can cause. Mr. President, please ensure that globalization and technological change are accompanied by a concern for fairness, and acknowledge the effects of deregulation on the market forces that impact the lives of individual consumers.

Barney Frank
Member of Congress
Massachusetts, 4th District

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