Debates over health care have focused for so long on economics that the proper goals for medicine seem to be taken for granted; yet problems in health care stem as much from a lack of agreement about the goals and priorities of medicine as from the way systems function. This book asks basic questions about the purposes and ends of medicine and shows that the answers have practical implications for future health care delivery, medical research, and the education of medical students.

The Hastings Center coordinated teams of physicians, nurses, public health experts, philosophers, theologians, politicians, health care administrators, social workers, and lawyers in fourteen countries to explore these issues. In this volume, they articulate four basic goals of medicine — prevention of disease, relief of suffering, care of the ill, and avoidance of premature death — and examine them in light of the cultural, political, and economic pressures under which medicine functions. In reporting these findings, the contributors touch on a wide range of diverse issues such as genetic technology, Chinese medicine, care of the elderly, and prevention and public health.

The Goals of Medicine clearly demonstrates the importance of clarifying the purposes of medicine before attempting to change the economic and organizational systems. It warns that without such examination, any reform efforts may be fruitless.

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.

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.

A provocative call to rethink America's values in health care.

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.

Originally published in 1993 by Simon and Schuster.

A provocative call to rethink America's values in health care.

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.

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.