Philip J. Boyle

New directions in nursing home ethics

We believe that a new agenda for the ethics of long-term nursing home care could be set by seeing nursing homes as communities of caring and interdependency. The goal should be not simply to eliminate or minimize dependency whenever possible, but to make a genuinely creative and nurturing use of the dependency that is an inevitable reality for most nursing home residents. Nursing homes are rarely places of curing, but they can and should be places of healing -- of making whole -- of enabling frail or chronically ill persons to use their dependency to grow as human beings... In general, nursing home regulation is a matter of striking a delicate balance between that degree of control necesary to ensure a basic standard of decent and humane care, and that degree of professional discretion needed to allow nursing homes to respond to their own particular problems of care as they make creative use of the dependency that is an essential fact of nursing home life.

Shaping Priorities in Genetic Medicine

... Such moral problems raise the question whether society should make all or only some of the potential and existing genetic technologies widely available. Add to this the very real concern that the throng of products and services generated through this research has the potential to put significant further pressure on a health care system that already cannot provide adequate services to all persons. Given current restructuring of U.S. health services along the lines of managed health care, the need and desire of public and private parties to manage health resources aggressively by controlling costs and quality of care will call the question about what services to make available, to whom, on what basis. By what criteria should priorities be set? Should genetic services sought by only a few be made available? Should genetic screening and testing be offered for conditions for which there is no cure? Should specific groups be targeted for the distribution of genetic services? Are any genetic services more important than others? Where do genetic services fit relative to other health services? And -- the perennial question -- who should make these decisions? What does the newly emerging debate over the fair distribution of health resources mean for genetics?