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Solomon M.Z.,The Hastings Center | Solomon M.Z.,Harvard University
Annals of the New York Academy of Sciences | Year: 2014

Modern medicine has transformed the dying experience. In the developed world, most of us no longer die from infectious diseases and sudden accidents, but from chronic illnesses that progressively worsen. Yet the U.S. healthcare system is not designed to meet the needs of people with chronic illness or of frail elders. In addition, our system incentivizes the use of technologies that are often helpful when an underlying condition is reversible but, when used very near the end of life, may only postpone the dying process and increase burdens on the patient. This state of affairs renders many people near the end of life without adequate symptom control, little or no social and psychological support, and inadequate involvement in decisions about when and how best to use modern technologies. This paper traces efforts over the last three decades to address problems related to modern dying. The author sees three phases: early work focused on securing patients' rights to refuse unwanted treatments, the next phase focused on building the specialty of palliative medicine, and the third and future phase must redesign our healthcare system to better align with how we die in the 21st century. © 2014 New York Academy of Sciences. Source

Gusmano M.K.,The Hastings Center
Italian Journal of Public Health | Year: 2010

Background: The main purpose of this essay is to review the role of primary care in the U.S. health care system and assess the probability that health reform will lead to greater emphasis on primary care. Methods: The author conducted a literature review to present an historical analysis of policies designed to increase the availability and use of primary care in the U.S. Results: Despite widespread agreement that the use of primary care should be expanded, U.S. policies have encouraged the growth of a system that relies predominantly on specialty care. The 2010 health reform law includes several provisions designed to increase the availability and use of primary care, but the new Congress has threatened to delay the law's implementation. Conclusions: As concepts, primary care and prevention enjoy nearly universal support in the U.S., but the reality does not match the rhetoric. Source

Callahan D.,The Hastings Center
Journal of Medical Ethics | Year: 2015

Much of my work in bioethics over the years has been throwing off ethics as pursued in the analytical tradition. I believe the field should steer clear of the rigid style of hyper-rationalist ethics and a reduction of ethics to a search for rules and principles. It should be open to a full range of influence, in style and substance, of literature, history and the social sciences. It should take in the full range of human life, individual and social. Source

Gusmano M.K.,The Hastings Center
Public Administration Review | Year: 2013

The responsiveness of the bureaucracy to political control is a long-standing issue for scholars in public administration. The legitimacy of decisions made by the bureaucracy often depends on the technical merits of these decisions, but deliberative decision making involving a broad array of relevant stakeholders offers another potential source of legitimacy for executive agencies. In this article, the author examines efforts to expand the role of the public in decision making at the U.S. Food and Drug Administration (FDA). The claim that patients and consumers should have a voice in FDA decisions is important, but it does not tell us how much influence they should have or what decisions require their input. Calls for creating a deliberative process for regulatory decision making are ubiquitous, but they are not likely to succeed unless agencies pay close attention to the challenge of doing this well. © 2013 by The American Society for Public Administration. Source

Sorenson C.,The London School of Economics and Political Science | Gusmano M.K.,The Hastings Center | Oliver A.,The London School of Economics and Political Science | Oliver A.,Keio University
Journal of Health Politics, Policy and Law | Year: 2014

Efforts to support and use comparative effectiveness research (CER), some more successful than others, have been promulgated at various times over the last forty years. Following a resurgence of interest in CER, recent health care reforms provided substantial support to strengthen its role in US health care. While CER has generally captured bipartisan support, detractors have raised concerns that it will be used to ration services and heighten government control over health care. Such concerns almost derailed the initiative during passage of the health care reform legislation and are still present today. Given recent investments in CER and the debates surrounding its development, the time is ripe to reflect on past efforts to introduce CER in the United States. This article examines previous initiatives, highlighting their prescribed role in US health care, the reasons for their success or failure, and the political lessons learned. Current CER initiatives have corrected for many of the pitfalls experienced by previous efforts. However, past experiences point to a number of issues that must still be addressed to ensure the long-term success and sustainability of CER, including adopting realistic aims about its impact, demonstrating the impact of Patient-Centered Outcomes Research Institute (PCORI) and communicating the benefits of CER, and maintaining strong political and stakeholder support. © 2014 by Duke University Press. Source

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