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Ethical Values at Stake in Health Care Reform

Charles J. Dougherty, PhD
JAMA. 1992;268(17):2409-2412. doi:10.1001/jama.1992.03490170081029.
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THERE is every reason to believe that the 1990s will be a decade of significant change in American health care. The number of proposals for reform of the system and the rising chorus of voices demanding change suggest that some major alterations in the system are inevitable.1 Because the American health care system consumes so much of the gross national product (GNP) and because it is composed of so many powerful interest groups, health care reform will be shaped by myriad economic, political, and bureaucratic factors. But reform in something as fundamental as health care ought not to proceed merely on the basis of self-interest and political accommodations. Ethical values should also play a key role in the debate. In this article some of the central ethical values at stake are articulated in the hope that they will be more readily available for use in the national dialogue on


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