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Precision Medicine and Distributive Justice - Wicked Problems for Democratic Deliberation (Hardcover)
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Precision Medicine and Distributive Justice - Wicked Problems for Democratic Deliberation (Hardcover)
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Metastatic cancer and costly precision medicines generate extremely
complex problems of health care justice. Targeted cancer therapies
yield only very marginal gains in life expectancy for most patients
at very great cost, thereby threatening the just allocation of
limited health care resources. Philosophers have high hopes for the
utility of their theories of justice in addressing the challenges
of resource allocation; however, none of these theories can address
adequately the "wicked" ethical problems that have resulted from
these targeted therapies. What we need instead, bioethicist Leonard
M. Fleck argues, is a political conception of health care justice,
following Rawls, and a fair and inclusive process of rational
democratic deliberation governed by public reason. His account
makes the basic assumption that we have only limited health care
resources to meet unlimited health care needs generated by emerging
medical technologies. The primary ethical and political virtue of
rational democratic deliberation is that it allows citizens to
fashion autonomously shared understandings of how to fairly address
the complex problems of health care justice generated by precision
medicine. While ideally just outcomes are a moral and political
impossibility, "wicked" problems can metastasize if rationing
decisions are made invisibly-in ways effectively hidden from those
affected by those decisions. As Fleck demonstrates, a fair and
inclusive process of democratic deliberation could make these
"wicked" problems visible, and subject, to public reason.
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