Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself.

Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.

The issues explored in this book have unfortunately come to be known as 'maternal-fetal conflicts'. The phrase is unsatisfactory because it is misleading: It places the emphasis on the well-being of the fetus instead of on the born child (who will bear the burden of any harm done prenatally); it assumes a conflict between a pregnant women and her offspring (while the issue is usually more complex and more broadly based); and it incorrectly implies that all pregnant women are appropriately regarded as mothers. For these reasons, I have chosen to avoid the phrase 'matern- fetal conflict' altogether, and will instead speak in terms of 'preventable prenatal harm'. I mention this at the outset, for those of you familiar with 'maternal-fetal conflicts' who might be wondering if I am addressing the same issues. Yes. But I am trying to look at them in a new - and I hope more fruitful - way. I would like to thank the other participants in the Hastings Center's maternal-fetal project - especially those who disageed with me - for being so thought-provoking. And I owe a lasting debt of gratitude to Henry Ruth and Allen Buchanan for their invaluable counsel.

The issues explored in this book have unfortunately come to be known as 'maternal-fetal conflicts'. The phrase is unsatisfactory because it is misleading: It places the emphasis on the well-being of the fetus instead of on the born child (who will bear the burden of any harm done prenatally); it assumes a conflict between a pregnant women and her offspring (while the issue is usually more complex and more broadly based); and it incorrectly implies that all pregnant women are appropriately regarded as mothers. For these reasons, I have chosen to avoid the phrase 'matern- fetal conflict' altogether, and will instead speak in terms of 'preventable prenatal harm'. I mention this at the outset, for those of you familiar with 'maternal-fetal conflicts' who might be wondering if I am addressing the same issues. Yes. But I am trying to look at them in a new - and I hope more fruitful - way. I would like to thank the other participants in the Hastings Center's maternal-fetal project - especially those who disageed with me - for being so thought-provoking. And I owe a lasting debt of gratitude to Henry Ruth and Allen Buchanan for their invaluable counsel.

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.

Health care in the US and elsewhere has been rocked by economic upheaval. Cost-cuts, care-cuts, and confusion abound. Traditional tort and contract law have not kept pace. Physicians are still expected to deliver the same standard of care -- including costly resources - to everyone, regardless whether it is paid for. Health plans can now face litigation for virtually any unfortunate outcome, even those stemming from society's mandate to keep costs down while improving population health. This book cuts through the chaos and offers a clear, persuasive resolution. Part I explains why new economic realities have rendered prevailing malpractice and contract law largely anachronistic. Part II argues that pointing the legal finger of blame blindly or hastily can hinder good medical care. Instead of "whom do we want to hold liable," we should focus first on "who should be doing what, for the best delivery of health care." When things go wrong, each should be liable only for those aspects of care they could and should have controlled. Once a good division of labor is identified, what kind of liability should be imposed depends on what kind of mistake was made. Failures to exercise adequate expertise (knowledge, skill, care effort) should be addressed as torts, while failures to provide promised resources should be resolved under contract. Part III shows that this approach, though novel, fits remarkably well with basic common law doctrines, and can even enlighten ERISA issues. With extensive documentation from current case law, commentary, and empirical literature, the book will also serve as a comprehensive reference for attorneys, law professors, physicians, administrators, bioethicists, and students.