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In pursuit of the dream that patients' exercise of autonomy could extend beyond their span of competence, living wills have passed from controversy to conventional wisdom, to widely promoted policy. But the policy has not produced results, and should be abandoned.
We undertook a qualitative e-mail survey of federally-funded principal investigators of their views of the US human subjects protection system, intended to identify the range of investigator attitudes. This was an exploratory study with a 14% response rate. Twenty-eight principal investigators responded; their comments were analyzed to show underlying… (More)
The ultimate aim of health care policy is good care at good prices. Managed care failed to achieve this goal through influencing providers, so health policy has turned to the only market-based option left: treating patients like consumers. Health insurance and tax policy now pressure patients to spend their own money when they select health plans,… (More)
To the Editor—The statement by the Infectious Diseases Society of America (IDSA)  is the keenest analysis of the institutional review board (IRB) system ever published in a medical journal. It describes a regulatory regime swamped with pointless paperwork (eg, the Health Insurance Portability and Accountability Act [HIPAA]), multiple IRBs making… (More)
for patients with families. An adve cate for one person is morally d e barred fiom making decisions when more than one have legitimate interests at stake. We must, then, move beyond the ethics of the dyad or even the contemporary triad. Instead, we must learn to think in terms of family justice. Fairness to all concerned will be a major factor in… (More)