Distributive Justice and the New Medicine
Mackin, Amy, Journal of Psychiatry & Law
Distributive Justice and the New Medicine, by George P. Smith III (Northampton, MA: Edward Elgar, 2008), 187 pp., $30.00
In this concise volume, Professor George P. Smith III ambitiously tackles some of the most controversial topics in modern science, health and medicine. Smith, a law professor at The Catholic University of America in Washington, D. C, is the author of numerous books on bioethical topics. Here, he examines four subjects under the heading "the new medicine" - modern American health care, genetic technology, human experimentation, and organ transplantation - all through a utilitarian lens (p. 8). In particular, he focuses on how new technologies and resources should be allocated in order to maximize social utility, which is Smith's concept of distributive justice.
Published in hard copy two years ago, and now available in paperback, this book has probably only gotten more relevant in that time. In particular, the chapters addressing health care reform and stem cell research mirror the major American headlines of 2010. Smith's observation that health care has always been rationed, in that not all people have been able to get all the care they need, is a compelling counterargument for some of the rhetoric surrounding health care reform. He astutely describes the American health care system as being set within a society that is "technologically driven, individualistic, wasteful and death defying" and where the ideology of the market place supplants efforts to distribute scarce health care resources in a way that will advance society as a whole (p. 18). Smith also correctly points out that our system often places physicians in the conflicted position of being responsible for both providing care and controlling costs.
Smith analyzes health care resource allocation primarily under the rubric of quality adjusted life years, or QALYs, that measure how many extra years of healthy life will be generated by particular treatments on particular types of patients. "Because public funds are expended on health care in recognition of the social good attached to health maintenance, society has every right to administer and control the monies expended in order to assure their wise and just allocation" (p. 31). Some of the conclusions to this utilitarian calculus are provocative and even disturbing. For example, Smith advocates amending the Americans with Disabilities Act so that states can make health care decisions without having to afford preferential, or even equal, treatment to people with disabilities (p. 37). Although others might say that individuals with disabilities are among those who need health care the most, and should therefore receive more resources based on their greater need, Smith's cost-benefit framework leads instead to the conclusion that people who are not expected to have many years of healthy life ahead of them are not the best recipients of society's scarce resources.
Perhaps the boldest chapter, however, is the one dealing with "eugenics, the science that deals with improving heredity" (p. 48). Smith starts with the premise that better health is the measure society should seek to maximize, and sets forth the idea that "the social good, within this context, could be equated with an economic policy that lessens the financial burden on citizens to support and maintain genetically defective citizens" (p. …