more emphasize is that medicine, although based in science, can be, and often is, used for social objectives. Conflicting values then come into play in decisions that can be beneficial or harmful to those affected. We have the law to shore up individual rights through due process, through the asseveration of autonomy and self-determination regarding principles of privacy, and we have a body of bioethical literature that likewise addresses individual rights ( Rawls 1971; Walzer 1983). On the other hand, both the law and bioethics are susceptible to interpretation; and this interpretation, based on cultural values, may easily shift at any point from emphasis on community or societal values to emphasis on individual values.
Since the mid- 1970s the increasing concern about the cost of health care has indicated that economic factors are pivotal in generating social and political decisions in health care. The crisis of economics in health care is being felt on all levels -- the care of children, the care of adults, the care of the mentally ill, and the care of the elderly. But it is this last group that is open to the most potential for abuse. They are a growing number in our society, and they are perceived increasingly as consumers of societal goods rather than as producers. Such factors weigh heavily in the interpretation of constitutional, legal, and bioethical principles regarding self-determination, autonomy, due process, and conflicts between the individual and society. They will continue to do so unless we ask the pertinent ethical questions: What kind of life do we want? What kind of world do we want? What must we do, or refrain from doing, to attain it?
Avila D. 1993. "Medical Treatment Rights of Older Persons and Persons with Disabilities: 1992 Developments". Clearinghouse Review: 1267-76.
Callahan Daniel. 1987. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster.
Cole T. R. 1987. "Class, Culture and Coercion: A Historical Perspective on Long Term Care". Generations 11:9-15.
Devereux George. 1967. From Anxiety to Method in the Behavioral Sciences. Paris and The Hague: Ecole Pratique des Hautes Etudes and Mouton.
Dworkin R. 1977. Taking Rights Seriously. Cambridge, Mass.: Harvard University Press.
Engel Heinrich. 1987. The Japanese House: A Tradition for Contemporary Architecture. Rutland, Vt., and Tokyo: Chas. E. Tuttle.
Feinson M. 1985. "Aging and Mental Health: Distinguishing Myth from Reality". Research on Aging 7:155.
Folstein N., J. D. Anthony, I. Parhad, B. Duffy, and E. Gruenberg. 1985. "The Meaning of Cognitive Impairment in the Elderly". Journal of the American Geriatrics Society 33:228.
Fromm Erich. 1947. Man for Himself. An Inquiry into the Psychology of Ethics. New York: Holt, Rinehart and Winston.