An Ethical Assessment
Late in the Senate floor debate on comprehensive health care reform, Senator Kerrey offered an important perspective on the nature of that discursive dispute: "I really, as a member of Congress, do not have the ability to make detailed decisions that very often are not economic decisions. They are moral decisions. They are ethical decisions, about life and death" (S11104). Senator Kerrey was in the unusual position of being both very right and very wrong. Much about the comprehensive health care reform debate was moral or ethical in nature. In fact, a special 1994 issue of The Journal of Medicine and Philosophy was devoted to an explanation of ethical and moral issues on the subject of health care reform. However, decisions about life and death are often the cornerstone of legislative practice. Members of Congress are often asked to explicitly vote on the life or death decision to engage in a particular military action or not. Much more often they must make less explicit or indirect life and death decisions in connection to legal sanctions, food and nutrition programs, educational benefits, and, of course, health care. In each of these cases, the decisions made by members of Congress may well determine whether people waste away in a punitive justice effort, fail to provide their young children with ample dietary supplements, lack the educational skills to pursue a career outside the "underground" economy, or have the ability to pay for a heart bypass operation.
Kerrey's comments further suggested that ethical assessments of the 1994 comprehensive health care reform debate would be appropriate due to the serious "life and death" consequences associated with the outcome. As noted, special journal issues and other formalized medical discussions have made some such efforts. In addition, Aday ( 1993) has suggested that simple issues of cost and accessability might well have been the "wrong" questions to raise if one were to examine the need for health care reform through an ethical lens. None of these assessments, however, have focused on the discursive behavior that actually shapes or frames the ethical issues surrounding comprehensive health care reform. As talk is power generally, it is also the vehicle for the deliberation and resolution of ethical issues. Indeed, an issue