This chapter introduces four specific areas of health care that promise to exacerbate the emerging crisis in medicine: organ transplantation; the treatment of disabled infants; the use of reproductive innovations; and the provision of adequate fetal environments. Although they involve different life stages, from preconception to near death, these health care areas share many characteristics. All clearly illustrate the extent to which new medical technologies and medical knowledge produce excruciating ethical and public policy impasses. They also raise questions of individual rights and obligations and of the extent to which societal good might negate personal autonomy. Together, these issues demonstrate the political difficulties we face in defining the proper role of government in making health care decisions in a pluralist society.
The discussion here is designed to describe the technical advances in each of the four areas and to explicate their policy implications. It does not analyze directly the accompanying ethical problems, nor does it specifically discuss questions concerning the possible rationing of medical resources as applied to each area. Also, examination of the role of government in these substantive areas is here kept brief: it is covered in considerably greater detail and in a more integrated fashion in succeeding chapters.
One of the most dramatic of the medical technologies, and the most expensive on a per case basis, is the transplantation of major human