Medicine, morals and money have, for centuries, lived in uneasy cohabitation. Dwelling in the social institution of care of the sick, each needs the other, yet each is embarrassed to admit the other's presence. Morality, in particular, suffers embarrassment, for it is often required to explain how money and medicine are not inimical. Throughout the history of Western medicine, morality's explanations have been con­ sistently ambiguous. Pla.o held that the physician must cultivate the art of getting paid as well as the art of healing, for even if the goal of medicine is healing and not making money, the self-interest of the craftsman is satisfied thereby [4]. Centuries later, a medieval medical moralist, Henri de Mandeville, said: "The chief object of the patient ... is to get cured ... the object of the surgeon, on the other hand, is to obtain his money ... ([5], p. 16). This incompatibility, while general, is not universal. Throughout history, medical practitioners have resolved the problem - either in conscience or to their satisfaction. Some physicians have been so reluctant to make a profit from the ills of those whom they treated that they preferred to live in poverty. Samuel Johnson described his friend, Dr. Robert Levet, a Practiser of Physic: No summons mock'd by chill delay, No petty gain disdain'd by pride; The modest wants of ev'ry day The toil of ev'ry day supplied [3].

Inhalt

I / Medical Economics and Ethics: Some Theoretical Considerations.- Economics and the Allocation of Resources to Improve Health.- Economic Cost and Moral Value.- II / Costs and Benefits in Medicine: Some Philosophical Views.- Computing the Quality of Life.- CBA, Utilitarianism, and Reliance Upon Intuitions.- Prior Consent and Valuing Life.- Cost-Benefit Analysis, Monetary Value, and Medical Decision.- III / Economics and Ethics in Health Policy.- Intervention Against Genetic Disease: Economic and Ethical Considerations.- Ethical Reflections in Genetic Screening: A Reply to Swint and Kaback.- Rationing Medical Care: Processes for Defining Adequacy.- Comments on "Rationing Medical Care: Processes for Defining Adequacy".- Rationing and Publicity.- Comments on "Rationing and Publicity".- IV / Controlling Costs/Maximizing Profit: The Role of Providers.- Physicians and Cost Control.- Shifting Priorities and Values: A Challenge to the Hospital's Mission.- Shifting the Priorities and Values: A Commentary on Hiller and Gorsky.- Notes on Contributors.