Rationing Sanity

cover art
192 pp., 6 x 9
ISBN: 9780878401451 (0878401458)

December 2003
LC: 2003006467

Hastings Center Studies in Ethics series


Table of Contents

Rationing Sanity
Ethical Issues in Managed Mental Health Care
James Lindemann Nelson, Editor
Mental illness is the poor, and somehow "damaged," cousin to physical ailments in the eyes of too many in our society. Compare the difference in how people would respond to someone who had fallen and broken their leg on the street, to how most react to those mentally ill among us, on those same streets, who spend their winters on steam grates and forage for food in dumpsters. Rationing Sanity is a provocative analysis of the mental health care system in the United States, dealing with issues of justice and access to mental health care.

How should a decent society, affluent but facing many serious calls on its resources, best care for citizens afflicted with severe and persistent mental illnesses? James Lindemann Nelson brings together, for the first time, scholars of the ethics of mental health care and top managed care policy analysts to address this crucial problem. Rationing Sanity integrates those perspectives with the thoughtful practice-based experience of physicians well versed in the actual care of people with emotional and behavioral problems. Over a period of years, the contributors met face-to-face to engage each other on the ethics of managed mental health care—the result is a unique, collaborative effort that provides a wealth of important new insights on not only how Americans can readjust their attitudes toward the mentally ill—but also how we may find more just and humane treatment for those afflicted.
James Lindemann Nelson is professor of philosophy at Michigan State University, and is the author, most recently, of Hippocrates' Maze: Ethical Explorations of the Medical Labyrinth.
Gregory E. Kaebnick and Daniel Callahan, Series Editors
"The ethical issues of managed care are more pronounced for mental health than for other areas, yet little systematic attention has been paid to them. Rationing Sanity makes a valuable contribution to the ongoing effort to rethink the importance of both professional and institutional values in the managed care environment."—Larry R. Churchill, Ann Geddes Stahlman Professor of Medical Ethics, Vanderbilt University Medical Center

"Not only does Rationing Sanity include excellent new work on the ethics of allocating scarce resources in health care, but it also focuses on controversies in mental health. This important collection will significantly enrich the contemporary debate in medical ethics."—Christian Perring, Department of Philosophy, Dowling College

Table of Contents
Introduction: Rationing Sanity
James Lindemann Nelson

1. Shifting Focus: The Historical Meaning of Managed Care and the Search for Ethics in Mental Health
Gary S. Belkin

2. The Ethics of Managed Care: Medical Ethics or Business Ethics?
Allen Buchanan

3. Whether to Discontinue Nonfutile Use of a Scarce Resource
Frances M. Kamm

4. The Just Allocation of Mental Health Care
Eric Rakowski

5. Resource Allocation for Mental Health Care and the Aggregation Problem
Bentson H. McFarland

6. Commentary on the Just Allocation of Mental Health Care
Laura Weiss Roberts, Teresita McCarty, and Sally K. Severino

7. The Democracy Problem in Mental Health Care Priority Setting
Dan W. Brock

8. The Democracy Problem as Applied to the Oregon Health Plan and its Prioritization of Mental Health Services
David A. Pollack

9. Saving the Worst Off (Principle)
James Lindemann Nelson

10. Managed Mental Health Care: Ethical Issues for Providers, Patients, and Managers
Tia Powell


Gary S. Belkin Dan W. Brock Allen E. Buchanan Frances M. Kamm Terisita McCarty Benston H. McFarland James Lindemann Nelson David A. Pollack Tia Powell Eric Rakowski Laura Weiss Roberts Sally K. Severino