Ethical issues related to the artificial heart

This paper is a general survey of ethical issues related to the artificial heart. It begins by looking at the history of funding of the artificial heart program through the National Institute of Health in 1965. Attention is paid to the problem of the lack of planning related to social, ethical, economic, and legal implications. The paper then deals with three areas of ethical concerns. They are those issues relating to the experimental versus therapeutic benefits, the cost, and public involvement with a private interest.

What's inside the black box: a case study of allocative politics in the Hill-Burton program

This paper explores the political and bureaucratic determinants of grant allocations within the Hospital Survey and Construction Act of 1946 (the Hill-Burton Act), which established the major hospital construction subsidy program in the United States. Resource allocation within the Hill-Burton Program was neither purely a function of external political forces impinging on the state nor purely a result of internal organizational factors. Instead, as shown in the analysis which follows, external political forces shaped program structure, operating routines, and rules and regulations at the time of the Program's formation. Rules and regulations depoliticized the grant allocation process while institutionalizing the interests of hospitals and other producers into the program structure. Consumer interests and influence are excluded from program decision making. Once established, the rules and regulations and a set of bureaucratic behaviors play a critical role in determining resource allocation. Rules and regulations facilitate distributing divisible benefits to producer interests in a politically predi-table way. Yet rules and regulations must also regulate the supply of hospital beds in accordance with local and national market conditions. The mode of operations required for distributing benefits in a politically predictable way limited the Program's ability to regulate hospital bed supply. This was a critical factor which led the Hill-Burton Program to subsidize excess capacity in the U.S. hospital system and is a useful way of explaning many similar dysfunctions within allocative programs such as Hill-Burton.