From a physician's perspective, personalized medicine can be seen as an extension of this effort. That set considered the prospects for comparative effectiveness research-the attempt to determine which medicines are most medically effective. This set of essays is an interesting bookend to another set of essays published in the Report recently. But what do we do, as a society, if a drug benefits only a small number of people, and perhaps provides them only a limited benefit, but is very expensive-therefore limiting the benefits that can be purchased for everybody else? The point of personalized medicine is to discover which treatments work for which people. And Len Fleck, a philosopher at Michigan State University, examines the potential costs of personalized medicine. In another essay, Ronni Sandroff, an editor at Consumer Reports, shares her views about consumers' right to obtain information about themselves it stands in tension, she notes, with the public goal of protecting people from harm. In one of the essays, for example, Karen Maschke, a Hastings research scholar, argues that personalized medicine relies on vast amounts of information gleaned from millions of patients, which generates a conflict between individual patients' traditional right to control what happens to tissues taken from them and information collected about them and the public goal of moving the research along. And here, the problem is conflict between private interests and public policy. Rather, it flows from a potential tension between the commitment not to hasten death and other aspects of hospice philosophy-namely, that the patient's ability to make informed choices is to be supported, and that the patient is not to be abandoned in the midst of medical need.Įlsewhere in this issue, a set of essays on so-called personalized medicine-the tailoring of medical care to a patient's particular phenotype-also looks at how private ethical commitments intersect with public policy. What should hospices do then? How far should they go in insisting on their own principles, and how much should they bend? The problem is not a straightforward conflict between hospice philosophy and the public good, however. Hospice philosophy is not to hasten death, but some patients in Oregon hospices can and do decide to hasten death. The focus of the article, though, is not so much the ethics of hospice care itself-what ethical principles ought to be at the core of hospice care, for example-as how those internal ethical commitments translate into action with a diverse public. In fact, their involvement is much more limited and circumspect, as authors Courtney Campbell and Jessica Cox document. Most patients who have sought physician-assisted death in Oregon did so while in hospice, suggesting to some people that hospices are centrally involved in physician-assisted death-both in patients' decision-making and in administering the medications.

The lead article is about how hospices in Oregon have dealt with the state's law permitting physician-assisted death.

It's a theme I find both fascinating and important. One of the themes running through this issue of the Hastings Center Report is the complexity of how private moral commitments cash out in the public sphere.

Sue hospice for hasten death