Within the next two decades, the elderly population in the United States will reach its zenith, comprising 73 million individuals, 20 percent of the nation, the baby boomers’ final surge. The process of their dying may become contentious. Should policymakers and bioethicists be satisfied with our current approach to dying, or should they begin now to reconceptualize it? We distill end-of-life discussions in the bioethics literature and popular press, paying particular attention to physician-assisted suicide and its uptake where legal. Evidence so far indicates that few of the dying opt for this alternative, suggesting that its role in assuring “death with dignity” cannot be, as may have been hoped, a leading one. The end-of-life literature on the whole lends credence to the fear that most of the dying, along with their families and physicians, will muddle through a morass of uncoordinated options, with futile medical intervention the most prominent outcome — despite more palliative strategies, such as home hospice care, being favorably described. We found no reason to recommend persistence in our current approach to dying and found good reason to urge early, conscientious, and thoroughgoing reconceptualization in policy and practice as well as in theory.

This essay explores efforts to establish interdisciplinary research associations by comparing two organizations that were founded in the early 1980s. One has focused on the field of politics and the life sciences and the other on health services research. Both are involved in securing recognition for a research area—or “field of research”—that had not previously been conceptualized as a coherent academic or professional enterprise. The motivation for this paper is my interest in politics and the life sciences (the field), the organization—the Association for Politics and the Life Sciences that was established in 1980 to foster scholarly study of the field—and its journal Politics and the Life Sciences. (For the sake of clarity I adopt the convention of signifying a field entirely in lower-case orthography, beginning an organizational name with capital letters and naming the related journals in italics.)

The authors assume that costs can no longer be contained in the United States health care system and that the present system cannot be sustained beyond the near future. Three of the authors are affiliated with an applied economic research and consulting firm, and the fourth is president of the Healthcare Financial Management Association. They are trained in business and city planning. The bibliography lists articles from such journals as Hospitals, Business & Health, Business Insurance, and Medical Economics.

The book is directed to members of hospital governing boards and other hospital administrators, but it will be of interest to students of health policy. Part I highlights tensions between what the authors call the worlds of doctors and hospital administrators struggling to survive, on the one hand, and health care planners worried about spiraling costs on the other. Part II contains five chapters that suggest reasons for growing costs and that criticize cost shifting as a remedy.

In Part III the authors evaluate alternative health care systems by presenting four future scenarios: incremental change, universal access, consumer choice model, and single payer system. In these chapters they also approach the fundamental purpose of the book—to “help physicians, hospitals, and health plans take the next steps to position themselves for the future.” While not highly analytical, the book is a readable and thoughtful supplement to more abstract critiques of the impact of today's health care system on distributive justice.

In 1996, the U.S. Fish and Wildlife Service made a proposal to restore and preserve 30,000 acres of wetlands in Indiana's Kankakee River basin. Local farmers opposed this, expressing concerns about how a wildlife refuge would affect farming communities along the Kankakee River. Undergirding what seems to be a simple conflict between incompatible environmental and economic interests is a more fundamental conflict between competing ethical frameworks for evaluating public policy. One helpful approach is to examine the normative issues in the Kankakee dispute in terms of the contrast between consequentialist and non-consequentialist ethical frameworks. This article attempts to establish that a failure to recognize alternatives to the consequentialist framework has resulted in a failure of opposing parties to recognize and address each other's ethical concerns. An analysis of the Kankakee wetlands dispute will reveal why it is important for environmentalists to be cognizant of alternatives to consequentialist ethical frameworks.

With the support of a grant from the Harry Frank Guggenheim Foundation, research is currently underway on a major effort to rethink the basic theoretical issue that inspired the emergence of sociobiology. That issue, in a nutshell, concerns the explanation for the origins and evolution of social life (human societies being only one example among many others).