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Book SynopsisTable of ContentsProvocative Prologue 1. Precision Medicine: An Introduction to Its Ethical Ambiguity 1.1. Precision Medicine: A Patient Story 1.2. Precision Medicine: What Is It? 1.3. Precision Medicine and the "Just Caring" Problem 1.4. Precision Medicine: Another Case, More Ethics Issues 1.5. Precision Medicine: Is Rough Justice "Just Enough?" 1.6. Precision Medicine: Key Ethics Issues 1.7. Summary and Conclusion 2. Precision Medicine: Hope, Hype, and Hysteria 2.1. Precision Medicine: The Evolving Understanding of Cancer 2.2. Immunotherapy: More Resistance and More Ragged Edges 2.3. Biomarkers: Seeking Therapeutic Precision 3. Precision Medicine, Diffuse Wickedness 3.1. Precision Medicine: Wicked Ethical Issues as Resistant to Ethical Analysis as Any Cancer to Targeted Therapies 3.1.1. Wickedness: A Conceptual Description 3.1.2. The Beginning of Wickedness: Cost Matters 3.1.3. Ibrutinib and CLL: A Paradigm of Wickedness 3.1.4. Ibrutinib: Complex wickedness 3.2. More Wicked Scenarios 3.2.1. Wickedness: Ragged Edges and Bright Lines 3.2.2. Hemophilia: Wickedly Rough Justice 3.2.3. Rare Genetic Disorders: More Rough Justice and Wickedness 3.2.4. Wickedness and PCSK9 Inhibitors 3.2.5. Hepatitis C: Another Warren of Wickedness 3.2.6. Kidney Dialysis: The Headwaters of Wickedness 3.3. Wicked Ragged Edges 3.4. Spinal Muscular Atrophy: Wickedness at Birth 3.5. A Wicked Summary 4. Precision Medicine, Imprecise Health Care Justice 4.1. Precision Health Reform: What Precisely Should be Included in a Benefit Package Guaranteed to All? 4.2. Key Challenges to Health Care Justice 4.3. The Insufficiency of a Sufficientarian Conception of Health Care Justice 4.4. Luck Egalitarianism and Health Care Justice: Should Responsibility Count? 4.5. Prioritarianism and Health Care Justice: Are Precise Priorities Possible? 4.6. Egalitarianism and Health Care Justice: What is Inequitable? 4.7. Utilitarianism and Health Care Justice: What Care is "Worth It?" 4.8. Libertarianism and Health Care Justice: Only Getting What You Can Pay For 4.9. Fair Equality of Opportunity and Health Care Justice 5. Rational Democratic Deliberation: Seeking Justice Together 5.1. Rational Democratic Deliberation: Taking Seriously the Tragedy of the Commons 5.2. Medicare: An Impending Tragedy of the Commons 5.3. The Just Caring Problem: A Quick Review 5.4. Public Reason: The Core of Rational Democratic Deliberation 5.5. Public Reason, Precision Medicine, and Wicked Problems 5.6. An Outline of a Fair Deliberative Process 5.7. Just Caring: An Illustrative Example of Democratic Deliberation 5.8. Rational Democratic Deliberation: The Justification Challenge 5.9. Democratic Deliberation: Getting to Reflective Equilibrium 5.10. Priority-Setting, Wide Reflective Equilibrium, and Rational Democratic Deliberation: Addressing the Stability Problem 5.11. Constitutional Principles of Health Care Justice: Delimiting Deliberation 6. Rational Democratic Deliberation: Disciplining Wicked Challenges Justly 6.1. Organizing Precisely a Flexible Deliberative Process 6.2. Just Deliberations: Tafamidis 6.3. Some Wicked Prefatory Comments 6.4. Wicked Problems, Wicked Analyses, Wicked Deliberation 6.4.1 Combinations of targeted therapies: More benefit? More cost? 6.4.2 Just tradeoffs: Optional or obligatory 6.4.3 The super responder challenge: must we maximize? 6.4.4 Ragged edges and rough justice 6.4.5 Lazarus patients: Can we afford them? 6.4.6 Rare cancer drivers: Can we afford the cost of searching? 6.5 Super Responders: Can Aspirational Precision Medicine Generate Actual Ethical Commitments? 6.5.1 Precision medicine and non-small-cell lung cancer 6.5.2 Precision medicine and melanoma 6.5.3 Precision medicine, breast cancer and therapeutic proliferation 6.6 Precision Medicine: When is Enough, Enough? 6.7 CAR T-cell Therapies: Medical Miracle, Ethical Abyss? 6.8 CLL, Ibrutinib, CAR T-cell Therapy: A Case Study in Endless Needs 6.9 Some Preliminary Conclusions (A Resting Place) 7. Obligatory Social Beneficence: The Sufficientarian Challenge 7.1 Obligatory Social Beneficence: Ending Endless Needs 7.2 Obligatory Social Beneficence: Application Criteria 7.3 Identifying the Limits of Social Beneficence 7.4 Seeking Sufficiency by Setting Priorities 7.5 How Many Artificial Hearts Will be Sufficient? Age-Based Rationing Redivivus 7.6 Being NICE: Health Care Justice and the Terminally Ill 7.7 NICE Alternatives: Canada 7.8 Two-tiered or Not Two-tiered? That is the Problem 8. Precision Medicine, Precision Health: Finding Just and Reasonable Trade-offs 8.1 Just Caring: Cancer, Targeted Therapies, and Cost Control 8.2 Cancer: Finding the First Cell/ Preventing Future Cells 8.3 Trading off Identified Lives and Statistical Lives: Ethical Issues 8.4 Can We Just Abandon Metastatic Cancer Patients to Save Money? 8.5 The Transition Challenge: Efficiency versus Compassion 8.6 Whole Genome Sequencing: Another Precision Health Ethical Challenge 8.7 Rational Democratic Deliberation: Not Precision Ethics But "Roughly Just" 9. Public Reason and Precision Medicine: Future Hopes 10. References
