This article explores the idea of extending “compassion” toward persons with spinal cord injury (SCI) from the perspective of the contemporary insurance marketplace and its familiar reliance on actuarialization and premium pricing practices. Assuming that these economic constructs, or their public sector analogues such as taxes and eligibility criteria, are necessary to achieve adequate reserves for insurers to pay claim costs, this article will present a number of arguments showing that compassion would be extremely difficult, if not impossible, to integrate coherently and elaborately into benefits calculations. Nevertheless, because compassion is an attractive ethical notion that many persons would want to embrace or at least not wish to abandon entirely, this article ends by describing a mechanism that might inform the compassionate inclinations of a private insurer. We will conclude by proposing the creation of an SCI “compassionate care committee” and discuss various criteria that might ethically guide such a committee’s compassionate deliberations.

compassion, ethics, health insurance, spinal cord injury
Wynia M, Cummins D, Fleming D, Karsjens K, Orr A, Sabin J, Saphire-Bernstein I, Witlen R. Improving fairness in coverage decisions: performance expectations for quality improvement. Am J Bioethics. 2004;4(3):87–100.
,
Improving fairness in coverage decisions: performance expectations for quality improvement
,
Am J Bioethics
, vol.
4
(pg.
87
-
100
)
Goetz J. Annotated bibliography on compassion. Available at: http://peacecenter. berkeley.edu/research_compassion _goetz1 .html. Last accessed August 21, 2007.
Nussbaum M. Upheavals of Thought: The Intelligence of Emotions. Cambridge, UK: Cambridge University Press; 2001:301–400.
,
Upheavals of Thought: The Intelligence of Emotions
(pg.
301
-
400
)
Spinal Cord Injury Facts and Statistics. Available at: http://www.sci-info-pages.com/facts.html. Last accessed March 5, 2007.
Hagglund K, Clay D. Rural healthcare initiatives in spinal cord injury. Available at: http://www.ed.gov/pubs/AmericanRehab/spring97/sp9702.html. Last accessed March 5, 2007.
DeJong G, Sutton J. Managed care and catastrophic injury: the case of spinal cord injury. Top Spinal Cord Inj Rehabil. 1998;3:1–16.
,
Managed care and catastrophic injury: the case of spinal cord injury
,
Top Spinal Cord Inj Rehabil
, vol.
3
(pg.
1
-
16
)
Facts You Should Know About Spinal Cord Injury. Available at: http://www.liferollson. org/site/pp.asp?c=egLLKTNJE&b=79270. Last accessed August 21, 2007.
Batavia A. Of wheelchairs and managed care. Health Aff. 1999;18(6):177–182.
,
Of wheelchairs and managed care
,
Health Aff.
, vol.
18
(pg.
177
-
182
)
Baily MA. Improving fairness in coverage decisions: appearance or reality? Am J Bioethics. 2004;4(3):110–112.
,
Improving fairness in coverage decisions: appearance or reality?
,
Am J Bioethics
, vol.
4
(pg.
110
-
112
)
Engelhardt T. The Foundations of Bioethics. 2nd ed. New York, NY: Oxford University Press; 1996.
,
The Foundations of Bioethics
Warnock M. Ethics Since 1900. 2nd ed. London, UK: Oxford University Press; 1968.
,
Ethics Since 1900
Beauchamp TL. Does ethical theory have a future in bioethics? J Law Med Eth. 2004; 32(2):209–217.
,
Does ethical theory have a future in bioethics?
,
J Law Med Eth.
, vol.
32
(pg.
209
-
217
)
Beauchamp TL. A defence of the common morality. Kennedy Inst Eth J. 2003;13(3):259–274.
,
A defence of the common morality
,
Kennedy Inst Eth J.
, vol.
13
(pg.
259
-
274
)
Engelhardt HT. Bioethics in the third millennium: some critical anticipations. Kennedy Inst Eth J. 1999;9(3):225–243.
,
Bioethics in the third millennium: some critical anticipations
,
Kennedy Inst Eth J.
, vol.
9
(pg.
225
-
243
)
Wilson A, ed. World Scripture: A Comparative Anthology of Sacred Texts. St. Paul, MN: Paragon House; 1995.
,
World Scripture: A Comparative Anthology of Sacred Texts
Ezhanikatt J, et al. Compassion. In: Hunter R, ed. Dictionary of Pastoral Care and Counseling. Nashville, TN: Abingdon Press; 1990.
,
Dictionary of Pastoral Care and Counseling
,
Compassion
Banja J. The improbable future of employment-based insurance. Hastings Cent Rep. 2000;30(3):17–25.
,
The improbable future of employment-based insurance
,
Hastings Cent Rep.
, vol.
30
(pg.
17
-
25
)
Benne R. The Ethic of Democratic Capitalism: A Moral Reassment. Philadelphia, PA: Fortress Press; 1981.
,
The Ethic of Democratic Capitalism: A Moral Reassment
Banja J, De Jong G. The rehabilitation marketplace: economics, values, and proposals for reform. Arch Phys Med Rehabil. 2000;81(2):233–240.
,
The rehabilitation marketplace: economics, values, and proposals for reform
,
Arch Phys Med Rehabil
, vol.
81
(pg.
233
-
240
)
Gervais KG, Garrett JE. Wanted: more assistance in benefits design. Am J Bioethics. 2004;4(3):119–121.
,
Wanted: more assistance in benefits design
,
Am J Bioethics
, vol.
4
(pg.
119
-
121
)
Dallek G, Pollitz K. External review of health plan decisions: an update. Menlo Park, CA: The Henry J. Kaiser Family Foundation; 2000. Also available at: http://www.kff.org.
Pollitz, K. ,
External review of health plan decisions: an update
,
2000
Google Scholar
 
See, for example, “Office of the Insurance Claims Ombudsman.” Available at: http://www.state.nj.us/dobi/ombuds.htm. Last accessed August 21, 2007.
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