Quality in health care is broad, complex, and not easily measured. This essay explores the many dimensions of quality in health care and shows that many understandings of it are narrowly configured to the agendas of the respective participants--providers, patients, and institutions--in today's health care arena. Also, there are many aspects of quality that defy measurement in the epidemiological sense. These are seen in the physician-patient relationship and in special clinical situations, such as the process of dying. Using the idea of quality to buttress ethical and policy decisions, particularly by managed care organizations, is often problematic, given this complexity. It is thus imperative that those so using quality be accountable that their understanding of it be arrived at by responsible means, that it addresses something meaningful, and that it not eclipse the many other dimensions of quality.

Flagrant child abuse and neglect touches community sensibilities and suggests the option of coerced contraception in dealing with irresponsible contraception. This idea is resisted by the notion that the right to reproduce is fundamental. Law and ethics uphold this right, seeing it grounded in privacy and bodily integrity. Gender, race and class issues also argue against the idea of coerced contraception. This essay challenges these traditional positions by constructing a case for coerced contraception from several viewpoints. On balance, the right to reproduce has considerably less legal and moral weight compared to the birthright of the child not to be harmed and to have an open future. Examined critically, coerced contraception does not represent an unusual or excessive burden. Strict scrutiny and due process issues are addressed in allowing coerced contraception to become public policy. Various objections to this thesis are anticipated and answered. These include, but are not limited to, the ideas that personal dignity and the physician patient relationship are endangered and that a slippery slope would lead to greater restrictions on personal freedom.

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