New Moral Framework for Health Care Reform

By Fulton, Jane | Humane Health Care International, November 1996 | Go to article overview
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New Moral Framework for Health Care Reform


Fulton, Jane, Humane Health Care International


The pages of Humane Health Care International reflect a compassion and a caring attitude toward patients, their families and society, that are not often found in our relationships with the formal health-care system in industrial nations. It is time to bring (to health care and to its reform) the same kind of moral framework that is reflected in the ethical principles of medicine, nursing, ministry, teaching, technologies and administration. It is time to establish a tribunal or ethics committee writ large to manage disputes and bring a humane approach to the process of changes in our health-care systems. This cannot be a committee that reflects on a difficult situation ex post, but rather one that is involved from the outset.

The tribunal would act as a third force between the power of government and its needs and the activities of the professions in health care. It would act as ethics committees do: it would examine the evidence with knowledge and experience, it would acknowledge and consider relevant moral positions, and it would ensure that patients are not forgotten.

Its recommendations and decisions would reflect the three dimensions of a broad moral framework: professional duty, fairness and the wider social costs and benefits of our various options. The tribunal is not just about being "smart enough to lead but (also) wise enough to know where we should be going." (1)

This third force would be constituted from a coalition of citizens actively involved in the formation of health policy. The public interest would be reflected in both process and outcome. The regional health authority model in Alberta provides one example of how the tribunal or third force could be structured. Although the regions have not viewed themselves as operating primarily within a moral framework, their actions demonstrate some components of an ethical approach because they moderate the force of government.

The normative model for these authorities requires them to operate within set fiscal boundaries. However, their choices of what to deliver and how services should be delivered reflect the knowledge and experience of professionals, fairness in citizens' access to services, and consideration of the social costs and social benefits of macro choices. The authority thus challenges the patient to accept a new environment.

Often attempts at health-care reform create as many problems as they solve. At the outset it is necessary to acknowledge that there is no such thing as perfect public policy, but we have an obligation to make policy as good as it can be. The ethical aspects of new healthcare sites, new information technologies, new public-private partnerships, and new population health goals will all be topics on the agenda of the tribunal. We assert that a community of concerned citizens is smart enough and wise enough to fit these emerging issues within a moral framework.

The tribunal will not only be separate from the media but will be seen to be separate. Currently, the media does not serve the public well, because it does not accurately and fairly inform them concerning health care events and issues. Without a second thought, reporters with little or no training in the health professions, health policy or research make their pronouncements for or against treatments, providers and events. As Adam Gopnick suggests, "A media that in its upper, more selfconscious reaches. . .once dealt in quiet signals now sounds and acts mean. In the past twenty years, the American press has undergone a transformation from an access culture to an aggression culture. . .Aggression has become a kind of abstract form, practiced in a void of ideas, or even ordinary sympathy. . ." (2) For example, we have great expectations of physicians--for kindness, dedication, and advocacy on our behalf--but we are prepared to revile them at the media's call. This media aggression, adds Bly, "Often seems to be fuelled by envy, an emotion that joins together journalists and ordinary citizens.

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