Buzz Words or Principles: Ethics & Health-Care Reform

Article excerpt

In June 1990, when I was lining up the witness list for a Senate Finance Committee hearing on the Patient Self-Determination Act, a prominent medical ethicist declined to testify for fear of having his views distorted and manipulated by the political process. The bill, which became law that fall and which required medical facilities to distribute information about living wills and durable powers of attorney, was the first piece of federal legislation to deal explicitly with end-of-life decision making--a major ethical issue. Yet this respected ethicist expressed skepticism about the capacity of a political forum, such as a congressional hearing, to capture adequately the nuances and complexities of the issue. Only two years out of divinity school and convinced of the political relevance of ethics, I argued with him that ethicists have a responsibility to engage in the public dialogue about health-care issues to ensure that the human and ethical dimensions be addressed along with economic factors.

Three years later, watching the national health-care debate, I think this bioethicist may have made a salient point about the relationship between ethics and politics.

As the Clinton administration begins to unveil its plan for our ailing system, the feasibility of marrying ethics and politics remains an open question. Of the four hundred or so members of the President's Task Force on National Health Reform, a small number were engaged in the discussion of ethical matters. Although the ethics group did not convene until many of the other "clusters" and "subgroups" were well underway, one of its tasks was to articulate the principles underlying the effort to reform health care. Thus, the parameters of the new health-care system were set before the ethics group ever met, and participants in groups constructing basic aspects of the plan said they had little or no exposure at all to the "ethics people." In one sense, that isolation might have been positive because each group was free to function without outside pressures. But then, we have to ask, what contribution did the ethics group make? And what relevance did its deliberations have in the formation of the Clinton health-care policy?

There is no question that in the realm of health-care reform, critical ethical choices must be made. One of the most politically difficult--medical rationing--wasn't even touched. In the view of an aide to Hillary Rodham Clinton, the administration needs to prove its credibility in containing overall health-care costs before even discussing whether some forms of medical care are worth the limited benefits they provide. …