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Healthcare

healthcareThere are major ethical issues involved in the delivery and provision of healthcare.  How are funds allocated?  Who gets what, and who decides?  How are outcomes measured?  What is 'success'?  What matters most: cost-efficiency? Population health or wellbeing?  Health inequality, or absolute measures of health?  Personal preference, or a more objective understanding of best interests?

To establish what ought to be the guiding principles of healthcare is not an easy task. There are many varying perspectives.  The ethics of 'principlism' is common, wherein there are four guiding principles: justice, autonomy, beneficence and non-maleficence.  Contemporary secular bioethics focuses on autonomy as the overriding value, yet many other commentators point out the deficits and dangers in this approach.  One of the natural outcomes of a focus on autonomy is the trend towards a market model of healthcare, a situation at odds with the traditional values of medicine.  It is also at odds with the reality of life for those with chronic and disabling conditions, or who are completely dependant on others for their daily needs.

Deciding who gets what is a central task for medical ethics.  Should scarce healthcare resources be divided according to need, or ability to pay, or potential for economic productivity, or some other criteria?  Should doctors at the bedside be the gatekeepers, or should financial managers or others make the rules from a distance?  Should people get healthcare whether or not they 'deserve' it – for example should criminals or heavy smokers receive transplants that are currently in shortage?  Should cosmetic surgery be publicly funded? 

Should healthcare be a right for all, and if so does this demand that people ought not be stopped from obtaining it, or does it mean that taxes ought to pay for it all?  Should we provide means-tested healthcare?  Should people be forced to take up health insurance, and if so, at what income level?
These ethical questions are different for each country and each state within countries, and involve a myriad of complexities.  It is important that the assumptions and values underlying financial and governance decisions be recognised and analysed.