Introduction to Ethics in Health Sector. 2 Why Is Ethical Analysis Needed? Problems are not just...
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Transcript of Introduction to Ethics in Health Sector. 2 Why Is Ethical Analysis Needed? Problems are not just...
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Introduction to
Ethics in
Health Sector
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Why Is Ethical Analysis Needed?
Problems are not just technical How do we know which problems
are important? How do we know a good solution?
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Ethical Theory Alone Is Not Sufficient
Philosophical terms often are not clearly defined
Using ethical analysis to guide decisions requires practice
Moving back and forth between cases and theory can help
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Three Categories of Ethical Argument Consequences (outcomes):
Utilitarianism Rights (starting points):
Liberalism Virtues (character):
Communitarianism
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Each Perspective Has Unresolved Issues
How do we measure consequences?
Which rights do citizens have? Who defines the community and its
values?
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Utilitarianism
Policies should be judged by their consequences
What matters is well-being of individuals All individuals count equally The best action is decided by adding up
the gains and losses to all individuals “The greatest good for the greatest
number”
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It is better to be a human being dissatisfied than a pig satisfied; better to be Socrates dissatisfied than a fool satisfied.
John Stuart Mill - Utilitarianism
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How Can We Measure Utility?
Individuals evaluate their own situation: subjective utilitarianism
Experts devise an index to measure everyone’s well-being: objective utilitarianism objective utilitarianism
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Subjective Utilitarian
Ask consumers about their “willingness to pay”
Use data about prevalence, costs, and prices to calculate costs and benefits
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Problems with Subjective Utilitarianism
Suppose consumers are foolish or uninformed?
Does “willingness to pay” really measure changes in well-being?
How do we account for the fact that the rich can pay more?
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Objective Utilitarianism
Construct an index to measure health (e.g., Disability-Adjusted Life Years)
Calculate health losses for different diseases
Set priorities based on cost-effectiveness
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biggest bang for the buck
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Problems with Objective Utilitarianism Who determines the index? Accountability and transparency Technical decisions can mask value
choices: Time Age of death Disability vs. death
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General Problems with Utilitarianism Concerned with aggregate
welfare not with distribution Lack of respect for individuals Can justify inequality Technical calculations can mask
values
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Liberalism Individuals have the capacity to make
moral choices about life
Therefore, they are entitled to respect to choose their own life plan
Therefore, they have a right to preconditions for such choices
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What Rights Do People Have?
Negative rights - to be left alone, to be free to choose, to speak, buy and sell: libertarianismtarian
Positive rights – to resources needed for a reasonable range of opportunity: egalitarian liberalism
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Libertarians
Right to control your own body Right to purchase health care Priority to market, with minimal
state limits on individual choice No redistribution by state
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Egalitarian Liberals Basic right to opportunity: health
itself Role of state to redistribute
resources to assure fairness Example: Right to AIDS drugs for
worst-off in society
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Problems With Liberalism
What positive rights to citizens have in the health care arena?
Do we treat those who cause their own ill health?
What geographic scope for redistribution? Are universal rights another form of cultural
imperialism?
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Communitarianism Individuals live in society – not in
isolation A good society requires citizens
with “virtuous” character Society should instill virtue and
create a desirable social order
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Who Decides What Is Virtuous? Each society decides for itself what
is virtue (relative communitarianism)
There is one definition of virtue for all societies (universal communitarianism)
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Problems for Relative Communitarians
How do we know the boundaries of communities?
How far can communities go to suppress dissent?
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Problems for Universal Communitarians
Lack of tolerance for local or minority cultures
What happens when those with conflicting visions meet?
How do we know whose vision is correct?
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Broader Question of Broader Question of JustificationJustification
Faith Intuition Logic The World There is no justification
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Mixed Positions
Using more than one theory Principled construction of a mixed
ethical position – some examples: Utilitarian who respects some rights Egalitarian liberal sensitive to local
customs
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Implications (1)
You cannot make health policy without values
Conflicts in values often occur in making policy decisions
Conflicts occur even “inside” a theory because its implications may be ambiguous
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Implication (2) Ethical analysis can help identify
implicit values in varying policy positions
Ethical analysis can help someone clarify their own position
Ethical analysis can increase consistency, transparency, and accountability
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That’s all, folks!