Is ethical analysis the missing link?

Brennan’s article, written during the Clinton administration—over a decade ago—is just as relevant now as it was then. Brennan puts forward several statements, including his assessment that medical care has, at its base, ethical roots. Because of this, “ethical roots ought to inform the institutions to which they give rise and their attendant financing arrangements”. He states, in his introduction, that ethics is generally left out of debates about finance reform, and that these debates are predominantly governed by economics and politics. This is logical; it’s hard to argue with real numbers and data, which is what economics can provide.

After presenting three solutions: health care insurance reform, health care financing reform, and health care cost reform, he concludes that financing and cost reforms are necessary to remedy the situation, and that an insurance reform is simply not enough. Whether or not Brennan’s assertion about ethics being at the root of health care is true, is not as important. Ethics is inherently linked to any social industry; working for the good of people. Ethics should be considered in any debate when an outcome will affect the well being of people.

However, the problem is figuring out how to get ethics involved. Right now, Congress, a room of politicians, decides on reforms. Brennan mentions, “The plan is only now taking shape…what will eventually emerge from Congress is impossible to predict.” He is referring to the issues of health care costs and restricted access that were addressed during the Clinton administration. However, as we all are very much aware of, the health care system is still dysfunctional. “The plan”, or any plan for that matter, has not yet seemed to work.

Right now we are in the beginning stages of Obamacare, a plan significantly based on reforming insurance. However, it seems unlikely that any big “plan” is likely to work, unless the way in which plans are created and approved is reformed. It will take more then just allowing ethics to enter the “debate”, ethics must take a main role, instead of the backseat position it has been holding for a long time. If the medical system is to indeed become the social institution that it logically should be, integrating ethics—an entity to speak on behalf of people’s health—is imperative.


9 thoughts on “Is ethical analysis the missing link?

  1. I agree with you that ethics needs to play a much bigger role in current decisions that go on in the United States. However, I think you definitely made the understandably contradicting point that: “it’s hard to argue with real numbers and data.” I think that politicians and other decision makers are afraid to incorporate ethics as a primary (or even secondary) decision maker because ethics may not seem valid or logical. Numbers and data can be proven wrong. Ethics, well, cannot really be proven because they are mostly based on opinions and arguments. Therefore, I definitely think that is difficult to argue that ethics should be the forerunner of decision making because ethics isn’t something that is necessarily practical. There aren’t blatant facts about what is considered “right” for the people. People have ideas, but people also have contradicting opinions. For example, abortion is an ethical dilemma that Democrats and Republicans have opposite views on. So, though I agree that ethics should be considered in this decision-making and planning of these systems, it will not be easy to make this happen.

  2. You argue a crucial point: ethics should be brought to the forefront of debate surrounding the designing and reform of any social institution. The purpose of a social institution is to fix problems that arise in society. When there appear kinks in these institutions, it is the responsibility of the government to enact reform in a way that benefits most of people. Otherwise, the social institution is no longer effective and should cease to exist. We have a health care system to heal and protect the health of the American people. When costs of maintaining this system became too much for individuals to pay out of pocket, cost sharing insurance schemes were created for profit. Now we are at a point, however, where the insurance schemes that should help people manage the costs of health care have become too much. How then is the government solving/preventing the societal problem of illness if the people it should be protect can’t afford protection?

    With the passing of the ACA, the government has begun to let ethics have more of a presence in healthcare reform; however, not enough. If the government were to really fix the broken health care system, they would control the number of profit-seeking individuals entering the system and truly take back to the concept of social welfare. In the United States, though, it is almost impossible to let ethics take a more prominent role without coming into conflict with other moral principles of autonomy and justice. The question comes back to what principles we value most—government non-maleficence and beneficence or physician and patient autonomy? A true free-market economy? I am curious to see whether this question will be answered in our lifetime.

  3. I do understand how it can be difficult to get ethics involved, especially when ethics varies from person to person. When creating a healthcare plan that will somehow effect every sector of the population, is is nearly impossible to create a code of ethics that will please everyone. And even so, it is nearly impossible for ethics to play a main role in political debates and health care, without strong public support and incentive. It is difficult to find such support in a crowd of politicians, economists, and policy makers, as these individuals often think in terms of concrete and measurable variables. When ethics plays a large role, these specialists are thrown off their course, as they are now expected to think in terms of immeasurable concepts like justice and morality. It is for this reason that ethicists often play a role in medical decision making. In a course I took last year entitled Predictive Health and Society, and ethicist for a hospital came to speak to us and told us about her profession. This woman told us that part of her job was to weigh various decisions with respect to moral considerations that were presented to her by the hospital staff. I think an ethicist should also play a major role in current political debate in order to reshape healthcare with ethical considerations as a focus.

  4. It is difficult to incorporate ethics in the decision making of the government and other political choices, because of the subjective voice that is given. When making decisions, it is logical to think about the well being of others. However, if there is data and statistics that reflects how a decision should be made then it is more supportive than opinions and objective. Evidence has always been proven to be more supportive, that word of mouth. In your post, you stated that one of the issues is how to get ethics involved. I think that a good way to get ethics involved would be through combining it with evidence. There may be a trend that could support the voice of the people, and incorporate ethical views.

  5. I completely agree that ethics needs to be more involved with the debate about finance reforms. I think the reason it has not been in the past is because of its subjectivity and easy ability to be argued with. Many people disagree on what is ethical, and basing reforms off of ethicality would be extremely controversial if there is not unanimous agreement. However, I think hours spent on arguing about ethicality are well worth it, because as stated, “medical care at its base has ethical roots.”

    In more recent years, financing and economics have seemingly become more important than the ethics of medical care. Pellegrino’s article regarding the self-interest versus beneficence debate in helping patients similarly reflects the recent prevalence of this issue. I do understand that numbers are easier to work with and are factual, but medicine was developed to help people and money should not be the main concern. I think the focus needs to shift back to ethics and moral behaviors.

  6. I think you make an excellent point when calling for ethics to be a critical aspect of large scale policy making. If ethics is to be a part of the medical profession, it needs to be included in every part of the medical profession, from top to bottom. It’s unrealistic to expect, and even demand, that doctors be ethical in each of their actions while the policies that control their actions are not made with ethics in mind. I also agree with Sabrina, however, that this is hard to do. As this class has shown, it’s seemingly impossible to find an absolute answer to a moral question. Ethics does involve a lot of opinions and generally the person with the best argument wins. But just because it was argued better doesn’t mean it’s “right”. It’s really hard to make policy-related issues already, let alone if we bring ethics into the picture. This doesn’t dismiss the need for ethical considerations when making policy decisions, it just shows how difficult it is to do so.

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