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Changing the Subject: Ethical Principles for Everyone in Health Care
- Frank Davidoff, MD, Editor
- Dr. Davidoff: American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.
Over a year ago, Annals and the BMJ published a working draft of ethical principles for everyone in health care (1, 2). The effort grew out of the conviction that the existence of separate moral frameworks, in which each professional group—physicians, nurses, hospital executives, others—tries to gain the moral high ground, reflects the flawed perception that its work improves the well-being of patients separately, when in fact health care works well only as a system of true interdependencies (3). Developed initially by a group of 15 interested people that included physicians, nurses, health care executives, academicians, ethicists, a jurist, an economist, and a philosopher, these Tavistock principles (so-called because the group first met near Tavistock Square in London) are intended ultimately to be a useful, shared working tool, rather than just high-minded words on paper.
Experienced legislators know that laws don't get passed unless the “three Ps”—problem, proposal, and politics—come together properly. First, there has to be a problem; more importantly, people have to agree there's a problem. Second, someone has to propose law that might help with the problem. And third, the politics have to line up in support of the proposed law. Ethical principles aren't laws, but like laws they guide and shape behavior. It seems only reasonable, therefore, to expect that a set of ethical principles for everyone in health care isn't likely to be adopted unless and until the “three Ps” are in place. Where do the ethical principles stand in that regard? What's the problem? What's in the proposal? And where are we on the politics?
Deciding whether there's a problem isn't hard: Health care systems throughout the world are rife with tough, complicated problems. Limited access to care, for financial and other reasons. Inefficiency and waste, including unnecessary and ineffective testing and …
