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Ethical dimensions of Health policy
Public Health 117 (2003) 72
Book Review Ethical dimensions of Health policy M. Danis, C. Clancy, L. Churchill; Oxford University Press, New York, 2002, ISBN 0-19-514070-2, £37.50 Much has been written on the role of ethics in medical treatment, and in particular the ethical parameters of the doctor – patient relationship. Less attention has been directed to the relevance of ethical norms to wider questions of healthcare provision, in particular issues of population-based health care. This ambitious book sets out to identify ways in which traditional understandings of ethics can assist in the formulation of health policy at national, regional and practice levels, and is a very welcome addition to literature on policy making in the context of health. Although the book focuses on American settings, and a couple of chapters look in some detail at the delivery of health care in the United States, for the most part the ideas explored in the book are universal to health care policy making. The book is usefully divided into sections, looking at Identifying the Goals of Health Care, Connecting Ethics and Health Policy, Examining the Ethics of How Policy is Made, and Ethical Controversies in Health Policy (resource allocation, accountability, vulnerable populations and health care research). Chapter authors are all based in US institutions, and much of the reference literature is US published, but there is sufficient acknowledgement of commentators and developments in the UK to make the book meaningful to this jurisdiction. For a text on ethics this is a very clear and readable book. Complex arguments around notions of distributive justice, equity, economic and social utilitarianism and Kantian duties are explained, explored and applied so as to highlight their relevance without diluting the sophistication of their theoretical bases. The early chapters tackle the difficult task of justifying the need for an awareness of principles of ethics to more abstract health goals, while the later chapters focus on
0033-3506/03/$ - see front matter doi:10.1016/S0033-3506(03)00031-3
particular health dilemmas and examine the usefulness of ethics in making difficult health care policy decisions. In the introduction to the book the editors make the point, in the American context, that ‘‘changes in health-care financing and delivery make the need to connect ethics and health policy even more apparent’’. Restructuring the health care funding, facilities and staff, and reconsideration of health care priorities, can also be said to characterize the National Health Service. There is a renewed awareness that medical services have only a partial role in the attainment of health for all, and that wider issues of distribution of goods and opportunities within societies have significant implications for the health status of both individuals and populations. Understandings of these wider issues and their relevance to health must be underpinned by understandings of ethics. This book provides a broad and at the same time rigorous introduction to the role of ethics in health policy. It is an essential read for anyone with health care policy making responsibilities, but also an interesting, enlightening and useful read for health care providers, personnel and for patients trying to make sense of the way in which health care is distributed. Most importantly it is a book which should be read by the authors of government papers on health provision, so that ethical consistency becomes more apparent in approaches to health care provision and delivery. Robyn Martin Research Professor in Public Health Law Faculty of Health and Human Sciences, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK E-mail address: [email protected] Tel.: þ 44-1707-285249; fax: þ 44-1707-285995 Accepted 30 August 2002
Book Review Ethical dimensions of Health policy M. Danis, C. Clancy, L. Churchill; Oxford University Press, New York, 2002, ISBN 0-19-514070-2, £37.50 Much has been written on the role of ethics in medical treatment, and in particular the ethical parameters of the doctor – patient relationship. Less attention has been directed to the relevance of ethical norms to wider questions of healthcare provision, in particular issues of population-based health care. This ambitious book sets out to identify ways in which traditional understandings of ethics can assist in the formulation of health policy at national, regional and practice levels, and is a very welcome addition to literature on policy making in the context of health. Although the book focuses on American settings, and a couple of chapters look in some detail at the delivery of health care in the United States, for the most part the ideas explored in the book are universal to health care policy making. The book is usefully divided into sections, looking at Identifying the Goals of Health Care, Connecting Ethics and Health Policy, Examining the Ethics of How Policy is Made, and Ethical Controversies in Health Policy (resource allocation, accountability, vulnerable populations and health care research). Chapter authors are all based in US institutions, and much of the reference literature is US published, but there is sufficient acknowledgement of commentators and developments in the UK to make the book meaningful to this jurisdiction. For a text on ethics this is a very clear and readable book. Complex arguments around notions of distributive justice, equity, economic and social utilitarianism and Kantian duties are explained, explored and applied so as to highlight their relevance without diluting the sophistication of their theoretical bases. The early chapters tackle the difficult task of justifying the need for an awareness of principles of ethics to more abstract health goals, while the later chapters focus on
0033-3506/03/$ - see front matter doi:10.1016/S0033-3506(03)00031-3
particular health dilemmas and examine the usefulness of ethics in making difficult health care policy decisions. In the introduction to the book the editors make the point, in the American context, that ‘‘changes in health-care financing and delivery make the need to connect ethics and health policy even more apparent’’. Restructuring the health care funding, facilities and staff, and reconsideration of health care priorities, can also be said to characterize the National Health Service. There is a renewed awareness that medical services have only a partial role in the attainment of health for all, and that wider issues of distribution of goods and opportunities within societies have significant implications for the health status of both individuals and populations. Understandings of these wider issues and their relevance to health must be underpinned by understandings of ethics. This book provides a broad and at the same time rigorous introduction to the role of ethics in health policy. It is an essential read for anyone with health care policy making responsibilities, but also an interesting, enlightening and useful read for health care providers, personnel and for patients trying to make sense of the way in which health care is distributed. Most importantly it is a book which should be read by the authors of government papers on health provision, so that ethical consistency becomes more apparent in approaches to health care provision and delivery. Robyn Martin Research Professor in Public Health Law Faculty of Health and Human Sciences, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK E-mail address: [email protected] Tel.: þ 44-1707-285249; fax: þ 44-1707-285995 Accepted 30 August 2002