Ethics and the debate on health care

The media coverage on debate regarding health care reform has been a non-stop display of people protesting “death panels” and “socialized medicine.” What hasn’t happened has been a discussion of the ethics of not providing health care to millions of people and bioethics in general. This hasn’t always been the case. Bioethics were very much the focus when the country discussed “The Tuskegee Syphilis Study” and the U.S. government issued the Belmont Report in 1978. This was the basis for the protection of human participants in research in the United States and very much should be a part of the health care policy debate. The Belmont Report’s core principles are:

(1) respect for persons: protecting the autonomy of all people and treating them with courtesy and respect and allowing for informed consent;

(2) beneficence: maximizing benefits for the research project while minimizing risks to the research subjects; and

(3) justice: ensuring reasonable, non-exploitative, and well-considered procedures are administered fairly (the fair distribution of costs and benefits to potential research participants.)

The “Tuskegee Study” was actually sponsored by the U.S. Public Health Service and studied syphilis in poor African American men in the South during the Jim Crow era of segregation. The men were not treated even after the discovery that penicillin could effectively treat syphilis in the 1940s. The study was carried out from 1932 until 1972. President Clinton officially apologized to the survivors and family members for the government’s participation in the study.

All of the bioethical principals for medical research are applicable to the debate on the reform of health care and bioethics is entering the debate. Justice, which hasn’t received enough attention to say the least, is also being discussed. According to an article in today’s NY Times (attached as “11: Debate over health policy” on Blogroll” The “dramatic advances in health care pose questions for bioethicists.” The article discusses the fact that the debate has centered on the organizational management of healthcare and ideological debates and not How do we think about the ultimate goals of te health care system and even about health itself.” (Daniel Callahan)

Most importantly to me is that the bioethics concerned in health care is not being discussed. What does it mean when there are multi-tiered levels of health care? What role is the pharmaceutical and medical device industries playing? What does end of life counseling really mean? There should be a number of questions regarding ethics for the nation as a whole including, how do we work “Justice” back into the discussion.

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