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Wednesday, 13 July 2011

Public health ethics - an overlooked perspective

The field on  biomedical ethics has blossomed over the past decade - and thankfully so.  Care to individual patients has been improved through a standard set of principles, which have their basis in the Hippocratic Oath and basically try to ensure that actions are beneficial, are not harmful, are applied with fairness to all, and respect for the individual.

The field of public health ethics has received much less attention.  With a recogntion that the general benefit of the population at times conflicts with the principle of respect for the individual.

Perhaps it seems not relevant in day to day practice. When looking at the allocation of scarce resources and investment in those actions that will benefit the greatest number - it should be considered. However, faced with the patient in dire need of care, respect for the individual and the desire to do good will naturally predominate.  When we are in crisis and in need of the emergency department this is a reassuring thought

Contrasting however, is that the ability to provide emergency care for future generations may well be compromised by our inability to direct existing resources.   We need only look south of the border to where 20% of the population could shy away from an emergency department for fear of the costs - the result being a population that despite its economic vitality, has some of the poorest indicators of health of the developed world.

Have you considered the difficult question of when should limitations be placed on individual care for the sake of protecting the public's health?  it is a question that does not carry political currency - and as such our response is to hide our heads in the sand hoping that each year the health system allocation of resources can continue to grow at twice the growth in the economy.   Even worse, is the compromise of services that might actually protect the public's health for the sake of squeezing a few drops more money to provide care services. 

Where are the ethicists challenging our shortsighted approaches to health allocation?

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