title: Ethics in American health 2: an ethical framework for health system reform.
abstract: I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage. In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health. This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.
authors.affiliation: Yale University School of Medicine, Graduate School of Arts and Sciences, and Law School, 60 College St, PO Box 208034, New Haven, CT 06520-8034, USA. jennifer.ruger@yale.edu
authors.forename: Jennifer Prah
authors.initials: JP
authors.lastname: Ruger
mesh_terms: D032921:Consensus; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis / Q000941:ethics; D003659:Decision Making, Organizational; D006233:Persons with Disabilities; D017598:Efficiency, Organizational; D028663:Ethical Theory; D019317:Evidence-Based Medicine / Q000941:ethics*; D018166:Health Care Reform / Q000941:ethics*; D006291:Health Policy; D006297:Health Services Accessibility / Q000941:ethics*; D006801:Humans; D010344:Patient Advocacy / Q000941:ethics; D011050:Policy Making; D012935:Social Justice / Q000941:ethics; D012945:Social Values; D014481:United States; D019472:Universal Health Insurance / Q000941:ethics