Ethics in American health 2: an ethical framework for health system reform.
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.
Ruger
Jennifer Prah
JP
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
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