This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who (...) should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be. (shrink)

Many clinicians believe that allowing costs to influence clinical decisions is unethical. They are mistaken in this belief, because it cannot be ethical to ignore the adverse consequences upon others of the decisions you make, which is what 'costs' represent. There are, however, some important ethical issues in deciding what costs to count, and how to count them. But these dilemmas are equally strong with respect to what benefits to count and how to count them, some of which expose ethically (...) untenable assumptions about such widely-used clinical criteria as survival rates. One of the advantages of systematic cost-effectiveness analysis is that it exposes these hidden assumptions, and requires explicit judgements to be made about which ethical position is appropriate in a particular policy context. This should have the important incidental benefit of improving the accountability of policy-makers to the community they are serving. (shrink)

This study is part of a programme to elicit and examine community preferences for health care in different contexts. Data were obtained from a group of predominantly Australian health care decision-makers. A short questionnaire contained six valuation questions and four demographic questions. The six valuation questions posed choices where equal health gains were to be allocated to different population groups based upon: age; sex; current health; socio-economic status; across time; and across different numbers of individuals. The results provide some evidence (...) that respondents were prepared to discriminate between health gains derived in different contexts especially where health gains were to be allocated between groups of different health status and over time. Further research is planned and the possible implications for health policy, and in particular for resource allocation in health care, are briefly discussed. (shrink)

This paper explores how medical practice ought to be conducted, in the face of scarcity, if our objective is to maximise the benefits of health. After explaining briefly what the cost-per-QALY criterion means, a series of ethical objections to it are considered one by one. The objectors fall into four groups: a. those who reject all collective priority-setting as unethical; b. those who accept the need for collective priority-setting, but believe it is contrary to medical ethics; c. those who accept (...) the need for collective priority-setting, and do not believe that it is contrary to medical ethics, but reject the role of QALYs in it; d. those who accept the need for collective priority-setting in principle, but are unwilling to specify how it should be done in practice. -/- The purpose of this discussion paper is to give each group a hard time! (shrink)

Practical Medical Ethics David Seedhouse The University of Liverpool, UK and Lisetta Lovett St George’s Hospital, Stafford, UK Creatively balancing philosophical theory with clinical needs, Practical Medical Ethics looks at medical decision-making from a remarkably fresh perspective. Concise, interactive and lively, the book offers a consistently applicable approach to problem solving in health care. A mix of clinically relevant cases, many of which illustrate commonplace ethical dilemmas, offers doctors and students a variety of ways to enhance their practical reasoning abilities. (...) With the aid of two decision-making tools—the unique Ethical Grid and a complementary Algorithm—fifteen medical scenarios are analysed. Often more than one solution is put forward, at which point the reader is challenged by exercises to develop the strongest possible justification for his or her preference. This colourful and imaginative book is intended for use in the design of courses for medical and other health care professionals, but is equally useful for independent study and practice. Practical Medical Ethics provides new skills and insights with minimum fuss and invigorating originality, and will enhance the talents of all who care for health. Other Related Books Health: The Foundations for Achievement David Seedhouse September 1986 Ethics: The Heart of Health Care David Seedhouse July 1988 Liberating Medicine David Seedhouse March 1991 Philosophical Medical Ethics Raanan Gillon October 1986. (shrink)

Liberating Medicine David Seedhouse Unit for the Study of Health Care Ethics, Department of General Practice, University of Liverpool, UK Amid the increasing debate about the practice of medicine and the delivery of health care lie certain fundamental questions: What is the purpose of medicine? What is the role of the medical profession? and Where should the limits of medical intervention be set? In a world of rapid scientific and technological advance, public expectations place increasing demands on the doctor’s skills, (...) and the scope of medical practice needs constantly to be redefined. Yet few guidelines exist on how to go about this. Liberating Medicine is designed to help doctors and health care professionals to understand the role, scope and purpose of their work, by showing that through heightened recognition of possible goals and potential limits, doctors will be more free to select the most beneficial targets for their health work, to plan their strategies for care freely within their practice, and to be able to liberate more fulfilling potentials in those for whom they care. Although rooted in theoretical analysis the book is essentially practical. It contains teaching exercises, a model which can be used to show doctors how close to the limits of practice they are, and a workable checklist for use in interactions with individual patients. All those involved in the study and practice of medicine—but particularly medical students and their teachers—will find this a thought-provoking, stimulating and innovative guide to the philosophical principles of medicine and how these can be applied to everyday practice. Other Related Books Health: The Foundations for Achievement David Seedhouse September 1986 Ethics: The Heart of Health Care David Seedhouse July 1988 Changing Ideas in Health Care Edited by David Seedhouse and Alan Cribb June 1989 Philosophical Medical Ethics Raanan Gillon October 1986. (shrink)

This inspirational book provides the philosophical backbone tocountless courses for health professionals. It poses twofundamental questions - "What is health?" and "How can more healthbe achieved?" - and answers them at a depth unmatched by any othertext in this field. David Seedhouse shows that these questions lieat the heart of health practice, and explains why all healthworkers should ponder them deeply. This second edition retains the freshness and enthusiasm of thefirst, while making the foundations theory and its practicalapplications clearer and (...) more accessible than ever. The bookincludes additional material and discussion, new case studies andrevised illustrations. * Describes and explores competing theories of health * Establishes a practical and ethical foundation for healthpromotion and education * Explains the foundations theory - a novel and comprehensive wayto understand health * Shows how the foundations theory might be used to create morehumane health services. (shrink)

Ethics: The Heart of Health Care - a classic ethics text in medical, health and nursing studies - is recommended around the globe for its straightforward introduction to ethical analysis. In this new edition David Seedhouse demonstrates tangibly and graphically how ethics and health care are inextricably bound together, and creates a firm theoretical basis for practical decision-making. He not only clarifies ethics but, with the aid of the acclaimed Ethical Grid, teaches an essential practical skill which can be productively (...) applied in day-to-day health care. This edition, which is even more readable than the first, includes additional case studies and teaching exercises, contains new material on ethical theory and offers two further decision-making tools - The Rings of Uncertainty and the Autonomy Test. The engaging new introduction reveals the genesis of the Ethical Grid, illuminates the intent and argument of the first edition, and explains why the book is needed today as much as ever. Intended for all who work in health care or health studies - indeed for anyone with an interest in health issues - this is a highly original, innovative and accessible work on a subject traditionally regarded as lofty and obscure. It clarifies a wide variety of complex ethical issues and will give the reader fresh inspiration and renewed confidence in dealing with the demands of modern health work. (shrink)