4th Global Conference
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Monday 4th July - Thursday 7th July 2005
Mansfield College, Oxford
Conference Programme, Abstracts & Papers
Session 10A: Health and Ethics
Chair: Peter Schulz
Health and Ethical Choices in Economics
Delphine Arweiler
Department of Health Policy, Management and Evaluation, Faculty of Medicine,
University of Toronto, Toronto, Ontario, Canada
Economists have used different
strategies to introduce the notion of health into economics. Notable
examples include the integration of some of the characteristics of health
into economic concepts and the referencing of intermediary concepts,
such as the demand for health care or health determinants, as echoes
of health. These strategies, which could be qualified as indirect conceptualizations
of health, reveal the difficulty economics has in conceptualizing health.
This presentation shows that the absence of a conceptualization of health
in economics leads to implicit ethical choices in economic analysis which
shape health policies.
In this discussion, we develop three dimensions
of health and the inherent ethical choices economists make when working
on health:
1) The choice of a life norm: Health can
be conceived of as a personal norm expressing the conjunction of biological
and psycho-social norms in a dialogue between the individual and his
or her environment. By often ignoring this complex personal normative
space, economists implicitly introduce a specific personal norm into
the assumptions upon which they base their economic models.
2) The
choice of social ends: Health is a collective
norm, a justification of the Welfare State through its bio-pouvoir, and
a relative universal right. That a degree of priority is attached to
health as a social end is often implied in economic models without being
discussed.
3) The choice of a particular allocation of resources: Economists
refer to different social representations of health which carry inherent
criteria for resource allocation. However, when choosing a specific representation,
economists often fail to recognize the allocative consequences of this
choice.
This presentation enlivens the dialogue between the interdisciplinary
approach to health and an economic theoretical framework which tend to
overlook the multidisciplinary dimensions of economics.
Qualifying for the Right to Die - A Dubious Privilege:
Assisted Dying for the Terminally Ill
Michele Wates
Oxford, United Kingdom
As long as societies have had laws, a central tenet
has been to protect people, especially those who may be physically and/or
mentally vulnerable, from being intentionally, or for that matter unintentionally,
killed. Legislation
has now been passed in some countries and is under consideration in
others that represents a far reaching and fundamental shift in the moral
basis of the law in relation to the taking of human life; establishing
the principle that a person may invite others to lawfully kill them.
This
may be all the more dangerous a development given societal attitudes
(including of course the attitudes of doctors and solicitors who respond
to people's requests to die) regarding the quality of life, or rather
the supposed lack of quality of life of people who have physical and/or
mental illnesses.
Who “qualifies” within the terms of
such legislation for the right to die is frequently disputable. Not only
does this present doctors with impossible dilemmas in practise, but that "right",
once established, is liable to be extended over time to include more
and more people, in the name of equal rights and nondiscrimination; as
has already proved to be the case in Holland.
Those who seek
to legalise the right to “medical assistance to
die” frequently use the language of human rights, access to choice,
and anti-discrimination. Whilst views on this matter differ among
disabled people, as in the general population, it is argued that legislation
upholding "the right" to die potentially jeopardises the human
rights, access to choice and freedom from discrimination of many more
people who do not wish to die, or who are ambivalent about ending
their lives, than it assists those who seek the right to end their lives.
Reconciling Discretion, Jurisdiction and Equity:
Funding of Health Services in Canada
Glennys Godlovitch and Nina
Preto
University of Calgary, Canada and
Barrister and Solicitor, Calgary, Canada
In the allocation of health resources
demand exceeds supply and rationing is required. The ethical and legal
debate has been taken to new ground recently in Canada , when the Supreme
Court was asked in a class action case whether a province’s public
health system must provide a behavioral therapy intervention. The argument
is poignant because despite some inroads the Canadian approach is predominantly
based on a single public health ethos. In general a Canadian needing
health services turns first to the public system.
Connor Auton is an autistic
British Columbia child. His parents had self-funded ongoing behavioral
therapy through an American provider, but the cost became prohibitive.
The intervention involves 1-on-1 therapist-child interaction for several
hours a day over several years. British Columbia ’s health
services commission refused to pay for the intervention, indicating that
it fell outside the range of support services for autistic children. However,
some provinces do cover the costs for up to 20 hours a week.
The authors
will discuss the moral and legal principles in Auton’s case,
which they argue raises questions not so much about fair opportunity of
access and accountability for reasonableness, but about the very domain
of what it is that could be accessed or rationed and who is to decide.
In this, it expands the current rationing and prioritization debates and
has implications for Zeliotis v Province of Quebec ,
presently pending, where the plaintiff claims provision of private health
service in Canada is a constitutional right.