The ethics of Healthcare is about 2000 years ahead of the ethics of Health Economics! All doctors in the UK take an amended Hippocratic oath when we qualify, in which we promise to:
- Do no harm
- Prioritise the patient
- Treat the whole person, not just the symptom
- Obtain prior informed consent
- Call on the expertise of others when needed
We also have our ethical code:
- Benficence – i.e. seek to do good
- Non-maleficence – i.e. don’t deliberately do harm
- Justice i.e. treat everyone equally
- Autonomy – i.e. respect the wishes of your patient
Kate Raworth argues in her simply marvellous book, Doughnut economics (in the Chapter “Get Savvy With Systems”), that the discipline of Economics simply does not have any such moral or ethical code. In fact, as George Di Martino puts it, “it is entirely cavalier regarding its responsibilities”. But in a world, based on theories (most of which are entirely outdated and impotent in solving the global issues we face today), it is vital that an ethical code is written on which economic decisions can be based. She makes the following suggestions:
- Act in service to human prosperity in a flourishing web of life, recognising all that it depends upon.
- Respect autonomy in the communities that you serve, ensuring their engagement and consent.
- Be prudential in policy making, seeking to minimise the risk of harm -especially to the most vulnerable – in the face of uncertainty.
- Work with humility, by making transparent the assumptions and shortcomings of your models and by recognising alternative economic perspectives and tools.
In some ways, I think you could take the ethical code of the medical world and simply apply it that of economics, but the four principles above give us a good starting framework.
The reason I want to explore this whole idea and will give some further blogs to this area of health economics is that, to my mind, it is ludicrous to be talking about ‘reimagining health’, if we are not also in the same breath ‘reimagining health economics’ or indeed ‘reimagining economics’. Much of what is happening within the world of health and social care at the moment is being driven by an economic model that lacks a moral compass or an ethical frame work. It is high time that this changed! Decisions made about how a health and social care system is organised and governed hugely impacts on how that health and social care is subsequently delivered. We cannot afford to separate our ethical principles from our commissioning strategies. There must be far more synergy between the two.
I love this quote from Donella Meadows:
“The future can’t be predicted, but it can be envisioned and brought lovingly into being. Systems can’t be controlled, but they can be designed and redesigned (emphasis mine). We can listen to what the whole system tells us, and discover how its properties and our values can work together to bring forth something much better than can ever be produced by our will alone”.
Plenty to think about there!