Wednesday, August 5, 2009

Principles for health worker

If you are a health worker and you want to understand ethics you have two choices. You can study texts which take ethical principles for granted, or you can read books inspired by a theory of health. Both types discuss practical cases, but with a profound difference. If you plump for ‘principles first’ books you step into quicksand. Different texts espouse conflicting axioms. Read enough and you’ll find ethical principles behind every practice.

Pro- and anti-abortion lobbies both have ethics on their side. There’s a school of thought that considers health care rationing morally abhorrent, and another that thinks efficient resource allocation is what ethics is all about. Some societies claim that health services are morally special, others believe they sell commodities like any other business. How do you choose between contrasting moral allegiances? And how do you respond to colleagues who do not hold your ethical beliefs? If they are utilitarian while you feel duty-bound to offer everyone equal care, how do you argue with them? If they insist they are right you’ll never change their minds by just telling them they aren’t.

You can escape the stalemate if you have a theory of health. If you do, your reasoning need not start with blind moral faith but with careful deliberation about the point of working for health in practical situations. If you share the philosophy of health that informs Ethics: The Heart of Health Care then your moral outlook is not a purely intellectual matter either. If you choose to uphold this philosophy you make a commitment born of centuries of compassionate practice. And once you’ve made it you no longer have to barter principles.

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