Ethical guidelines outlined for health care reform

Healthcare reform

A new consensus report published on September 20th in the ethics journal The Hastings Center Report outlines a basic ethical framework necessary for health system reform.

The report, "Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform," highlights key ethical obligations and recommendations to guide health system reform proposals in order to improve access to care. The report was authored by members of the Ethical Force Program, a multi-stakeholder collaboration led by the American Medical Association's (AMA) Institute for Ethics.

"By all accounts, health care in America faces many ethical challenges - one of the most notable being that 47 million people are without health insurance," said Paul Schyve, MD, chair of the Ethical Force Program Oversight Body and senior vice president at The Joint Commission. "One of the barriers to change has been the lack of consensus on the fundamental principles that should govern reform of the American health care system. This report provides a shared ethical framework for health reform agreed upon by individuals who represent the perspectives of patients, practitioners, employers, politicians, and the public."

In the report, the group outlines four fundamental ethical obligations that are mandatory for successful access to health care in a just society. According to the ethical framework:

Every member of society must have an adequate array of core health care benefits.
The contents and limits of health care benefits must be established through an ethical process.
The health care system must be sustainable.
The health care system must ensure that its stakeholders have clear responsibilities for which they are accountable.
"The ethical framework is based on shared American values, such as equality of opportunity, justice and compassion for our most vulnerable," said Mark A. Levine, MD, member of the Ethical Force Program Oversight Body and chair of the AMA's Council on Ethical and Judicial Affairs. "These are values that everyone can embrace, yet until now, they haven't been organized and articulated in such as way as to help drive health system reform. That's what this report can do."

"As the number of uninsured continues to increase, we are faced with a forceful reminder that action is desperately needed," said Ardis Hoven, MD, member of the Ethical Force Program Oversight Body and member of the AMA Board of Trustees. "The uninsured live sicker and die younger. Currently, 47 million Americans, including nearly nine million children, are without health insurance coverage. That's not just a statistic, it's a tragedy. As we work together toward reform, we can use this ethical framework to create a system where all Americans have access to the health care they need."

The release of the Ethical Force Program report comes only a few weeks after the launch of the AMA's "Voice for the Uninsured" campaign, a three-year, multi-million dollar campaign to spur action to cover the uninsured. The AMA is reaching out to voters and candidates to talk about the problem and the AMA's solution, and encouraging Americans to vote in 2008 with the issue of the uninsured in mind. For more information about the AMA campaign and the AMA proposal, please visit www.VoiceForTheUninsured.org

The Ethical Force Program report, "Improving Access to Health Care: A Consensus Ethical Framework to Guide Proposals for Reform," is published in the September/October 2007 edition of The Hastings Center Report, a leading bimonthly ethical journal on for issues in health, medicine and the environment.