by Carolyn N. Kinder
For many years different ethical theories have been used to justify decisions about important health issues in society. Health care providers want to go forward with promoting the general welfare of society without allowing any one group or individuals to benefit at the expense of another. Promoting the general welfare of the society involve justice. Justice is a higher ethical value that requires treating people fairly. Theories of fairness suggest that each person should have equal opportunity. The theory of fairness has been rationalized in several ways.
First, the egalitarians believe that fairness involves the distribution of goods equally among all members of society. The concept of distributive justice is based on the idea of innate merit. All people by virtue of birth and their common humanity should merit some share of the total amount of goods and services turned out by the economic system according to abilities and needs. Others think that a person’s claim to economic goods ought to be limited to some minimum standard of distribution. Still others think that the distributed benefits should be limited to certain specific goods, such as medical care (1)
Second, the libertarians focus on social and economic rights. They believe that the government should not interfere with individual action, even to insure equal opportunity. The notion is that a just society protects the rights and freedoms of its citizens. This protection allows them to improve their circumstances through their own efforts (2).
Third, the utilitarians believe in the distribution of health care and favor equality of access to needed services. The utilitarians judge the rightness and wrongness of an action by its consequences, or what will happen if the action is not performed. Utilitarianism’s theory of value says that good consequences are those that produce or promote happiness or pleasure, bad consequences those that produce or promote the reverse .
The strength of the utilitarianism is that it provides us with a procedure for deciding what to do: that is, whichever action produces, on balance, the greatest amount of happiness. Happiness is claimed to be something measurable and comparable. This means that in principle, utilitarianism provides definite answers to the question of how we ought to act.
An important feature of utilitarianism is that it regards the question of whether a given course of action conforms to established social norms or ethical codes as relevant only to the extent that such conformity has a bearing on happiness or unhappiness. Anyone breaking the rule experience adverse consequences. Impartiality is another important feature of utilitarianism. It does not say that goodness of action produce happiness for me; rather, the good is determined by the overall net happiness achieved. The principle of utility is derived from the very point of morality, which is to improve the lot of human beings living together. Morality relates to the improvement of the human condition, which means alleviating suffering and increasing happiness (3).
Communitarians believe in communal values with traditional practices. Social goals play a major role in making decisions about health. For example, if an organ transplant were a concern, then the communitarians would ask questions about decisions relevant to acts, policies, and rules that would best respect and promote the general welfare of the society. Communitarians view principles pluralistically as to promote diverse moral communities.
In sum, regardless of the system, individual people make the analysis in all ethical systems. Every principle or policy that we develop must be a statement about the way that individuals make choices, struggle with the problems of availability or scarcity of resources in the society. Specifically, policies related to health care must be judged in terms of their impact on the welfare of individual people.
This means that ethical systems are based on the recognition that society has no importance except to serve individual people of which they are made up. Therefore, the concept of equity plays an important role in policy analysis. However, careful considerations must be given to justice or fairness to the value of distributing services or goods in society (4).