Ethics and economic appraisals in health care

Although the author recognizes that the ethical point of view could be an aid to a group of professionals, he examines the ethical value of economic appraisal in health care. First of all he considers the issue of the experimental nature of appraisals and demonstrates that certain studies using human subjects do not respect the most elementary ethical rules: conformity of the experiment to the present state of scientific knowledge, consideration for the risks which the experiment could involve for the subject, consent of the person concerned. Without aiming at an exhaustive list he then looks at the different value conflicts which could be picked out, a characteristic of ethical research. He states first of all that economic appraisals in health care try to bring together very different value systems in using common criteria in decisions, but this cannot completely eliminate these systems and the conflicts which stem from them. In particular he underlines the phenomenon of occultation which could result from the use of mathematical formulae. After the contradictions between medicine and economics he then goes on to point out the contradictions between the levels of understanding reality, between fields of economic or social considerations. Finally, he insists on the mobility of ethical thought and on the vigilance which it is always necessary to observe.