Core and comprehensive health care services: 3. Ethical issues

Area of Science:

• Medical Ethics
• Health Policy
• Public Health

Background:

• Ethics is a primary consideration in defining core and comprehensive health care services for public funding.
• The Canadian Medical Association (CMA) Working Group emphasizes ethics alongside two other factors in service determination.
• Ethical considerations guide judgments and positions at both individual and societal levels.

Purpose of the Study:

• To delineate the role of ethics in determining publicly funded health care services.
• To identify and explicate ethical criteria and processes for service allocation.
• To address ethical issues concerning criteria for services and the decision-making process.

Main Methods:

• Discussion of five key ethical criteria: fairness, age, lifestyle, identifiable versus statistical patient, and futility.
• Examination of an ethical process involving public, physician, and payer roles.
• Presentation of a checklist for assessing the fairness of the decision-making process.

Main Results:

• Five ethical criteria (fairness, age, lifestyle, identifiable vs. statistical patient, futility) are proposed for evaluating health care services.
• An ethical process requires defined roles for the public, physicians, and government payers.
• Accountability of all participants is essential for a fair process.

Conclusions:

• Ethical principles and values are fundamental to decisions about public health care funding.
• A fair process for determining publicly funded services necessitates public involvement and transparent decision-making.
• The checklist aids in evaluating fairness, preventing discrimination, and ensuring adequate public and provider input.