Health equity and ethics: is there a role for ethical theory?
Monique Jonas1, School of Population Health, University Of Auckland Grafton 1School of Population Health, University Of Auckland, Grafton, Auckland, New Zealand
Abstract
Health inequities are widely recognised as amongst the most urgent and ethically significant challenges confronting health systems in Aotearoa New Zealand and Australia. Their dimensions and impacts on individual and population health outcomes are increasingly well documented. In Aotearoa, research demonstrating inequitable access to healthcare and disparities in health outcomes attracts significant media coverage and public debate. But despite the ethical character of this discourse, it is not always clear what value ethical theorists can add to it. At the level of theory, the case for addressing inequities is not in dispute. Theorists often see their role as crafting new ethical arguments. When those arguments receive wide acceptance, theorists tend to vacate the space, leaving operational and implementational matters to others. In our roles as educators, ethical theorists typically avoid expressing personal commitments in an effort to embody neutrality and preserve students’ access to a range of normative positions. Both factors may leave ethical theorists feeling unprepared to enter the sometimes tumultuous field of ethical public discourse, leaving colleagues from other disciplines unsupported and creating a silence that may be open to multiple interpretations.
This paper considers the role of ethical theory and theorists in public discourse when the flame of theoretical interest in an ethical issue has abated. I draw upon the example of equity adjustment tools, used to prioritise patients on surgical waitlists, to delineate several public roles for ethical theorists in ongoing discourse about theoretically settled but unrealised ethical challenges. I call for a renewed commitment to the role of critic and conscience and continued reflection about how ethical theorists should go about ‘doing ethics’ in our modern world.
Biography
Monique Jonas is an Associate Professor of ethics at the University of Auckland’s School of Population Health. Her recent research has focused on ethical issues in parental decision-making, the status of health advice and the ethics of advice-giving. She chairs New Zealand’s Health Research Council Ethics Committee and has served on the National Ethics Advisory Committee and the National Health Committee.