Philosophy of healthcare

The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. (Although veterinary concerns are worthy to note, the body of thought regarding their methodologies and practices is not addressed in this article.) For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of their life. This perennial concern is especially prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life.[1]

The philosophy of healthcare is primarily concerned with the following elemental questions:

  • Who requires and/or deserves healthcare? Is healthcare a fundamental right of all people?
  • What should be the basis for calculating the cost of treatments, hospital stays, drugs, etc.?
  • How can healthcare best be administered to the greatest number of people?
  • What are the necessary parameters for clinical trials and quality assurance?
  • Who, if anybody, can decide when a patient is in need of "comfort measures" (allowing a natural death by providing medications to treat symptoms related to the patient's illness)?

However, the most important question of all is 'what is health?'. Unless this question is addressed any debate about healthcare will be vague and unbounded. For example, what exactly is a health care intervention? What differentiates healthcare from engineering or teaching, for example? Is health care about 'creating autonomy' or acting in people's best interests? Or is it always both? A 'philosophy' of anything requires baseline philosophical questions, as asked, for example, by philosopher David Seedhouse.

Ultimately, the purpose, objective and meaning of healthcare philosophy is to consolidate the abundance of information regarding the ever-changing fields of biotechnology, medicine, and nursing. And seeing that healthcare typically ranks as one of the largest spending areas of governmental budgets, it becomes important to gain a greater understanding of healthcare as not only a social institution, but also as a political one. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems; be it nurses, doctors, allied health professionals, hospital administrators, health insurance companies (HMOs and PPOs), the government (Medicare and Medicaid), and lastly, the patients themselves.

Lyndon Johnson signing Medicare bill, with Harry Truman, July 30, 1965
President Johnson signing the U.S. Medicare bill. Harry Truman and his wife, Bess, are on the far right. (1965)

Ethics of healthcare

Hippocrates rubens
Hippocrates, the ancient Greek physician, considered the father of Western medicine.

The ethical and/or moral premises of healthcare are complex and intricate. To consolidate such a large segment of moral philosophy, it becomes important to focus on what separates healthcare ethics from other forms of morality. And on the whole, it can be said that healthcare itself is a "special" institution within society.[2] With that said, healthcare ought to "be treated differently from other social goods" in a society.[3] It is an institution of which we are all a part whether we like it or not. At some point in every person's life, a decision has to be made regarding one's healthcare. Can they afford it? Do they deserve it? Do they need it? Where should they go to get it? Do they even want it? And it is this last question which poses the biggest dilemma facing a person. After weighing all of the costs and benefits of her healthcare situation, the person has to decide if the costs of healthcare outweigh the benefits. More than basic economic issues are at stake in this conundrum. In fact, a person must decide whether or not their life is ending or if it is worth salvaging. Of course, in instances where the patient is unable to decide due to medical complications, like a coma, then the decision must come from elsewhere. And defining that "elsewhere" has proven to be a very difficult endeavor in healthcare philosophy.

Medical ethics

Whereas bioethics tends to deal with more broadly-based issues like the consecrated nature of the human body and the roles of science and technology in healthcare, medical ethics is specifically focused on applying ethical principles to the field of medicine. Medical ethics has its roots in the writings of Hippocrates, and the practice of medicine was often used as an example in ethical discussions by Plato and Aristotle.[4] As a systematic field, however, it is a large and relatively new area of study in ethics. One of the major premises of medical ethics surrounds "the development of valuational measures of outcomes of health care treatments and programs; these outcome measures are designed to guide health policy and so must be able to be applied to substantial numbers of people, including across or even between whole societies."[5] Terms like beneficence and non-maleficence are vital to the overall understanding of medical ethics. Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a doctor-patient relationship.

Nursing ethics

Like medical ethics, nursing ethics is very narrow in its focus, especially when compared to the expansive field of bioethics. For the most part, "nursing ethics can be defined as having a two-pronged meaning," whereby it is "the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice."[6] This definition, although quite vague, centers on the practical and theoretical approaches to nursing. The American Nurses Association (ANA) endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession.[7] The importance of values is being increasingly recognized in all aspects of healthcare and health research.[8][9] And since moral issues are extremely prevalent throughout nursing, it is important to be able to recognize and critically respond to situations that warrant and/or necessitate an ethical decision.

Business ethics

Balancing the cost of care with the quality of care is a major issue in healthcare philosophy. In Canada and some parts of Europe, democratic governments play a major role in determining how much public money from taxation should be directed towards the healthcare process. In the United States and other parts of Europe, private health insurance corporations as well as government agencies are the agents in this precarious life-and-death balancing act. According to medical ethicist Leonard J. Weber, "Good-quality healthcare means cost-effective healthcare," but "more expensive healthcare does not mean higher-quality healthcare" and "certain minimum standards of quality must be met for all patients" regardless of health insurance status.[10] This statement undoubtedly reflects the varying thought processes going into the bigger picture of a healthcare cost-benefit analysis. In order to streamline this tedious process, health maintenance organizations (HMOs) like BlueCross BlueShield employ large numbers of actuaries (colloquially known as "insurance adjusters") to ascertain the appropriate balance between cost, quality, and necessity in a patient's healthcare plan.[11] A general rule in the health insurance industry is as follows:

The least costly treatment should be provided unless there is substantial evidence that a more costly intervention is likely to yield a superior outcome.[12]

This generalized rule for healthcare institutions "is perhaps one of the best expressions of the practical meaning of stewardship of resources," especially since "the burden of proof is on justifying the more expensive intervention, not the less expensive one, when different acceptable treatment options exist."[12] And lastly, frivolous lawsuits have been cited as major precipitants of increasing healthcare costs.[13]

Political philosophy of healthcare

In the political philosophy of healthcare, the debate between universal healthcare and private healthcare is particularly contentious in the United States. In the 1960s, there was a plethora of public initiatives by the federal government to consolidate and modernize the U.S. healthcare system. With Lyndon Johnson's Great Society, the U.S. established public health insurance for both senior citizens and the underprivileged. Known as Medicare and Medicaid, these two healthcare programs granted certain groups of Americans access to adequate healthcare services. Although these healthcare programs were a giant step in the direction of socialized medicine, many people think that the U.S. needs to do more for its citizenry with respect to healthcare coverage.[14] Opponents of universal healthcare see it as an erosion of the high quality of care that already exists in the United States.[15]

U.S. Medicare (2008)

Patients' Bill of Rights

In 2001, the U.S. federal government took up an initiative to provide patients with an explicit list of rights concerning their healthcare. The political philosophy behind such an initiative essentially blended ideas of the Consumers' Bill of Rights with the field of healthcare. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the healthcare industry.[16] Standardizing the nature of healthcare institutions in this manner proved provocative. In fact, many interest groups, including the American Medical Association (AMA) and Big Pharma came out against the congressional bill. Basically, having hospitals provide emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the two biggest stumbling blocks for the bill.[16] As a result of this intense opposition, the initiative eventually failed to pass Congress in 2002.

Health insurance

Tommy Douglas' (centre left) number one concern was the creation of Canadian Medicare. In the summer of 1962, Saskatchewan became the centre of a hard-fought struggle between the provincial government, the North American medical establishment, and the province's physicians, who brought things to a halt with a doctors' strike.

Health insurance is the primary mechanism through which individuals cover healthcare costs in industrialized countries. It can be obtained from either the public or private sector of the economy. In Canada, for example, the provincial governments administer public health insurance coverage to citizens and permanent residents. According to Health Canada, the political philosophy of public insurance in Canada is as follows:

The administration and delivery of health care services is the responsibility of each province or territory, guided by the provisions of the Canada Health Act. The provinces and territories fund these services with assistance from the federal government in the form of fiscal transfers.[17]

And the driving force behind such a political philosophy in Canada was democratic socialist politician Tommy Douglas.

Contrasting with the U.S., but similar to Canada, Australia and New Zealand have universal healthcare systems known as Medicare and ACC (Accident Compensation Corporation), respectively.[18]

Australian Medicare originated with Health Insurance Act 1973. It was introduced by Prime Minister (PM) Gough Whitlam's Labor Government, and was intended to provide affordable treatment by doctors in public hospitals for all resident citizens. Redesigned by PM Bob Hawke in 1984, the current Medicare system permits citizens the option to purchase private health insurance in a two-tier health system.[19]

Research and scholarship

Considering the rapid pace at which the fields of medicine and health science are developing, it becomes important to investigate the most proper and/or efficient methodologies for conducting research. On the whole, "the primary concern of the researcher must always be the phenomenon, from which the research question is derived, and only subsequent to this can decisions be made as to the most appropriate research methodology, design, and methods to fulfill the purposes of the research."[20] This statement on research methodology places the researcher at the forefront of his findings. That is, the researcher becomes the person who makes or breaks his or her scientific inquiries rather than the research itself. Even so, "interpretive research and scholarship are creative processes, and methods and methodology are not always singular, a priori, fixed and unchanging."[21] Therefore, viewpoints on scientific inquiries into healthcare matters "will continue to grow and develop with the creativity and insight of interpretive researchers, as they consider emerging ways of investigating the complex social world."[22]

Clinical trials

Clinical trials are a means through which the healthcare industry tests a new drug, treatment, or medical device. The traditional methodology behind clinical trials consists of various phases in which the emerging product undergoes a series of intense tests, most of which tend to occur on interested and/or compliant patients. The U.S. government has an established network for tackling the emergence of new products in the healthcare industry. The Food and Drug Administration (FDA) does not conduct trials on new drugs coming from pharmaceutical companies.[23] Along with the FDA, the National Institutes of Health sets the guidelines for all kinds of clinical trials relating to infectious diseases. For cancer, the National Cancer Institute (NCI) sponsors a series or cooperative groups like CALGB and COG in order to standardize protocols for cancer treatment.[24]

Quality assurance

The primary purpose of quality assurance (QA) in healthcare is to ensure that the quality of patient care is in accordance with established guidelines. The government usually plays a significant role in providing structured guidance for treating a particular disease or ailment. However, protocols for treatment can also be worked out at individual healthcare institutions like hospitals and HMOs. In some cases, quality assurance is seen as a superfluous endeavor, as many healthcare-based QA organizations, like QARC, are publicly funded at the hands of taxpayers.[25] However, many people would agree that healthcare quality assurance, particularly in the areas cancer treatment and disease control are necessary components to the vitality of any legitimate healthcare system. With respect to quality assurance in cancer treatment scenarios, the Quality Assurance Review Center (QARC) is just one example of a QA facility that seeks "to improve the standards of care" for patients "by improving the quality of clinical trials medicine."[25]

Birth and death

Reproductive rights

The ecophilosophy of Garrett Hardin is one perspective from which to analyze the reproductive rights of human beings. For the most part, Hardin argues that it is immoral to have large families, especially since they do a disservice to society by consuming an excessive amount of resources. In an essay titled The Tragedy of the Commons, Hardin states,

To couple the concept of freedom to breed with the belief that everyone born has an equal right to the commons is to lock the world into a tragic course of action.[26]

By encouraging the freedom to breed, the welfare state not only provides for children, but also sustains itself in the process. The net effect of such a policy is the inevitability of a Malthusian catastrophe.

Hardin's ecophilosophy reveals one particular method to mitigate healthcare costs. With respect to population growth, the fewer people there are to take care of, the less expensive healthcare will be. And in applying this logic to what medical ethicist Leonard J. Weber previously suggested, less expensive healthcare does not necessarily mean poorer quality healthcare.[12]

Birth and living

The concept of being "well-born" is not new, and may carry racist undertones. The Nazis practiced eugenics in order to cleanse the gene pool of what were perceived to be unwanted or harmful elements. This "race hygiene movement in Germany evolved from a theory of Social Darwinism, which had become popular throughout Europe" and the United States during the 1930s.[27] A German phrase that embodies the nature of this practice is lebensunwertes Leben or "life unworthy of life."[28]

In connection with healthcare philosophy, the theory of natural rights becomes a rather pertinent subject. After birth, man is effectively endowed with a series of natural rights that cannot be banished under any circumstances. One major proponent of natural rights theory was seventeenth-century English political philosopher John Locke. With regard to the natural rights of man, Locke states,

If God's purpose for me on Earth is my survival and that of my species, and the means to that survival are my life, health, liberty and property — then clearly I don't want anyone to violate my rights to these things.[29]

Although partially informed by his religious understanding of the world, Locke's statement can essentially be viewed as an affirmation of the right to preserve one's life at all costs. This point is precisely where healthcare as a human right becomes relevant.

The process of preserving and maintaining one's health throughout life is a matter of grave concern. At some point in every person's life, his or her health is going to decline regardless of all measures taken to prevent such a collapse. Coping with this inevitable decline can prove quite problematic for some people. For Enlightenment philosopher René Descartes, the depressing and gerontological implications of aging pushed him to believe in the prospects of immortality through a wholesome faith in the possibilities of reason.[30]

Death and dying

One of the most basic human rights is the right to live, and thus, preserve one's life. Yet one must also consider the right to die, and thus, end one's life. Often, religious values of varying traditions influence this issue. Terms like "mercy killing" and "assisted suicide" are frequently used to describe this process. Proponents of euthanasia claim that it is particularly necessary for patients suffering from a terminal illness.[31] However, opponents of a self-chosen death purport that it is not only immoral, but wholly against the pillars of reason.

In a certain philosophical context, death can be seen as the ultimate existential moment in one's life. Death is the deepest cause of a primordial anxiety (Die Anfechtung) in a person's life. In this emotional state of anxiety, "the Nothing" is revealed to the person. According to twentieth-century German philosopher Martin Heidegger,

The Nothing is the complete negation of the totality of beings.[32]

And thus, for Heidegger, humans finds themselves in a very precarious and fragile situation (constantly hanging over the abyss) in this world. This concept can be simplified to the point where at bottom, all that a person has in this world is his or her Being. Regardless of how individuals proceed in life, their existence will always be marked by finitude and solitude. When considering near-death experiences, humans feels this primordial anxiety overcome them. Therefore, it is important for healthcare providers to recognize the onset of this entrenched despair in patients who are nearing their respective deaths.

Other philosophical investigations into death examine the healthcare's profession heavy reliance on science and technology (SciTech). This reliance is especially evident in Western medicine. Even so, Heidegger makes ang allusion to this reliance in what he calls the allure or "character of exactness."[33] In effect, people are inherently attached to "exactness" because it gives them a sense of purpose or reason in a world that is largely defined by what appears to be chaos and irrationality. And as the moment of death is approaching, a moment marked by utter confusion and fear, people frantically attempt to pinpoint a final sense of meaning in their lives.

Aside from the role that SciTech plays in death, palliative care constitutes a specialized area of healthcare philosophy that specifically relates to patients who are terminally ill. Similar to hospice care, this area of healthcare philosophy is becoming increasingly important as more patients prefer to receive healthcare services in their homes. Even though the terms "palliative" and "hospice" are typically used interchangeably, they are actually quite different. As a patient nears the end of his life, it is more comforting to be in a private home-like setting instead of a hospital. Palliative care has generally been reserved for those who have a terminal illness. However, it is now being applied to patients in all kinds of medical situations, including chronic fatigue and other distressing symptoms.[34]

Role development

The manner in which nurses, physicians, patients, and administrators interact is crucial for the overall efficacy of a healthcare system. From the viewpoint of the patients, healthcare providers can be seen as being in a privileged position, whereby they have the power to alter the patients' quality of life. And yet, there are strict divisions among healthcare providers that can sometimes lead to an overall decline in the quality of patient care. When nurses and physicians are not on the same page with respect to a particular patient, a compromising situation may arise. Effects stemming from a "gender gap" between nurses and doctors are detrimental to the professional environment of a hospital workspace.[35]

See also


  1. ^ Yuval Levin, "Putting Health in Perspective," The New Atlantis
  2. ^ Norman Daniels, "Healthcare Needs and Distributive Justice," Bioethics Ed. John Harris (New York: Oxford University Press, 2001), 319.
  3. ^ Daniels, "Healthcare Needs and Distributive Justice," 319.
  4. ^ Edmund D. Pellegrino, "The Philosophy of Medicine Reborn" (Notre Dame: University of Notre Dame Press, 2008), 258.
  5. ^ Dan Brock, "Quality of Life Measures in Health Care and Medical Ethics," Bioethics Ed. John Harris (New York: Oxford University Press, 2001), 387.
  6. ^ Janie Butts and Karen Rich, "Moral and Ethical Dimensions in Professional Nursing Practice," Role Development in Professional Nursing Practice Ed. Kathleen Masters (Sudbury: Jones and Bartlett Publishers, 2005), 66.
  7. ^ Butts and Rich, "Moral and Ethical Dimensions in Professional Nursing Practice," 70.
  8. ^ Kelly, M; Heath, I; Howick, J; Greenhalgh, T (2015). "The importance of values in evidence-based medicine". BMC Medical Ethics. 16 (69). doi:10.1186/s12910-015-0063-3.
  9. ^ Fulford, KWM; Peile, H; Carroll, H. Essential Values-Based Practice. ISBN 9780521530255.
  10. ^ Leonard J. Weber, Business Ethics in Healthcare: Beyond Compliance (Bloomington: Indiana University Press, 2001), 30.
  11. ^ Actuaries, HMOs, and State Politics
  12. ^ a b c Weber, Business Ethics in Healthcare: Beyond Compliance, 31.
  13. ^ Are Frivolous Lawsuits Driving Up Healthcare Costs?
  14. ^ Center for Economic and Social Rights. "The Right to Health in the United States of America: What Does It Mean?" Archived 27 September 2007 at the Wayback Machine (29 October 2004).
  15. ^ Leonard Peikoff, "Health Care Is Not a Right," (11 December 1993).
  16. ^ a b Summary of the McCain-Edwards-Kennedy Patients' Bill of Rights Archived 14 April 2008 at the Wayback Machine
  17. ^ Provincial/Territorial Role in Health
  18. ^ Medicare AustraliaACC Government Website
  19. ^ Australian Government Department of Health and Ageing
  20. ^ Philippa Seaton, "Combining Interpretive Methodologies: Maximizing the Richness of Findings," Beyond Method: Philosophical Conversations in Healthcare Research and Scholarship Ed. Pamela M. Ironside (Madison: University of Wisconsin Press, 2005), 217.
  21. ^ Seaton, "Combining Interpretive Methodologies: Maximizing the Richness of Findings," 217.
  22. ^ Seaton, "Combining Interpretive Methodologies: Maximizing the Richness of Findings," 217-18.
  23. ^ Guidance for Industry, Investigators, and Reviewers in Exploratory Drug Studies (FDA January 2006)
  24. ^ Mission Statement of the National Cancer Institute (NCI)
  25. ^ a b Quality Assurance Review Center
  26. ^ Garrett Hardin, "Freedom to Breed is Intolerable," The Tragedy of the Commons
  27. ^ Naomi Baumslag, Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus (Westport: Praeger Publishers, 2005), 35.
  28. ^ Baumslag, Murderous Medicine: Nazi Doctors, Human Experimentation, and Typhus, 39.
  29. ^ John Locke, "Human Nature and God's Purposes," Stanford Encyclopedia of Philosophy
  30. ^ René Descartes, "Possibility and Human Freedom," Stanford Encyclopedia of Philosophy
  31. ^ Daniel Callahan, "Terminating Life-Sustaining Treatment of the Demented," Bioethics Ed. John Harris (New York: Oxford University Press, 2001), 93.
  32. ^ Martin Heidegger, "What Is Metaphysics?" Basic Writings Ed. David Krell (New York: HarperCollins Publishers, 1993), 98.
  33. ^ Heidegger, "What Is Metaphysics?," 94.
  34. ^ "Palliative Care across the Continuum" Center to Advance Palliative Care
  35. ^ Mary W. Stewart, "The Social Context of Professional Nursing," Role Development in Professional Nursing Practice Ed. Kathleen Masters (Sudbury: Jones and Bartlett Publishers, 2005), 114.

External links

Annemarie Mol

Annemarie Mol (born 13 September 1958) is a Dutch ethnographer and philosopher. She is the Professor of Anthropology of the Body at the University of Amsterdam.Winner of the Constantijn & Christiaan Huijgens Grant from the NWO in 1990 to study 'Differences in Medicine', she was awarded a European Research Council Advanced Grant in 2010 to study 'The Eating Body in Western Practice and Theory'. She has helped to develop post-ANT/feminist understandings of science, technology and medicine. In her earlier work she explored the performativity of health care practices, argued that realities are generated within those practices, and noted that since practices differ, so too do realities. The body, as she expressed it, is multiple: it is more than one but it is also less than many (since the different versions of the body also overlap in health care practices). This is an empirical argument about ontology (which is the branch of philosophy that explores being, existence, or the categories of being.) As a part of this she also developed the notion of 'ontological politics', arguing that since realities or the conditions of possibility vary between practices, this means that they are not given but might be changed.Mol has been member of the Royal Netherlands Academy of Arts and Sciences since 2013.Mol has written and worked with a range of scholars including John Law.In a recent talk, Mol relates the concept of globalization to the interconnections of nature.

Catholic Church and health care

The Roman Catholic Church is the largest non-government provider of health care services in the world. It has around 18,000 clinics, 16,000 homes for the elderly and those with special needs, and 5,500 hospitals, with 65 percent of them located in developing countries. In 2010, the Church's Pontifical Council for the Pastoral Care of Health Care Workers said that the Church manages 26% of the world's health care facilities. The Church's involvement in health care has ancient origins.

Jesus Christ, whom the Church holds as its founder, instructed his followers to heal the sick. The early Christians were noted for tending the sick and infirm, and Christian emphasis on practical charity gave rise to the development of systematic nursing and hospitals. The influential Benedictine rule holds that "the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them". During the Middle Ages, monasteries and convents were the key medical centres of Europe and the Church developed an early version of a welfare state. Cathedral schools evolved into a well integrated network of medieval universities and Catholic scientists (many of them clergymen) made a number of important discoveries which aided the development of modern science and medicine.

Saint Albert the Great (1206–1280) was a pioneer of biological field research; Desiderius Erasmus (1466-1536) helped revive knowledge of ancient Greek medicine, Renaissance popes were often patrons of the study of anatomy, and Catholic artists such as Michelangelo advanced knowledge of the field through sketching cadavers. The Jesuit Athanasius Kircher (1602 – 1680) first proposed that living beings enter and exist in the blood (a precursor of germ theory). The Augustinian Gregor Mendel (1822-1884) developed theories on genetics for the first time. As Catholicism became a global religion, the Catholic orders and religious and lay people established health care centres around the world. Women's religious institutes such as the Sisters of Charity, Sisters of Mercy and Sisters of St Francis opened and operated some of the first modern general hospitals.

While the prioritization of charity and healing by early Christians created the hospital, their spiritual emphasis tended to imply "the subordination of medicine to religion and doctor to priest". "[P]hysic and faith", wrote historian of medicine Roy Porter "while generally complementary... sometimes tangled in border disputes." Similarly in modern times, the moral stance of the Church against contraception and abortion has been a source of controversy. The Church, while being a major provider of health care to HIV AIDS sufferers, and of orphanages for unwanted children, has been criticised for opposing condom use. Due to Catholics' belief in the sanctity of life from conception, IVF, which leads to the destruction of many embryos, surrogacy, which relies on IVF, and embryonic stem-cell research, which necessitates the destruction of embryos, are among other areas of controversy for the Church in the provision of health care.

Children in clinical research

In health care, a clinical trial is a comparison test of a medication or other medical treatment (such as a medical device), versus a placebo (inactive look-alike), other medications or devices, or the standard medical treatment for a patient's condition.

To be ethical, researchers must obtain the full and voluntary informed consent of participating human subjects. If the subject is unable to consent for him/herself, researchers can seek consent from the subject's legally authorized representative. For a minor child this is typically a parent or guardian since as under the age of 18 cannot legally give consent to participate in a clinical trial.

Christine Mitchell

Christine I. Mitchell (born December 8, 1951) is an American filmmaker and bioethicist and the executive director of the Center for Bioethics at Harvard Medical School (HMS).

Health care reform

Health care reform- is for the most part, governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies

Expand the array of health care providers consumers may choose among

Improve the access to health care specialists

Improve the quality of health care

Give more care to citizens

Decrease the cost of health care

Health economics

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking.

A seminal 1963 article by Kenneth Arrow, often credited with giving rise to health economics as a discipline, drew conceptual distinctions between health and other goods. Factors that distinguish health economics from other areas include extensive government intervention, intractable uncertainty in several dimensions, asymmetric information, barriers to entry, externalities and the presence of a third-party agent. In healthcare, the third-party agent is the physician, who makes purchasing decisions (e.g., whether to order a lab test, prescribe a medication, perform a surgery, etc.) while being insulated from the price of the product or service.

Health economists evaluate multiple types of financial information: costs, charges and expenditures.

Uncertainty is intrinsic to health, both in patient outcomes and financial concerns. The knowledge gap that exists between a physician and a patient creates a situation of distinct advantage for the physician, which is called asymmetric information.

Externalities arise frequently when considering health and health care, notably in the context of infectious disease. For example, making an effort to avoid catching the common cold affects people other than the decision maker.

Health humanities

Health humanities refers to the application of the creative or fine arts (including visual arts, music, performing arts) and humanities disciplines (including literary studies, languages, law, history, philosophy, religion, etc.) to discourse about, express, and/or promote dimensions of human health and well being. This applied capacity of the humanities is not itself a novel idea; however, the construct of the health humanities has only recently begun to emerge over the first decade of the 21st Century. Historically, the roots informing the health humanities can be traced back to, and can now be considered to include, such multidisciplinary areas as the medical humanities and the expressive therapies/creative arts therapies.

In the health humanities, health (and the promotion of health) is understood according to the constructivist (and other non-positivist) principles indigenous to the humanities, as opposed to the positivism of science. The health humanities are rooted in dialogical (negotiated, intersubjective voices of multiple truths), versus monological (a singular, authoritative voice of "the" truth) perspectives on health. As such, evidence upon which health practices are based is generally considered axiological (based in meanings, values, and aesthetics), versus epistemological (based in factual knowledge), in orientation. The health humanities are not an alternative to the health sciences, but rather offer a contrasting paradigm and pragmatic approach with respect to health and its promotion, and can function in a manner that is complementary and simultaneous relative to the health sciences.

The health humanities are a growing movement internationally. A conference on the health humanities was held October 13–15, 2006, at Green College, University of British Columbia. The conference was co-organized by Judy Segal (UBC English) and Alan Richardson (UBC Philosophy) and featured presentations by Jacalyn Duffin, Carl Elliott, Nicholas King, Lorelei Lingard, Robert Proctor, Susan Squier, Andrea Tone, and Kathleen Woodward. In January 2009, Paul Crawford became the world's first Professor of Health Humanities at The University of Nottingham, and with Dr Victoria Tischler, Charley Baker, Dr Brian Brown, Dr Lisa Mooney-Smith and Professor Ronald Carter created an international health humanities initiative that included the AHRC-funded International Health Humanities Conference (IHHC). The first field description for Health Humanities was presented in the key article "Health Humanities: The future of Medical Humanities" (Crawford, Brown, Tischler, & Baker, 2010), published in the Mental Health Review Journal.The 1st International Health Humanities Conference was held 6–8 August 2010, at The University of Nottingham, United Kingdom. The conference opened with Professor Crawford's address entitled ‘Health humanities: Literature and Madness’ and included keynote lectures by Professor Kay Redfield Jamison and Professor Elaine Showalter. Mark A. Radcliffe, who also spoke at the conference, reported on 'health humanities' in his weekly column for the Nursing Times. The conference was also reported in the Bethlem Blog. The 2nd International Health Humanities Conference was hosted in the USA, 9–11 August 2012, at Montclair State University in New Jersey, with the theme of "Music, Health, and Humanity." The 3rd International Health Humanities Conference was held 5-7 September 2014, once again at the University of Nottingham, and featured the theme of "Traumatextualities: Trauma in the Clinical, Arts and Humanities Contexts." The 4th International Health Humanities Conference was held 30 April and 1-2 May 2015, at the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, Denver, featuring the theme of "Health Humanities: The Next Decade (Pedagogies, Practices, Politics)." The 5th International Health Humanities Conference was held 15-17 September 2016, at the University of Seville, Seville, Spain, featuring the theme of "Arts and Humanities for Improving Social Inclusion, Education, and Health: Creative Practice and Mutuality." . The 6th Annual was held March 9-11, 2017 at the University of Texas Houston on the theme of "Diversity, Cultures, and the Health Humanities". The 8th International Health Humanities Conference will be held March 28-30, 2019 at DePaul University (Chicago) on "The Environments of the Health Humanities: Inquiry and Practice".

Textbooks on the health humanities include Health Humanities Reader and Health Humanities, Medical Humanities: An Introduction, and forthcoming Research Methods in the Health Humanities (OUP).

In 2015 a Health Humanities Centre was established at University College London, dedicated to research and teaching in the Health Humanities, including an MA in Health Humanities.

Health insurance

Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury. It includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment" (p. 225).

Health system

A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.

Healthcare industry

The healthcare industry (also called the medical industry or health economy) is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health. The modern healthcare industry is divided into many sectors and depends on the interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of individuals and populations.The healthcare industry is one of the world's largest and fastest-growing industries. Consuming over 10 percent of gross domestic product (GDP) of most developed nations, health care can form an enormous part of a country's economy.

List of philosophies

Philosophical schools of thought and philosophical movements.

Medical ethics

Medical ethics is a system of moral principles that apply values to the practice of clinical medicine and in scientific research. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict. These values include the respect for autonomy, non-maleficence, beneficence, and justice. Such tenets may allow doctors, care providers, and families to create a treatment plan and work towards the same common goal. It is important to note that these four values are not ranked in order of importance or relevance and that they all encompass values pertaining to medical ethics. However, a conflict may arise leading to the need for hierarchy in an ethical system, such that some moral elements overrule others with the purpose of applying the best moral judgement to a difficult medical situation.There are several codes of conduct. The Hippocratic Oath discusses basic principles for medical professionals. This document dates back to the fifth century BCE. Both The Declaration of Helsinki (1964) and The Nuremberg Code (1947) are two well-known and well respected documents contributing to medical ethics. Other important markings in the history of Medical Ethics include Roe v. Wade in 1973 and the development of Hemodialysis in the 1960s. More recently, new techniques for gene editing aiming at treating, preventing and curing diseases utilizing gene editing, are raising important moral questions about their applications in medicine and treatments as well as societal impacts on future generations.As this field continues to develop and change throughout history, the focus remains on fair, balanced, and moral thinking across all cultural and religious backgrounds around the world. Medical ethics encompasses a practical application in clinical settings as well as scholarly work on its history, philosophy, and sociology.

Medical ethics encompasses beneficence, autonomy, and justice as they relate to conflicts such as euthanasia, patient confidentiality, informed consent, and conflicts of interest in healthcare. In addition, medical ethics and culture are interconnected as different cultures implement ethical values differently, sometimes placing more emphasis on family values and downplaying the importance of autonomy. This leads to an increasing need for culturally sensitive physicians and ethical committees in hospitals and other healthcare settings.

Medical humanities

Medical humanities is an interdisciplinary field of medicine which includes the humanities (philosophy, ethics, history, comparative literature and religion), social science ( psychology, sociology, anthropology, cultural studies, health geography) and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. The core strengths of the medical humanities are the imaginative nonconformist qualities and practices.Medical humanities is mainly concerned with training medical practitioners. This contrasts with health humanities which more broadly links health and social care disciplines with the arts and humanities.

Medicare (United States)

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older, younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease).

In 2018, Medicare provided health insurance for over 59.9 million individuals—more than 52 million people aged 65 and older and about 8 million younger people. On average, Medicare covers about half of healthcare expenses of those enrolled. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, co-pays and deductibles, and general U.S. Treasury revenue.

According to annual Medicare Trustees reports and research by the government's MedPAC group, enrollees almost always cover remaining out-of-pocket costs with additional private insurance, by joining a public Medicare health plan, or both.

Medicare is divided into four Parts. Medicare Part A covers hospital (inpatient, formally admitted only), skilled nursing (only after being formally admitted to a hospital for three days and not for custodial care), and hospice services. Part B covers outpatient services including some providers' services while inpatient at a hospital, outpatient hospital charges, most provider office visits even if the office is "in a hospital", and most professionally administered prescription drugs. Part D covers mostly self-administered prescription drugs. Part C is an alternative called Managed Medicare which allows patients to choose health plans with at least the same service coverage as Parts A and B (and most often more), often the benefits of Part D, and always an annual out-of-pocket spend limit which A and B lack. A beneficiary must enroll in Parts A and B first before signing up for Part C.


Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.Medicine has been around for thousands of years, during most of which it was an art (an area of skill and knowledge) frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, or an ancient philosopher and physician would apply bloodletting according to the theories of humorism. In recent centuries, since the advent of modern science, most medicine has become a combination of art and science (both basic and applied, under the umbrella of medical science). While stitching technique for sutures is an art learned through practice, the knowledge of what happens at the cellular and molecular level in the tissues being stitched arises through science.

Prescientific forms of medicine are now known as traditional medicine and folk medicine. They remain commonly used with or instead of scientific medicine and are thus called alternative medicine. For example, evidence on the effectiveness of acupuncture is "variable and inconsistent" for any condition, but is generally safe when done by an appropriately trained practitioner. In contrast, treatments outside the bounds of safety and efficacy are termed quackery.

Nursing ethics

Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distinguished by its emphasis on relationships, human dignity and collaborative care.

Sydney Selwyn

Sydney Selwyn (7 November 1934 – 8 November 1996) was a British physician, medical scientist, and professor.

He was a medical microbiologist with an interest in bacteriology, authority on the history of medicine, avid collector, writer, lecturer, world traveller, and occasional radio and TV broadcaster.

The Values Exchange All Schools Project

The Values Exchange All Schools Project is a free website which aims to involve every school in the world in careful, shared debate about issues that matter most to young people, to help explore thinking and values (both personal and cultural) surrounding these issues. The All Schools Project has grown out of the philosophical work of Professor David Seedhouse


Professor David Seedhouse's work has previously been applied in the field of Health promotion, the Philosophy of healthcare, and medical ethics, and is now being applied further for schools.

Any school worldwide is free to sign up to the site and to explore any case of interest. The All Schools project has evolved into the Values Exchange Community - which was launched at on October 21, 2011.

Winkler County nurse whistleblower case

The Winkler County nurse whistleblower case was a series of legal proceedings in West Texas that centered on the retaliation upon two nurses who submitted an anonymous state medical board complaint against a physician in 2009. The case attracted national attention for its implications on whistleblowing by nurses. After witnessing what they believed to be unsafe medical care, nurses Anne Mitchell and Vicki Galle submitted an anonymous complaint against Dr. Rolando Arafiles to the Texas Medical Board (TMB).

When he learned of the complaint, Arafiles spoke with the sheriff of Winkler County, who was his friend and one of his patients. Arafiles alleged that the nurses' reports to the medical board constituted harassment. The sheriff investigated and obtained the TMB complaint, which provided enough information about Mitchell and Galle to make them identifiable. Galle and Mitchell were terminated from the hospital and faced criminal charges of misuse of official information. Galle's charges were dropped before trial and Mitchell was acquitted by a jury. In the aftermath of Mitchell's trial, Arafiles, several county officials and a hospital administrator all faced jail time for their roles in the retaliation against the nurses.

The case raised questions about the extent of whistleblower protection for healthcare providers who report patient care concerns to licensing authorities. Texas law included remedies against retaliation for whistleblowers, but no known U.S. state had whistleblower laws that addressed appropriate prosecutorial conduct. According to the Texas Nurses Association, "No one ever imagined that a nurse would be criminally prosecuted for reporting a patient care concern to a licensing agency." After the Mitchell case, protection from prosecution was incorporated into Texas whistleblower laws. The TMB stopped investigating anonymous complaints about physicians in September 2011.

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