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AJPH First Look, published online ahead of print Aug 13, 2008
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October 2008, Vol 98, No. 10 | American Journal of Public Health 1756-1763
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.121350

HEALTH POLICY AND ETHICS

Ethics in American Health 2: An Ethical Framework for Health System Reform

Jennifer Prah Ruger, PhD

Jennifer Prah Ruger is with the School of Medicine, Graduate School of Arts and Sciences, and Law School, Yale University, New Haven, CT.

Correspondence: Requests for reprints should be sent to Jennifer Prah Ruger, PhD, Yale University School of Medicine, 60 College St, PO Box 208034, New Haven CT 06520-8034 (e-mail: jennifer.ruger{at}yale.edu).

I argue that an ethical vision resting on explicitly articulated values and norms is critical to ensuring comprehensive health reform. Reform requires a consensus on the public good transcending self-interest and narrow agendas and underpinning collective action for universal coverage.

In what I call shared health governance, individuals, providers, and institutions all have essential roles in achieving health goals and work together to create a positive environment for health.

This ethical paradigm provides (1) reasoned consensus through a joint scientific and deliberative approach to judge the value of a health care intervention; (2) a method for achieving consensus that differs from aggregate tools such as a strict majority vote; (3) combined technical and ethical rationality for collective choice; (4) a joint clinical and economic approach combining efficiency with equity, but with economic solutions following and complementing clinical progress; and (5) protection for disabled individuals from discrimination.




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J. P. Ruger
Ethics in American Health 1: Ethical Approaches to Health Policy
Am J Public Health, October 1, 2008; 98(10): 1751 - 1756.
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