Ethical dimensions of health policy

Edited by M Danis, C Clancy, L R Churchill. (Pp 394; £37.50). Oxford University Press, 2002. ISBN 0-19-514070-2

The main aim of the book is to examine the connections between ethics and health policy. Experts from different disciplines and spheres have contributed. The book is structured in four parts. From an ethical deliberation on healthcare goals readers proceed through an intermediate chapter to political decision making. The final chapter deals with ethical controversies on the resource allocation, accountability, vulnerability, and ethics of the health services research.

The book focuses to a large extent on the US reality and provides an insight into the history of their healthcare reforms as well as the recent debate on a universal healthcare system based on social solidarity. European or other readers may learn from a very profound and sophisticated consideration of how ethical and political approaches may interfere. The pragmatic claim that the bioethical debate descends from academic heights and influences directly political decisions is illustrative. Readers face the debate on justice from a reverse side. Concepts that are taken for granted in Europe are being vindicated and legitimised (Rawls is repeatedly reflected). An outline of a future collective and organisational rather than personal accountability for health care is innovative (Cassel, McParland). The postmodern practice as delineated by Malone and Luft may be viewed as visionary although stimulating. New health services research agenda such as research of trust, privacy, internet practices has been suggested.

Several conclusions seem to be self evident, sometimes an effort to square the circle may be suspected. However, the focus on inherence of values in policy making, on negotiating culture and procedural aspects as crucial in setting and implementing healthcare goals makes the text instructive. A lesson of democracy in health care is the essence that readers breathe as the fresh air at each page. Even when not all authors share the same opinion the book is illuminated by an optimistic faith that connecting ethics and health policy is viable—a sustainable health policy necessitates a moral legitimacy and bioethics shall promote the social action.