As you may have noticed under “About the author” (to the right of your screen), I’ve recently been accepted to Creighton University’s graduate program in health care ethics. Based in Omaha, Nebraska, Creighton “is a Catholic and Jesuit comprehensive university committed to excellence in its selected undergraduate, graduate and professional programs.” Now and then I’ll share some of my work at Creighton here on bioethike.com. Here’s a discussion piece on Larry Churchill’s “What Ethics Can Contribute to Health Care Policy,” and Daniel Callahan’s “Ends and Means: The Goals of Health Care.”
When the 111th Congress reconvenes September 8 in Washington, D.C., the first order of business will be to breath a collective sigh of relief that the inglorious “town hall” meetings on health care are over. The second order of business will be to make extended travel plans for the next recess, much deserved on all sides.
The current debate/advertisement/uproar/opportunity for political advantage concerning health care should convince even the most middle-of-the-road sort that our work together at Creighton in the field of health care ethics could neither be more timely nor more serendipitous. Literally, we are living through what we will be learning.
I found both articles assigned for this week very stimulating. I particularly appreciated Churchill’s argument that underlying our ethical conversations are tacit, ethical assumptions that remain, for the most part and to our theoretical and practical impoverishment, systematically unscrutinized. As a Lutheran pastor, I daily live in that world where both lay and clergy operate from unstated theological premises that cause them either to question their faith or to dismiss aspects of it as they apply what they personally believe to daily living.
I also found Churchill’s description of ethics as a “humanizing activity” particularly winsome. “Moral agnosticism” in the secular sphere where competing ethical assumptions vie for a place at the table resonates with me. While Churchill ethical dialogue in primarily conflict resolution terms, I see his point. But keeping our lines of respectful communication open, we a) provide broader and more stable for health policy initiatives; and 2) we can assist in identifying and evaluating the aims and purposes of health policy.
Callahan’s observations that a pluralistic society such as ours is averse to establishing and seeking to achieve goals was also refreshing. Further, his mention of the American temperament and our resistance to debating publicly about important life issues helped provide further support for revisiting our current health-care crisis. Although I was not entirely convince of the validity of his suggestions for causes of the crises, his suggestions for policy directions, namely a) being responsive to population subgroups; b) enhancing population health; and c) facilitating equitable health care, seemed reasonable, so reasonable that only the Grinch–with a heart two sizes too small–would disagree with them.
A few questions and thoughts arise from the readings. First, I wonder how far we are willing to go individually, corporately, or as a society when it comes to uncovering those systematically unscrutinized ethical assumptions, as Churchill puts it, that we bring to the table. As I read both pieces, I began to think that there were underlying assumptions in them that might bear further reflection. One of those might be the relatively short distance, that is, the unstated inference moves both authors make from “health care crisis” to “universal health care.” Second, it would seem to me, and perhaps this is more of an editorial aside not within the scope of our assignment, that some weight should be given to medicine, health care, and health policy from an international perspective. In comparison to other developed nations, America, for the reasons stated by both authors, has been a laggard in developing a comprehensive health care system for all of its citizens. Third, and this keys in on Callahan’s piece, if we are to go with the assumption that public health serves a complementary role to medicine, what might that look like? The roles currently being played, it seems to me, are complementary, but misaligned. Would universal care by necessity rule out public health’s subsidiary role? Or just necessitate overarching government influence?
Maintaining an open mind and a sincere willingness to contemplate and discuss these issues with our colleagues in health care, as I understand it from Churchill, is foundational to our role as ethicists in providing an environment for fruitful reflection and discernment as we go about facilitating consensus in health policy. That being done, and cognizant of context, biases, and obstacles and threats as suggested by Callahan, we should be better prepared to respond to his vision of three policy directions, with the goal to providing sustainable and affordable health care for all.
