Health Policy Ethics Workshop
The state of research, training and practice in the emerging field of health policy ethics was the focus of a CHEPA-sponsored workshop held in June 2009. The workshop attracted a mix of academics, practising ethicists and policymakers, who discussed developments in the field and its future evolution.
The event held at McMaster University was attended by about 30 people from across Canada, and featured five keynote speakers who addressed issues including the distinctiveness of health policy ethics from clinical or research bioethics, appropriate training for health policy ethics expertise, and how ethics can affect the design and implementation of health policy.
The workshop was organized by CHEPA member Mita Giacomini, to cultivate this new interdisciplinary field.
Health policy ethics concerns the pursuit of “the good” through policymaking, as well as the normative analysis of policy agendas, processes and outcomes. Analytic perspectives derive from ethics, bioethics, philosophy, law and related disciplines.
Speakers at the workshop included:
Jennifer Prah Ruger, associate professor of public health and medicine at Yale University, and a Senior Research Fellow at the MacMillan Center for International and Area Studies;
Fiona Miller, associate professor in the Department of Health Policy, Management and Evaluation at the University of Toronto, and a former CHEPA member;
Francoise Baylis, professor in the Department of Bioethics at Dalhousie University and Canada Research Chair in Bioethics and Philosophy;
Catherine MacPherson, ethics program manager with Annapolis Valley Health, one of nine district health authorities in Nova Scotia;
Frank Wagner, a bioethicist with the Joint Centre for Bioethics and an assistant professor in the Department of Family and Community Medicine at the University of Toronto.
Jennifer Prah Ruger affirmed the need for a distinctive, new field of health policy ethics that embraces health ethics, policy, and law. She identified theoretical challenges, including taking stock of existing frameworks, as well as applying new frameworks to previously defined problems for critical new insights. Important topical areas for health policy ethics research include access to health care, health financing and insurance, resource allocation and health policy reform. Potential frameworks for understanding these problems include, for example, utilitarianism, deliberative democracy, the health capability paradigm or rights-based frameworks, among others. Prah Ruger offered examples from U.S. health policy dilemmas to illustrate how methods of economics, social science and political science can be enhanced with greater emphasis on ethics.
Fiona Miller offered key arguments both for and against health policy ethics as a distinct research field for health policy. Policy problems are “made, not found,” and the field of health policy has been very ambivalent about recognizing and working with the political and moral dimensions of health policy problems. A central challenge is justifying ethical frameworks, since ethics and values are by nature not evidenced-based, yet evidence-based reasoning is prized in health care disciplines and policymaking. (View Miller's presentation).
Francoise Baylis, drawing on her extensive experience in ethics policy consultation, detailed current challenges that apply to training for the field of health policy ethics. A key concept is legitimacy. Legitimate inputs come from lay and public views in addition to expertise-based views. Legitimate outputs – or the policies themselves – are those that serve the public good. Policy includes roles for “architects” of ethical decision processes, as well as “advocates” for a full range of interests. Training people for these roles requires a focus on developing knowledge, abilities and character. Emerging models for bioethical consultant training may help guide the content and requirements of health policy ethics training. (View Baylis's presentation).
Catherine MacPherson, who works in health care administration, said that although there is a significant amount of discussion taking place regarding ethics in health policy, more attention is needed regarding how ethics should or could work its way through the policy development process. Academic dialogue should address both conceptual and pragmatic issues. MacPherson noted in particular the problems of timing ethics input effectively, and the desirability of integrated knowledge translation approaches which engage researchers early in the policy process. She surveyed some examples of ethics being included in policy development, which have shown that the timing and nature of ethics engagement are key to incorporating it into health policy.
Frank Wagner, the final speaker of the day, described ongoing efforts to bring health policy ethics into the functioning of Ontario’s Local Health Integration Networks. He explained the reasons for the need for ethical frameworks, and described several ongoing projects aimed at helping LHINs include ethics as they plan, implement and fund health care delivery at a local level. He demonstrated the power of the vignette as a way of communicating ethical principles and issues effectively to diverse audiences involved in policy making. (View Wagner's presentation).