(N.16) Ethical Analysis in Health Policy

Question 1

T or F: ethics occasionally plays a role in every policy issue

Answer 1

F: Ethics ALWAYS plays some role in every policy issue

Question 2

T or F: policy is, above all, concerned with choice among competing values

Answer 2

T: Some decision on whose/which value works out in

Question 3

Values

Answer 3

one’s judgement of what is important or of worth, the assumption of which can be the basis for ethical action

Question 4

In health policy and politics, stakeholders talk a great deal about ‘values,’ but …

Answer 4

do not always clarify what they mean

• Ethics can be front and center in policy, but not always make explicit

Question 5

ex. how countering values may pose as a problem

Answer 5

Evidence told us speed limits will reduce vehicle/pedestrian deaths
○ Not so simple, some people don’t agree
May value other things
○ Ford said this was “nuts, nuts, nuts”
○ 30km/hr in Toronto would have unfavourable implications like traffic

Question 6

How do you balance certain values (personal freedom and the common good)

Answer 6

• Fairness varies in peoples eyes, requires value judgment
  ○ Fairness, equity, solidarity, human rights,

Question 7

When do values enter into policymaking?

Answer 7

At every step (though, not always explicitly)
when …
a. values are invoked (equity, fairness, autonomy)
- assume people care
- need to make argument that they do

b. evaluative language is used (right/wrong, good/bad)
- Arrows in grocery stores to promote physical distancing: one thinks you’re wrong for not following, other is quickly grabbing diapers

c. establishing policy objectives
- Any policy objective evolves ethics, reflects what we think is important
- Explicitly talking about ethics by talking about objectives

d. navigating trade-offs
- Do we want healthcare workers to be more protected with 2 doses vs more people getting partial protection from 1
- Need to make a trade-off

e. navigating uncertainty
- Judgement to wonder how much error in thinking is tolerable to act/implement knowing there may be risks
- Can’t be decided by law/science, need to be value judgement

Question 8

Ethics

Answer 8

the SYSTEMATIC study of moral choices; it concerns the values that underpin moral choices and the language used to describe those choices

seeks to identify, clarify, and resolve questions dealing with concepts of right and wrong, good and bad

Question 9

ethics is just using ____ if not backed up

Answer 9

rhetoric

Question 10

Is-ought problem

Answer 10

One cannot logically infer what one ethically ‘ought’ to do simply on the basis of how things ‘are’
- “Hume’s law”

Question 11

Example (of what not to do) - is-ought

Answer 11

Premise: COVID-19 vaccines are effective in reducing risks of severe disease/death

Conclusion: One ought, morally speaking, to be vaccinated

**Doesn’t logically follow from state and fact
**Need to insert an ethical premise
○ Doesn’t state it is bad, what if people don’t take it that way
○ Assume people are on the same page with right/wrong or good/bad = not true
**logical fallacy

Question 12

How TO do it = Science + ethics
(is-ought)

Answer 12

Premise 1: COVID-19 vaccines are effective in reducing risks of severe disease,/death

Premise 2: Being vaccinated against COVID-19 represents a minimal burden for nearly all

Premise 3: One ought to prevent suffering and death, especially when doing so carries a minimal burden

Conclusion: One ought, morally speaking, to be vaccinated
**Need to introduce explicit ethical argumentation

Question 13

Descriptive moral relativism

Answer 13

As a matter of empirical fact, there are deep and widespread moral disagreements across different societies, and these disagreements are much more significant than whatever agreements there may be

Question 14

Metaethical moral relativism

Answer 14

The TRUTH or FASLITY of moral judgments, or their justification, is NOT ABSOLUTE OR UNIVERSAL, but is relative to the traditions, convictions, or practices of a group of persons

• Different views of MAID - not truth to the matter
• Undermines ethics for many
• Many people think determining what is moral/not should be determined by ethics

Question 15

T or F: ethics is subjective

Answer 15

F: Ethics isn’t about ‘opinions’!
- You may have an opinion, but that doesn’t mean it is ‘right’, coherent, justified, or ought to be the basis for policy
- Can’t have proper debate if ethics is subjective

ex. multiple births @Mount Sinai
- terminate some fetuses in pregnancy = ensure at least 1 fetus survives
- 0 policies on how doctors do this
- Practices are up to the doctor
- Discussion on right/wrong depends on what hospital you go to/what doctor does procedure
- Undermines same care = luck of the draw

Question 16

Ethical theory (3)

Answer 16

1. The ‘right’ is prior to the ‘good’
2. The ‘good’ is defined prior to, and independent of, the ‘right’
3. Virtue ethics

Question 17

The ‘right’ is prior to the ‘good’

Answer 17

(Chivalry, plagiarism, lying)

Deontological ethics
= ‘Logos’: the science or study of
= ‘Deon’: duty

• identify duties and reason from them to determine the right course of action
• Ex. Government has legal duty to protect public from infectious diseases = you ought to act to protect = not acting is wrong

Question 18

The ‘good’ is defined prior to, and independent of, the ‘right’

Answer 18

(Religion, education, money)

Teleological ethics
= ‘Logos’: The science or study of
= ‘Telos’: ends, purpose, goal

• identify good ‘ends’ and reason from them to determine the right course of action
• What is right has to do with outcomes
• Right thing to do is whatever gets you $$
• Utilitarianism

Question 19

Virtue ethics

Answer 19

Honesty, trustworthy .etc and acting in a way that embodies these virtues

Question 20

Utilitarianism

Answer 20

Example of consequentialism = where outcomes of actions are the only factor of moral relevance

• Duties don’t matter
• Defines the ‘good’ independent (and prior) to the ‘right’
• Typically (or classically): ‘the greatest happiness for the greatest #’
  ○ Comes to tensions with duties
• indifferent to distribution of the ‘good’, unless that distribution results in negative utility
  ○ Doesn’t focus on how it is distributed in society

Question 21

Ethical frameworks

Answer 21

• Articulate morally relevant, ‘mid-level’ (i.e., between theory and practice) values and principles and steps to apply them to inform action
• Can draw from (multiple) theories, values, and principles in light of practical ethical challenges

Question 22

Harm principle

Answer 22

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others
- His own good, either physical or moral, is not a sufficient warrant

• Government has massive power/authority over people
• Only justification to do so is to prevent harm to other people
• Ex. Vaccines, smoke-free policies

Question 23

Precautionary principle

Answer 23

When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically

• Don’t need full evidence to prove health will be harmed, just use precaution
• Sometimes can’t generate the evidence, gives policy makers leverage

Question 24

Least restrictive means

Answer 24

the full force of state authority and POWER SHOULD BE RESERVED FOR EXCEPTIONAL CIRCUMSTANCES and that more coercive methods should be employed only when less coercive methods have failed

= Want to achieve health objective, don’t go straight to stick, start with sermon, then carrot, then stick

Question 25

Reciprocity

Answer 25

Once public health action is warranted…[e.g., quarantine; isolation] there is an obligation on a social entity such as a public health department to assist the individual (or community) in the discharge of their ethical duties

-ethical duty to stay home and protect others = Society won’t make you lose your job, they will support you through this

Question 26

Descriptive ethics

Answer 26

What do people believe is ‘right’ or ‘good’ with respect to a health policy issue?

○ Surveys from Canadian public
○ Social scientists

Question 27

Theoretical ethics

Answer 27

What makes a decision or action an ethical one?
○ Provide a reason to that being the case
○ Philosophers

Question 28

Normative ethics

Answer 28

What should be done in a specific circumstance?
○ Applied ethicists
○ Most relevant in policy

Question 29

Despite its fundamental importance, explicit, _____ policy analysis arguably remains the most neglected analytic method in the field

Answer 29

normative