Power and Politics

Question 1

What are the four pillars in Beauchamp and Childress taxonomy of medical ethics?

Answer 1

• Autonomy (freedom to act independently)
  
  • Non-maleficence (do no harm)
  • Beneficence (do good)
  • Justice (fairness)

Question 2

Give an example of when the 4 pillars come into conflict?

Answer 2

They can conflict with public health principles (when health of wider population justifies overriding the rights of the individual)

Question 3

What is utilitarianism?

Answer 3

when the ethical validity of an action is determined by the outcome/consequences (as compared to intensions), aims to maximise human wellbeing/happiness.

Question 4

Give an example of when utilitarianism doesn’t apply?

Answer 4

NICUs are least cost effective in hospitals

Question 5

What is social justice?

Answer 5

The idea of social contract between rulers and the ruled.

‘‘Society should treat all equally well who have deserved equally well of it’’ —> everyone should have fair chance

Question 6

What is distributive justice?

Answer 6

Active seeking and promoting equality​

Wealth redistribution/unconditional basic income​

Question 7

What was the veil of ignorance?

Answer 7

This was a though experiment.

- The thinker to imagine they have no idea what class, position or social status they will be born into
- What type of society or social contract would they want
- Almost everyone chooses fairer society

Question 8

What is Politics vs politics?

Answer 8

Politics - relates to political parties and the philosophy of government, driven by politicians - typically elected decision maker.
politics - the process of us gaining or applying power in local groups or organisations

Question 9

What is collectivism?

Answer 9

A political ideology.
e.g. Marx or Lenin More egalitarian (egalitarianism - based on the principle that all people are equal and deserve equal rights and opportunities), people are given equal opportunity and wealth is redistributed partially by progressive taxation or wholly by state action on salaries or company profits.

Question 10

What is libertarianism?

Answer 10

A political ideology.
e.g. John Stuart Mill - the state should not interfere with the individual’s autonomy (situation would only warrant government interference if someone else is coming to harm), free market, capitalism - people make their own choices for good or for ill.

In context of social policies (incl. health services or systems), how much should state interfere with personal liberties.

Question 11

Who described the Harm Principle and what is it?

Answer 11

John Stuart Mill - Harm principle: the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.’’
–> Mill believed that individuals are sovereign and state interference should be constrained as a default.

Question 12

What do you need to effect change?

Answer 12

• The right message
  
  • The right person
  • The right time

Question 13

What is power?

Answer 13

Power = the ability to exercise one’s will over others.

Question 14

What is authority?

Answer 14

Authority = the ability to influence people and outcomes

- Think about the authority of medical professionals

Question 15

What are coalitions?

Answer 15

Coalitions = a group of stakeholders who work together for a shared goal.

Question 16

Summarise Responsibility Deal.

Answer 16

• 2010-2015 Coalition Government launched the Public Health Responsibility Deal (PHRD)
  
  • Co-regulatory regime places alcohol industry at heart of policy making, rather than public health actors who were very sceptical as evidence based measured not amenable to the industry partners off the table, resulting in public health withdrawal from the process and so limiting their access to the government.
  • Study looks at how alcohol industry actors were able to influence policy through long-term relationship building and partnership working on policy decision making. Is there a fundamental conflict of interest?
  • e.g. minimum unit pricing (implemented in Scotland), strongly supported by international research evidence on policies to address alcohol related harm, strongly opposed by alcohol industry who prefer voluntary and co and self-regulatory approaches. –> Both of which have limited evidence of their effectiveness

Question 17

What is the Nuffield Ladder of Bioethics?

Answer 17

• Framework used to consider the proportionality of containing individual liberty.
  
  • Categorises interventional approaches, does not provide justification

Question 18

How many rungs are there in the Nuffield Ladder of Bioethics?

Answer 18

Eight (8- least choice, 1-most choice)

Question 19

What is the 8th rung of the Nuffield Ladder of Bioethics?

Answer 19

8. Eliminate choice - regulate in such a way as to entirely eliminate choice, for example, through compulsory isolation of patients with infectious diseases.

Question 20

What is the 7th rung of the Nuffield Ladder of Bioethics?

Answer 20

7. Restrict choice - regulate in such a way as to restrict the options available to people with the aim of protecting them, for example removing unhealthy ingredients from foods, or unhealthy foods from shops and restaurants.

Question 21

What is the 6th rung of the Nuffield Ladder of Bioethics?

Answer 21

6. Guide choices through disincentives - fiscal and other disincentives can be put in place to influence people not to peruse certain activities, for example through taxes on cigarettes or by discouraging the use of cars in inner cities through charging schemes or limitations of parking spaces.

Question 22

What is the 5th rung of the Nuffield Ladder of Bioethics?

Answer 22

5. Guide choices through incentives - regulations can be offered that guide choice by fiscal and other incentives, for example offering tax breaks for the purchase of bicycles that are used as a means of travelling to work.

Question 23

What is the 4th rung of the Nuffield Ladder of Bioethics?

Answer 23

4. Guide choices by changing the default policy - for example, in a restaurant instead of providing chips as a standard side dish (with healthier options available), menus could be changed to provide a more healthy option as standard (with chips as an option available).

Question 24

What is the 3rd rung of the Nuffield Ladder of Bioethics?

Answer 24

3. Enable choice - enable individuals to change their behaviours, for example offering participation in an NHS ‘stop smoking’ programme, building cycle lanes, or providing free fruit in schools.

Question 25

What is the 2nd rung of the Nuffield Ladder of Bioethics?

Answer 25

2. Provide information - inform and educate the public, for example, as part of campaigns to encourage people to walk more or eat five portions of fruit and vegetables per day.

Question 26

What is the 1st rung of the Nuffield Ladder of Bioethics?

Answer 26

1. Do nothing or simply monitor the current situation

Question 27

What is co-regulation?

Answer 27

Co-regulation - institutionalised engagement between government and industry actors to deliver policy goals

Question 28

What is self-regulation?

Answer 28

Self-regulation - industry bodies to regulate their activities with minimal government intervention or oversight, (e.g. the Portman Group’s code of practice on the marketing of alcohol products)