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'Will we ever be able to separate health ethics from economics?'


Sometimes at the weekend my wife and I will compare items of interest in the news; a battle of the headlines, if you will, to see whose news is most interesting. The unspoken aim of the game is to get the other person to engage with your chosen news item, thus abandoning their own.

“Did you know that 25% of adults only walk for an hour a week?” I said to my wife.

“Natalie won Masterchef then,” she murmured.

I ignore her. “Do you think that hour includes just being at home - going to the toilet, putting the rubbish out?” I ask.

“Natalie probably walks a lot in the kitchen. I think chefs walk quite fast? Can you think of a job where you have to walk faster than a chef?”

You see what she’s doing there? Trying to coax me away from the fundamental issue of regular exercise in order to construct some sort of job-walking graph. I’m having none of it.

“Forty-three per cent reported walking less than 2 hours a week.”

“I reckon I walk more than an hour doing all the cooking,” she said. And before I can think it’s out: “Doing all the cooking? I cook more than you.”

“Yeah, but you don’t cook as well. You ought to watch Masterchef.”

“I don’t want to watch Masterchef,” I say. “What sort of person watches people they don’t know cooking food they can’t taste for people they don’t like?”

“Normal people,” she said triumphantly.

I can’t help wondering about the relationship we, the public, have with health information. Some may embrace it as a helpful tip and decide to walk a bit more. Others may dismiss it as obvious or dull. Others still move to conspiracy theory, imagining the media is encouraging us to walk more because they want to save petrol and so, in an expression of personal freedom, they vow to drive to the kitchen in future. Nonsense of course, but the combination of deep suspicion about information provided by research (the MMR vaccine, for example) and the need to express personal freedom (MMR for example) appears to be a powerful health determinant.

In recent years, the MMR vaccine was a potent example of the uneasy relationship between clear information and the variable that is humanity. In recent weeks we are seeing the consequences of that and it is striking - to those of us who campaigned for the vaccine at least - how quiet the shouty anti-immunisation people seem to be now. Shame does that, I suppose.

Personally I think it might be interesting to have a fuller debate about the ethics of health information, personal responsibility and health choices, but perhaps in these days, in this economy, and against the backdrop of political misanthropy that characterises this government, it doesn’t feel safe to try.

Let’s face it, if we ask difficult ethical questions about, say, children who are not immunised being excluded from school or excessive drinkers not having access to liver transplants, the discussion very quickly becomes about economics and affordability. Perhaps that’s because economics is a clearer measure of what is “right”. At heart money rules all curiosity; does that belittle us professionally?

It is interesting I think how discussion, development and even ethics has become dominated by economics. Wondering what is right or best lies a long way behind what something costs in our hierarchy of concern. It is a modern reality I suppose. Will it always be like that now?

Mark Radcliffe is senior lecturer, and author of Gabriel’s Angel


Readers' comments (6)

  • I think a fuller debate about the ethics of health information, personal responsibility and health choices is important and the fact that these issues are not being engaged with is another example of tinkering round the edges of health instead of developing the principles. 'Free at the point of delivery' is a key founding principle of the NHS but it doesn't address what should be delivered and what responsibilities each partner in health should have - NHS staff, patients/public, government. Plus you could add responsibilities of food, alcohol and cigarette manufacturers to those who should be partners in health - just to mention a few.

    As to whether what is right or best will always lie a long way behind cost - I really hope not because apart from anything else that is not a truly cost-effective or sustainable way forward. The swing of the pendulum of history suggests sense may prevail again one day but if it doesn't we are doomed to an increasingly unjust, rampantly 'me, me' society and will perish. The signs all round are not good and are not confined to health issues - look at the obsession of some for an EU referendum, despite acknowledging that it isn't a key issue for the country, and no acknowledgement that the EU has helped to sustain peace - communication and agreement may be difficult at times but EU countries haven't gone to war with each other. That's worth a very great deal.

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  • PS to above - meant to say thanks so much Mark for continuing to write for NT - your pieces are the ones I most appreciate and look forward to.

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  • Mark I only wish the shouty people had gone quiet - not so! They are now complaining that their children have been put at risk because they are not provided with single vaccines by the NHS!!

    I have no idea how you get through to people like that.

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  • Bridget - Thank you. That is kind.
    Sarah - I don't know either but I think noticing them as shouty might be a start?

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  • tinkerbell

    sometimes at the end of a discussion my husband feels so frustrated with me he tells me to 'eff off'. I don't answer so he asks quickly 'aren't you talking to me'. I don't answer cos' obviously not.

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  • tinkerbell

    On the tv tonight a programme about Emily Wilding Davison who became the first martyr for the suffragette movement. She was trying to pin the scarf of 'votes for women' to the Kings Horse in the Derby, she died June 8 1913 4 days after the event having never recovered from being in a coma following being hit by the Kings horse. They think she had positioned herself in exactly the right place to do this, pin the 'votes for women' scarf to the horse but hadn't realised the speed at which the horses would round the bend.

    She had previously been imprisoned and violently force fed whilst in prison.

    Emily Pankhurst encouraged the suffragettes to be activists but the suffragette movement stood down during the first world war from their militant activities to help with the war effort. Women just wanted the vote.

    Now we have the vote we can vote against governments that are amoral and unethical. This is what a democracy is all about, if the government doesn't represent the society we want don't vote for it. We vote for the society we want.

    We don't have to become like America with profit driven health care. Not everything should be about money especially not our ethics.

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