Ethical basis of policy-making

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Health systems should allow all beneficiaries to assume personal responsibility for their own health.’

GIVEN the general perception of the pervasiveness of corruption through all levels of the three branches of the Philippine government, an emphasis on rooting out corruption by any new administration is welcome.

Corruption in the legislature is almost taken for granted. Most people have lost faith in the justice system and law practitioners lead in the cynical view that decisions even at the highest levels can be bought and sold. The last administration took the reputation of the executive branch down to all-time lows. Thus, the present campaign against corruption is popular and most Filipinos believe that this is long overdue.

But it would be naive to think that corruption exists only in government. It is almost as pervasive in the private sector. As the saying goes, there would be no bribe-takers in government if there were no bribe-givers from business institutions. Many social-minded critics of Philippine culture actually believe that predilection for promoting self-interest is most deeply ingrained among the most fervent believers of free-enterprise capitalism.

Anti-corruption programs are actually counter-productive when they result in paralysis of the bureaucracy. Graft-free public works agencies would be useless if no infrastructures are ever built. Cleansing the tax-collecting mechanisms would do no good if revenues were not generated. A virtuous but ineffective security apparatus would not serve the interests of communities that are left unprotected.

In some areas of governance, fighting corruption can actually be a bad thing if it were the only thing that government agencies did. For example, the Department of Health takes pride in the surveys showing that it is perceived as the "least corrupt" department of the last administration. However, an analysis of the effects of neglect in the health sector can be interpreted as evidence that allowing health inequities to continue may in reality be unethical if not downright immoral.

By tolerating the existence of profound health inequities, most stakeholders of the Philippine health may in fact be guilty of violating the bio-ethical principles of non-maleficence, beneficence, justice, and respect for the autonomy of individuals, families, and communities.

Non-maleficence ("doing no harm") is the principle that requires health authorities to protect the health of individuals and communities, especially that of vulnerable groups in society. A system that allows 10 women to die of preventable pregnancy-related causes on a daily basis certainly bears responsibility for this harm. Allowing harmful practices - such as the promotion of smoking and potentially harmful "cosmetic" interventions - is also a violation of the principle of non-maleficence.

Beneficence requires the health community to make evidence-based and up to date health interventions available to everyone who needs them. Denying contraceptives to poor women who no longer wish to become pregnant, maintaining price-barriers to common antibiotics, and prescribing only expensive medicines to individuals with chronic conditions are examples of violations of the principle of beneficence.

Justice is the principle that mandates equity, social justice, and universality in the operations of any health system. The principle is violated when life-expectancy in impoverished rural areas is 15 years less than that in rich urban gated villages. It is not served when life-saving but expensive treatments (such as Caesarian sections or dialysis) are accessible to those who can pay but denied to individuals who happen to be poor.

Finally, the principle of autonomy compels health systems to respect individual and communal rights to self-determination and self-reliance. As well, health systems should allow all beneficiaries to assume personal responsibility for their own health. The principle is violated by a top-down approach to health policy-making where beneficiaries of health services do not have a voice in determining allocation of resources for health. It is violated by a system that preserves professional authority for providers while denying information to recipients. A fragmented health system that obstructs access to appropriate health services by forcing health service seekers to navigate a complex process without assistance also violates the principle of autonomy.

In short, minimizing corruption in the health system may be necessary in order to effectively and efficiently carry out programs of health service delivery but it is not sufficient to assure its compliance to the accepted bioethical norms of behavior in health. Governance structures in such a system must take into account the existence of continuing health inequity - defined as unequal, unfair, and unjust access by some groups to the services needed to achieve individual and societal health goals. Policies that fail in this are in fact unethical if not immoral.

Below is an excerpt from the above article by A.G ROMUALDEZ JR., M.D.

An article in The Lancet, a leading international medical and public health journal, has accused the government of Canada of hypocrisy in its policies regarding the asbestos industry. Asbestos, established as a cause of mesothelioma (a deadly form of lung cancer), has long been banned for use in construction in almost all developed countries - including Canada. Nevertheless, that country is still one of the world’s major exporters of the lethal material to countries that still allow its use - such as India, Indonesia, and the Philippines.

Because the link between mesothelioma and chrysotile (a generic term name for asbestos) was not fully established and accepted until the 60s, past occupational exposure, even in developed countries has resulted in a continuing rise in the incidence of cases. As an example, the article states, "In the UK, the mesothelioma death toll has increased from 895 in 1990 to 2249 in 2008. It could be a decade before cases begin to fall again."

In this light, our health regulatory must review current policies that allow the Philippines to continue importing asbestos from the world’s biggest producers like Canada, Brazil, Kazakhstan, and Russia. The Philippines should also support attempts - long resisted by these supplier countries - to include chrysotile in the Rotterdam Convention (a list of controlled substances maintained by the United Nations).

source: http://www.malaya.com.ph/12152010/edromuald.html