Shared Statement of Ethical Principles for the Health Care System

Six major principles should govern health care:

1. Health care is a human right.

• Because health care is a human right, all health care systems should ensure universal access to basic services, regardless of ability to pay.

• Caring for sick people is a social obligation that transcends commerce. Institutions that provide health care may be owned for profit, but care is delivered under a higher standard of duty.

• Health care is financed at least in part by governments, which also heavily subsidize the training of those who work in health care and the research that forms its knowledge base. Therefore, individual providers or organizations do not have total discretion in providing and charging for services. They must recognize an obligation to society.

• Stewardship of the specialized knowledge of medicine and health care requires that everybody in health care, including recipients, contribute to extending that knowledge through research. Those providing care must also spread their knowledge through teaching, publication, and collaboration with colleagues, regardless of their organizational affiliation.

• Stewardship of financial capital and physical resources requires efficiency in their use and investment in their renewal.

2. The care of the individual is at the center of health care, but the whole system needs to work to improve the health of populations.

• The personal experience of illness is the principal concern of individual patients, and the principal focus of the health care delivery system must be individual patients. Those who provide care for individual patients are not in that role responsible for the care of populations. However, they should be mindful that actions taken on behalf of individual patients will affect others and that they will sometimes have to balance competing needs.

• Those who provide care should be advocates for their patients and for the populations they serve, but never in ways that are unfair to others.

3. The health care system must treat illness, alleviate suffering and disability, and promote health.

• Everybody in health care must strive to contribute to each of these aims.

• Teaching and research contribute to curing illness, alleviating suffering and disability, and promoting health, and they must be supported within the health care system.

4. Cooperation with each other, those served, and those in other sectors is essential for all who work in health care.

• Only with cooperation can health care delivery systems produce the best outcomes and value for individuals and society.

• Among the essential tasks in health care that require collaboration are:

— assuring an environment that uses the best available evidence from research and that minimizes unnecessary and inappropriate practice variation;

— ensuring that information about identifiable patients is kept confidential except with their permission;

— helping to sustain healthy and safe communities;

— providing a safe, secure, clean, and disciplined working environment within health care.

• All those working in any part of the health care system must be committed to developing the skills needed to work creatively in the presence of interpersonal and intergroup tensions.

5. All who provide health care must work to improve it.

• Health care organizations must establish ways to identify old procedures that should be modified or abandoned and new procedures or discoveries that may lead to improvements. They should introduce these improvements quickly.

• Those providing care must keep their practices up to date and participate in improvements that raise the quality of care, reduce costs, or both.

• Those providing care should never impede improvements in patient care because their financial interests might be harmed.

6. Do no harm.

• Those who organize and those who provide health care must recognize that every intervention has the possibility to harm.

• Errors in health care can cause harm. All those providing care should work to make it ever safer.

Source: American Academy of Arts and Sciences, Cambridge, MA.