Share ethical principles for everybody in health care: a working draft from the Tavistock Group
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In this week's BMJ, the Tavistock Group - comprising physicians, nurses, health care executives, academics, ethicists, a jurist an economist and a philosopher from four nations (the US, the UK, Mexico and South Africa) - presents its latest draft of a set of comprehensive ethical principles to guide all those working in health care and to engender a sense of togetherness and co-operation within health care systems.
Simultaneously published in the Annals of Internal Medicine (1999; 130:143-7) and the Nursing Standard (1999;13(19):33-7) the guidelines aim to address the ethical problems inherent within complex health care systems, which are serviced by teams of professionals and their ever sophisticated technology (as opposed to the scenario 150 years ago when individual practitioners worked autonomously, visiting patients in their homes). These professionals work in an environment of increasing demands on their resources; financial pressures; limited resources and inadequate health care delivery systems which inevitably serve to create ethical tensions.
The Tavistock Group details five major principles which it believes should govern health care systems, the first of which underlines that health care is a fundamental human right. The second principle states that even though the care of individuals is at the centre of health care delivery, this must be viewed and practiced within the overall context of continuing work to generate the greatest possible health gains for groups and populations. Thirdly, the Group suggests that health care systems are responsible for preventing illness and alleviating disability and fourthly that co-operation between all those working within health care systems is imperative, both for the individual patient and for the population as a whole. Finally, the authors cite the improvement of quality as being at the heart of all health care systems.
The Tavistock Group elaborates on each of these principles and emphasises that they have been drafted by way of a discussion document, it welcoming contribution from readers in all nations and all disciplines, in order to work towards a formalised set of shared ethical guidelines.
Contact:
Dr Donald Berwick, President, Institute for Health care Improvement, Boston, US
t: +1 617 754 4852
f: +1 617 754 4865/48
email: dberwick@ihi.org