Clinical ethics have become far too preoccupied with the individual, autonomy and informed consent, argued Baroness Onora O’Neill at the Nuffield Council on Bioethics‘ 20th anniversary lecture last night. This preoccupation risks marginalising important ethical issues of increasing relevance for global and public health, through its focus on the ethical implications of any particular action for the individual patient. Addressing these issues requires re-establishing the ethics of global health within political philosophy, so that we can use the framework of justice, accountability, and trust to evaluate the ethical ramifications of particular public health interventions. This broadening of the scope of public health ethics relates closely to the mission of the Nuffield Council on Bioethics – specifically its focus on the ways in which modern medicine and medical research raises new ethical problems. As Baroness O’Neill highlighted so clearly, modern medicine (and research) is a systems enterprise, in which established structures have major implications for a patient or clinician but cannot be directly chosen by them. Within these systems, many components are global public goods – their use by one individual (or group) does not prevent others from using them, and it is not easy to prevent others from using the goods without payment. Astonishingly, an example proposed in the lecture by Baroness O’Neill of a global public good in the global health arena was Open Access to health information. It takes effort (and convoluted structures) to prevent individuals from accessing and using knowledge. Wider access benefits all. Yet we all have a role to play in providing global public goods such as access to information. As Baroness O’Neil proposes, a new approach to thinking about global health ethics gives us tools to recognise our responsibilities with regard to public health interventions and systems– notably, even publishing systems.
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