In many of these cases, I tend to come down on the side of the dilemma that would support a public health or population-based solution. This means choosing a community-based option over individual rights or virtues, including the vested interests of the individual. This is especially true if the cost to the individual in question is not measured in terms of health or well-being, but more in economic terms. It is a question of civic or community virtues versus individual rights. Interestingly, when we were participating in the experiment of setting priorities for the Oregon Health Plan, we consciously tried to balance sets of competing principles: • the provision of "caring" as opposed to "curing," especially when the pursuit of a cure seemed counterproductive, futile, or insensitive; • the value to the community versus the value to the individual; and • the benefits of extending or saving lives in relation to the likelihood of a return to a level of function that is sufficient to make life meaningful. These same principles, and variations on them, can be applied to resolution of many of the dilemmas described above. It is not possible to provide more detailed discussions of these challenging issues in this article. However, the presentation of these issues and their complexity should underscore two basic assertions. Policy makers need clinically informed and ethically oriented experts to assist in the policy process. Likewise, health professionals have an ethical obligation to be aware of and, when feasible, to participate in the creation and resolution of health policy dilemmas.
ASJC Scopus subject areas
- Psychiatry and Mental health