When Is It Ethical to Withhold Prevention? — NEJM

From the conclusion:

Realistically, no framework that we could develop will eliminate what appear to be ethical inconsistencies between these different situations. But we can acknowledge that we currently have a systemic bias against prevention and that decisions about whether to provide or withhold proven preventive actions are not just tough budgetary choices, but are also ethical ones. Because withholding primary prevention leads to unnecessary suffering and death, I believe that as a society we should be just as creative in finding ways to pay for it as we have been in finding ways to pay for the penniless woman’s lung-cancer treatment.

I recently presented a paper on a subject close to this, on big data ethics. A framing argument had to do with the obligations “the public good” puts on agencies, public or not. The classic turn in the NEJM perspective is to be “realistic,” which is to say, recognise scarcity or the inability to satisfy all. But the conclusion also raises some deeply problematic terms, like “we” “as a society” and so on. Terms that assert a unified society and, thus, the possibility of an identifiable public good, or that which benefits the people as a whole.

I find the terms problematic not because I would disagree with the notion of  a “we” or of “society” to which the we would be belong or comprise it. It’s problematic because these same terms so easily become terms of division, of exclusion, not inclusion; of nations bounded by essential identities, wherein “culture” might as well be bred in the bone and not just what one does.

Yet, of course, medical decisions are inevitably nowadays financial ones, and no more so than in the US. It’s not likely to change soon or fast; and indeed costs are only going to rise. Which is where the logic of the public good comes into play, and solutions that serve that good and articulated by governmental agencies become very real.


Perspective from The New England Journal of Medicine — When Is It Ethical to Withhold Prevention?

Source: When Is It Ethical to Withhold Prevention? — NEJM