Nonetheless I am more than curious for feedback and have made a promise to myself to post as much of what I write as is humanly possible.
Does Fairness mean Equality?
By striving for fairness are we undermining the very purpose of fairness?
The principle of equality has deep historical and cultural roots. The idea that “every man is born equal” is both attractive and iconic. There is however a fallacy here, which is that no man is born equal. There are inherent characteristics imbued at birth (and subsequently during development) that make this idea incoherent.
Equality is defined in the Oxford English Dictionary as “The condition of being equal in quantity, amount, value, intensity, etc.” The suggestion here is that equality means uniformity. This is not only undesirable, but impossible. No two organisms can have the same makeup and occupy the same place in space and time. There are always advantages conferred by these differences that make complete equality unworkable. Human society consists of even greater differences: those of genetics, gender, ethnicity, class, social background and countless others. These differences cannot be ignored for they can determine the course of one’s life dramatically, and - depending on one’s views of free will – they can be outside an individual’s control.
This complex philosophical question is difficult to answer, and beyond the scope of this essay. However, studying empirical evidence, it is clear that there is a strong correlation (of varying degrees) between many of these factors and many health and social problems.
This is mostly acknowledged in healthcare, and common sense has dismissed dogmatic ideas of uniformity and universality. It would be ridiculous for instance to provide cervical screening to male patients. However there is the potential to widen this principle beyond the simple remit of obvious differences.
There have been attempts to provide fairness through inequality on a socio-political level through policies of Affirmative Action. There is debate over the ethical implications of these policies, both from a practical and moral perspective. The moral argument can be reduced to ideas of reverse discrimination. On the practical side, it is argued that these policies change public perceptions so fundamentally that they undermine the very objectives attempted to be reached.
In contrast, there is also the potential that actions like this could help redistribute resources to where they are most needed. When visiting a General Practitioner in Lewisham I was told that screening attendance was far lower there than in other, more affluent, areas of the country. The interventions for those conditions were therefore less successful as diagnosis was delayed. It might be fairer to invest more in encouraging individuals from these areas to attend screenings. However, it was the GP’s opinion that it was the responsibility of those who did not attend and further investment from an already overstretched service is not justified.
The ability for society to accept these ideas is heavily influenced by resource availability. In the current climate there is increased strain on resources in healthcare and the country as a whole. Deciding how these resources should be distributed will be increasingly more important in healthcare in the near future.
There are clearly differing views within society of what real justice is. Ideas vary between individuals and parties. It is possible that by doing away with certain ideas of equity, society can actually become fairer by appreciating differences and aiming to counteract their negative effects.
Whilst this may sound rather attractive on paper, there are clear issues in translating ethical principles into ethical practice. As with any principle it will not be interpreted nor applied identically by every individual. There will always be those who, willingly or unwillingly, misuse the idea to justify actions that undermine its very purpose.
Equality is a core belief within our society, regardless of its flaws. It is deeply ingrained into almost every citizen’s understanding of social justice. Policies that suggest favouritism of certain groups over others could easily challenge this understanding to such a degree that the principle is invalidated. It might be better to accept the devil you know than the devil you don’t.
It is possible to be so consumed by making an idea work in theory that it loses its practical use. Amartya Sen famously criticised Rawls (and others) in The Idea of Justice for ascribing to what he named “transcendental institutionalism” – the search for a perfect notion of justice. Justice is a complex, imperfect entity and establishing a real connection between theory and practice is of key importance.
Reasons for choosing Medical Ethics
Medical ethics is an essential part of clinical practice. It is within this specialty that we are most able to address the dilemmas that arise in the healthcare profession and question what ought to be done.
The deeper I have explored, the more I have learnt that the practice of medicine is far more muddled than is often acknowledged, particularly in discussions at student level. The reality involves constant debate over practice and conflicts arise between many parties: between patients and doctors; between doctors and their peers; and between doctors and the government. Each group has a different set of priorities and there is rarely complete agreement over any major healthcare policy decision.
This is exacerbated by the fact that some doctors do not perform their role as well as they could. My experience in the clinical setting as both a patient and a student has been varied in this regard. Many (if not most) doctors performed their roles admirably and undoubtedly supported their patients to the best of their abilities. However, this is not universal and some doctors clearly performed better than others. I have encountered more than one doctor who appeared self-interested and dismissive of their patients’ feelings and concerns. I have even heard stories from my peers of doctors performing actions that are clearly negligent and unprofessional.
These are not isolated events; in fact Medicine is no stranger to scandal. Throughout history there are cases of questionable ethical decision-making by those at even the highest levels of authority. Most notorious of course are the Nazi experiments during the Second World War and the consequent Doctors’ Trials in Nuremberg. There are however more recent examples: those of Baby P and the Staffordshire Hospital Crisis have demonstrated the potential for repeated failure on multiple levels of the healthcare service.
With such potential, I feel a keen sense of duty as a future medical practitioner to learn the skills necessary for good clinical judgement – not only for my patients’ sakes, but to feel comfortable with the decisions I make.
This is my long term goal, but there is an immediate sense of gratification that can be felt by pursuing this study. I take great interest in ethical issues and relish attempting to understand complex problems and find practical solutions to ethical dilemmas. Decisions are made in a constantly changing socio-political landscape. There are many variables that can alter how decisions are made: There can be changes in resources themselves (such as changes to NHS funding); changes of social values (such as those of assisted suicide and mental health); and also due to advances in technology (bioethical issues). I already take an individual interest in all of these matters and being able to integrate them into my thought process is something I enjoy.
In my spare time I love to write and maintain a blog (www.sharkattack-i.blogspot.com) in which I try to explore many of the issues that I find myself musing over. I try to cover a broad range of topics, but most of my writings focus on key interests of ethics, politics and film.
I am also a member of the KCL Film Society and Debating Society; both of which provide the opportunity to express my opinion, as well as listen to opinions completely different to my own. Debating also offers the unique opportunity to argue opinions from a viewpoint that one doesn’t hold - something which helps foster a deeper understanding of other views, as well as improving one’s reasoning and oratorical skills.
I hope that when I complete the course I will have gained skills to make effective decisions in clinical practice, as well as having broadened my mind by sharing my views with other interested students. I have no doubt that this will be the case.
