Two Calls for Papers

The lead article in this Report calls for people working on bioethical issues to do work on population health. To date, argues Norman Daniels, bioethicists have focused on exotic new medical technologies and on special kinds of personal relationships in medical settings (especially relationships between doctor and patient or researcher and subject). Daniels argues that bioethicists should also be thinking about the problems of equity that beset population health, and he offers a taxonomy of these problems and a twelve-point agenda for taking them on.

Much of what has been published in the Hastings Center Report on issues of equity has centered on concerns about research conducted on human subjects and the distribution of its risks and benefits. Is enough research being done on the health problems of developing countries? Is it okay to do research in developing countries on the health issues of developed countries, and if so how? But much less has appeared in these pages on such questions as, "When is a health disparity between populations unjust?" and "What sorts of methods for reducing health disparities are acceptable?" (Should policy target those whose health can be most easily improved, but who may not be the very worst off, or should it target the very worst off, even though doing so may not raise the overall health of the target population as quickly as possible?) Yet ask almost anyone to identify the biggest ethical issues in medicine and health care, and they are very likely to say that access to health care is one of them. And if access to health care is important because reducing health disparities is important, then much more than just the access issue needs attention. As Daniels puts it, health is affected "not just by the ease with which we can see a doctor or be treated in a hospital, and not simply by the reduction in risks that come from traditional public health measures—though these factors surely matter—but also by broader aspects of social policy interacting with our social position and the underlying inequality of our society." So when is a health disparity unjust?

All of these sample questions about the ethics of population health are drawn from Daniels's paper. In identifying these questions, Daniels is in effect issuing a call for papers. It has not been standard practice at the Report to issue calls for papers, but this is a good occasion for an exception to the rule. The motion is seconded. Especially interesting would be papers that address the issues of population health not completely in the abstract, but in the context of actual policy choices and proposals (such papers would fall under Daniels's fifth agenda item).

Also included in the Report's call for papers, though, are the familiar but often neglected issues of access to health care. The second paper in this issue, which does not take up any of the questions Daniels offers as part of a "broader bioethics agenda," but which still falls outside the range of the usual bioethics agenda, perhaps already marks progress toward this goal. It offers a reconsideration of the values that underlie universal access, and it argues that there is much for political conservatives to love in these values—and much that conservatives outside the United States in fact do love. The argument is largely conceptual, and when it offers empirical observations deals mostly with generalizations, all of which is very much within standard practice for the Report. Papers on actual policy choices and proposals are also welcome.