Medical ethics / ethics of medical care and the MDG’s resolutions related to healthcare
The principle objectives of the United Nations Economic and Social Council (ECOSOC) are to improve living conditions, achieve full employment, and consolidate the conditions for economic, social, and developmental progress.
The Annual Ministerial Examination is a new function of ECOSOC, mandated by the heads of state and government at the World Summit in 2005. Notably, its objective is to evaluate the improvements in the implementation of the Millennium Development Goals (MDGs) and to increase and accelerate steps taken to execute the developmental agenda. High-level forums permitting vast participation of partners are organized toward this end, so that lessons can be shared and successful actions and attempts identified.
Within this framework, an overarching annual topic of political, social, or economic interest that requires closer examination is selected. The theme of the 2009 Examination is “The realization of approved goals and commitments on an international level for worldwide public health.”
In July 2009 in Geneva, a Ministerial Declaration will address and celebrate the efforts of the diverse participants in the annual ECOSOC theme of the Ministerial Examination.
Under the patronage of the International Association of Economic and Social Councils and Similar Institutions (AICESIS), The fondation Ostad Elahi: Ethics and Human Solidarity— a public interest organization with Special Consultative Status to the Economic and Social Council of the United Nations (ECOSOC) whose mission is to promote solidarity through the development of the theory and practice of ethics—proposes to introduce this general topic and to coordinate a roundtable of experts on the theme of “medical ethics / ethics of medical care and the Millennium Development Goals resolutions related to healthcare,” with the objective of proposing recommendations at the Ministerial Meeting in Geneva.
Roundtable
The problem of world health currently examined by the Millennium Development Goals is of paramount importance, as three of its eight objectives are directly related: from 2000 to 2015, infant mortality is to be reduced by two-thirds (obj. 4), to improve the health of mothers, maternal mortality is to be reduced by a quarter (obj. 5), and combating HIV/AIDS, malaria, and other diseases. Access to essential drugs is also reaffirmed in target 17, objective 8.
Naturally, the Millennium Development Goals as a whole (struggle against poverty, equality among human beings, education, etc.) are more or less directly linked to the question of health.
All observers, including those actively involved in the discussion at an international level to evaluate the progress of the Millennium Development Goals, estimated at the midway point that immense efforts must be undertaken to approach these objectives by 2015, efforts that have been essentially measured as proportional to financial and human investments placed at the disposal of developing countries by developed countries. One element of a qualitative nature that appears to be neglected in the overall estimation of means likely to favor the fulfillment of the Millennium Development Goals is that of medical ethics, and more generally the ethics of medical care, carried out in the field in countries needing aid.
Yannick Jaffré and Jean-Pierre Olivier de Sardan indicate that, “The qualification level of healthcare professionals trained on internship sites of diminishing quality has been in considerable decline, and professional practice has been veering away from all deontology.” When adding to this assessment another factor stressed by Pierre Morange —namely, that “the request by countries and embassies for intervention in maternal and child healthcare is weak,” and that “the marginalization of francophone African countries suffering from a certain inequality of access to recent European and worldwide aid, notably with respect to preventive care, care of the infected, or research in AIDS, tuberculosis, or malaria, could increase,” it is apparent that the question of ethics is not without effect on progress toward the fulfillment of the Millennium Development Goals related to healthcare.
The goal of this roundtable is not to discuss the question of ethics in relation to the degree of corruption (public and private) of target countries, which the Morange Report considers as “the most pressing problem the mobilization dynamics of the private sector is confronted with,” but rather to evoke a certain number of questions related to the nature, implementation, and evolution of medical ethics in target countries and the real, supposed, or desired impact of this ethics on the progress toward realizing the Millennium Development Goals for healthcare.
For most western countries, research and action in the field of medical and healthcare ethics is now necessarily on the agenda, even if “it is still a struggle for it to be fully adopted in medical practice.” What about in developing countries? What specific questions of medical ethics/ethics of medical care have been observed in the field?
How can non-ethical behavior in the healthcare sector of developing countries be concretely eliminated? At what level should action be taken within the systems themselves, and what level of support can be obtained? What preoccupations, visions, and practices in medical and healthcare ethics (content, awareness campaigns, implementation, transmission, etc.) are shared by the various parties involved, whether governments, public or private institutions, or social organizations? What impact can ethics have on the realization of the Millennium Development Goals for healthcare? Is this impact measurable or quantifiable, and if so, how?
Faced with the extent of the problem at hand, the complexity of public health issues, and their interdependence with other problems (demographic, climatic, geopolitical, economic, etc.) these ethical questions may not be secondary after all. Indeed, the authors of the UNAIDS external evaluation report for the period 1996-2001 admit that, “The program has not yet found an answer as to how to explain and diffuse the means to change behavior and improve the efficiency of humanitarian actions. Preventive programs face the very complicated task of changing sexual behaviors. The reason for the rare success of these programs is not understood” and recommends to UNAIDS that this constitute “an area of major work for the future.”
This change in behavior, both hoped for and expected—is it not at heart a fundamentally ethical approach?
