Abstract
The purpose of this research project is to advance our understanding of the ethical values that do and should determine priorities when business values intersect with healthcare values in our healthcare system. There are few subjects of more importance because of the impact of healthcare on the quality of life or individuals and communities. In Canada, publicly funded universal healthcare, what we call medicare, is widely regarded as a one of our most important collective achievements.
In Canada, healthcare is publicly funded. However, even in publicly funded systems, business and the private sector play an important role. The pharmaceutical industry is an example. In our system, the medical practices of doctors operate in many cases as small businesses. The result is that although medicare in Canada is publicly funded, about 30% of healthcare is in the private sector. Furthermore, because of growing costs, the role of privately delivered healthcare is being widely debated and evaluated.
What is at issue in debates over privately funded healthcare is the compatibility of business values with their focus on profitability with healthcare values that make the wellbeing of patients and clients the highest priority.
The focus of our study
The study we are proposing will look at the role of ethics where business and health care values intersect. We will pay particular attention to the Canadian health care system where business currently has a role that is likely to continue and perhaps increase in importance. The issue here is not whether there is a place, ethically speaking, for business in healthcare. Rather, the question is: what ethical issues result when business interests and healthcare interests do intersect, as quite clearly they do in a wide variety of ways. What, for example, are the ethical dimensions of situations where healthcare values involving the care of a patient or patients intersect with business imperatives of efficiency, or profitability or fairness in structuring market based competition? Answering these questions is a complex task that requires both conceptual and methodological development before doing advanced research.
We propose to look at ethics at intersection of business and healthcare as it affects individuals (a micro level focus), organizations (a meso level focus) and systems (a macro level focus). Business and healthcare values intersect in hospitals when a hospital administrator facing budget constraints makes decisions that affect the care of a patient or an academic healthcare researcher looks for private sector funding for a research project (micro level). Business and healthcare values intersect when pharmaceutical companies are faced with research, development and drug pricing (meso level) decisions. At a system wide level, business and healthcare concerns intersect in discussions about intellectual property rights and patents, as the Harvard Mouse case that was eventually resolved by the Supreme Court of Canada, illustrates.
We propose to map the points of intersection in healthcare systems like medicare of business and healthcare values. We will engage in an analytical literature review with the goal of ferreting out accounts of the business and healthcare values meeting those points of intersection. We propose then to analyse the accounts and descriptions of the business and healthcare values meeting at those points of intersection and the ways they are intersecting using theories and models commonly used to describe the purpose of business and the purpose of healthcare, for example profit maximization and stakeholder theories of business and human rights theories and utilitarian theories of healthcare.
The ultimate goal is to understand more clearly how to ensure that high ethical standards govern the intersection of business and healthcare. The purpose of this project is to prepare the ground for research that has this objective.