Analyzing the politico-moral foundations of the Iran’s health system based on theories of justice
AbstractPublic health ethics is a field that covers both factual and ethical issues in health policy and science, and has positive obligations to improve the well-being of populations and reduce social inequalities. It is obvious that various philosophies and moral theories can differently shape the framework of public health ethics. For this reason, the present study reviewed theories of justice in order to analyze and criticize Iran’s general health policies document, served in 14 Articles in 2014. Furthermore, it explored egalitarianism as the dominant theory in the political philosophy of the country’s health care system. According to recent theories of justice, however, health policies must address well-being and its basic dimensions such as health, reasoning, autonomy, and the role of the involved agencies and social institutions in order to achieve social justice beyond distributive justice. Moreover, policy-making in the field of health and biomedical sciences based on Islamic culture necessitates a theory of social justice in the light of theological ethics. Educating people about their rights and duties, increasing their knowledge on individual agency, autonomy, and the role of the government, and empowering them will help achieve social justice. It is recommended to design and implement a strategic plan following each of these policies, based on the above-mentioned values and in collaboration with other sectors, to clarify the procedures in every case.
2. Bielecki A, Nieszporska S. The proposal of philosophical basis of the health care system. Med Health Care Philos. 2017; 20(1):1-13.
3. Bielecki A, Stocki R. Systems theory approach to the health care organization on national level. Cybern Syst 2010;41(7):489-507.
4. Jonsen A, Seigler M, WinsladeWJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. New York: Macmillan; 1982.
5. McCullough LB, Ashton CM. A methodology for teaching ethics in the clinical setting: a clinical handbook for medical ethics. Theor Med. 1994;15(1):39-52.
6. Kass NE. An ethics framework for public health. Am J Public Health. 2001;91(11):1776-82.
7. Marckmann G, Schmidt H, Sofaer N, Strech D. Putting public health ethics into practice: a systematic framework. Front Public Health. 2015;3:23.
8. Ten Have M, van der Heide A, Mackenbach JP, de Beaufort ID. An ethical framework for the prevention of overweight and obesity: a tool for thinking through a programme’s ethical aspects. Eur J Public Health. 2013;23(2):299-305.
9. Childress J, Bernheim R. Introduction: a framework for public health ethics. In: Bernheim R, Childress J, Melnick A, Bonnie R, eds. Essentials of Public Health Ethics. USA: Jones & Bartlett Publishers; 2015, p. 1-20.
10. Powers M, Faden R, Saghai Y. Liberty, Mill and the framework of public health ethics. Public Health Ethics. 2012;5(1):6-15.
11. Kymlicka W. Contemporary Political Philosophy: An Introduction. USA: Oxford University Press; 2002.
12. Rajabi F, Esmailzadeh H, Rostamigooran N, Majdzadeh R. What must be the pillars of Iran's health system in 2025? Values and principles of health system reform plan. Iran J Public Health. 2013;42(2):197-205.
13. Huster S, Schramme T. Expanding the normative framework of public health ethics: Some results from an interdisciplinary research group. Public Health Ethics. 2014;8(1):4-6.
14. Strauss A, Corbin JM. Basics of Qualitative Research: Techniques and procedures for developing grounded theory. California:Sage publications;1998.
15. Childress JF. Moral considerations: bases and limits for public health interventions. In: Bernheim R, Childress JF, Melnick A, Bonnie R, eds. Essentials of Public Health Ethics. USA: Jones & Bartlett Learning, LLC, an Ascend Learning Company; 2015, p. 21-43.
16. Beauchamp T, Childress J. Principles of Biomedical Ethics. USA: Oxford University Press; 2013.
17. Callahan D. Autonomy: a moral good, not a moral obsession. Hastings Cent Rep. 1984;14(5):40-2.
18. Annas GJ, Mariner WK. (Public) health and human rights in practice. J Health Polit Policy Law. 2016;41(1):129-39.
19. Daniels N. Just Health: Meeting Health Needs Fairly. USA: Cambridge University Press; 2008.
20. Faden R, Kass NE, Powers M. AIDS, Women and the Next Generation: Towards a Morally Acceptable Public Policy for HIV Testing of Pregnant Women and Newborns. New York: Oxford University Press; 1991.
21. Powers M, Faden RR. Social Justice: the moral foundations of public health and health policy. USA: Oxford University Press; 2006.
22. Larijani B, Zahedi F. Health promotion, Islamic ethics and law in Iran. JMed Ethics Hist Med. 2006(Suppl. 1):7-9.
23. Cohen RA, Martinez ME. Health Insurance Coverage, Early Release of Estimates from the National Health Interview Survey, 2011. www.cdc.gov/nchs/data/nhis/earlyrelease/insur201112.pdf (accessed on: 2011)
24. Research and Development Committee. Packages of Revoluton and Innovation in Medical Education. Iran: Deputy of Medical Education, MOHME; 2016. [in Persian]
25. Ollila E, Ståhl T, Wismar M, Lahtinen E, Melkas T, Leppo K. Health in All Policies in the European Union and its Member States. http://ec.europa.eu/health/ph_projects/2005/action1/docs/2005_1_18_frep_a4_en.pdf. (accessed on: 2006)
26. Maruzzi M. Environment and Health: perspectives from the intersectoral experience in euroup. Health in All Policies: Prospects and Potentials. Helsinki, Finland: Ministry of Social Affairs and Health. https://extranet.who.int/isacs/case/1102. (accessed on: 2006)
27. Kekes J. Justice: A conservative view. Soc Phil Pol. 2006;23(2):88.
28. Buchanan DR. Should people with unhealthy lifestyles pay higher health insurance premiums? J prim prev. 2011;32(1):17-21.
29. Wikler D. Personal and social responsibility for health. Ethics int affairs. 2002;16(02):47-55.
30. Prainsack B. Justice & Solidarity in Priority Setting in Health care: Taking solidarity seriously – can it help? Brussels joint initiative of the King Baudouin Foundation and the Belgian Advisory Committee on Bioethics. https://www.kbs-frb.be/.../Justice-and-solidarity-in-priority-setting-in-health. (accessed on: 2013)
31. Cockerham WC. Health lifestyle theory and the convergence of agency and structure. J Health Soc Behav. 2005;46(1):51-67.
32. Sen AK. The Idea of Justice. USA: Harvard University Press; 2009.
33. Sen Ak. Inequality Reexamined. MA: Harvard University Press; 1992.
34. Buchanan DR. Promoting justice and autonomy in public policies to reduce the health consequences of obesity. Kennedy Inst Ethics J. 2015;25(4):395-417.
35. Hofrichter R. Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. San Francisco:Wiley; 2003.
36. Schröder-Bäck P, Clemens T, Michelsen K, Sørensen K, Borrett G, Brand H. Public health ethical perspectives on the values of the European Commission's White Paper:" Together for Health". Cent Eur J Public Health. 2012;20(2):95.
37. Have HAT, Gordijn B. Bioethics in a European Perspective. Netherlands: Springer; 2013.
38. Hoedemaekers R, Dekkers W. Justice and solidarity in priority setting in health care. Health Care Anal. 2003;11(4):325-43.
39. Rogers WA. Virtue ethics and public health: a practice-based analysis. Monash bioeth rev. 2004;23(1):10-21.
40. Rozier MD. Structures of virtue as a framework for public health ethics. Public Health Ethics. 2016;9(1):37-45.
41. Karen M, Meagher B. Considering virtue: public health and clinical ethics. J Eval Clin Pract. 2011;17(5):888-93.
42. Gostin LO. Mapping the Issues: Public Health, Law and Ethics. http://scholarship.law.georgetown.edu/facpub/374. (accessed on: 2010)
43. Den Exter A. International Health Law and Ethics: Basic Documents. Netherlands: Maklu Pub; 2015.
44. The Joint United Nations Programme on HIV/AIDS(UNAIDS). Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses. http://www.unaids.org/sites/default/files/media_asset Key_Human_Rights_Programmes_en_May2012_0.pdf. (accessed on: 2012)
45. Den Exter A. International Health Law: Solidarity and Justice in Health Care. Netherlands: Maklu Pub; 2008.