Power and Politics (1)

Question 1

What are the 4 pillars of ethics, according to Beauchamp and Childress’ taxonomy of medical ethics?

Answer 1

ethics - justifying what is right or wrong

Autonomy = freedom to act independently
Non-malificience = do no harm 
Beneficience = do good
Justice = fairness

Conventional: Autonomy, Non-Maleficence, Beneficence, Justice
However autonomy conflicts with some public health principles – sometimes health of wider population justifies overriding autonomy + rights of the individual

Question 2

What is consequentialism?

Answer 2

Ethical validity of an action is based on the outcome of that action - e.g. a good outcome from an action that questions moral values is still considered ethically valid

Question 3

What is utilitarianism?

Answer 3

• an ethical approach - branch of consequentialism

Argues that the ethical validity of an action is based on the outcome of the action

• Focuses on maximising human welfare/wellbeing
• The ethically right choice in a given situation is the one that produces the most happiness and the least unhappiness for the largest amount of people
• involves the so-called hedonic calculus
• It focuses more on ends rather than means

Jeremy Bentham (who also was the founder of UCL)

Question 4

What is the issue with pure utilitarianism?

Answer 4

WASH (water, sanitation and hygiene) and vaccination programmes maximise human well-being

These are so effective, according to utilitarianism, there’s almost a reason to stop everything else and only put efforts into WASH and vaccines

(all money can not purely be spent on this alone)

• Issues: using this logic, cannot justify more economically costly areas of healthcare

Question 5

What is the least cost-effective part of a hospital?

Answer 5

NICU
Neonatal intensive care unit - economically, these infants born preterm with major issues = costly to look after
Esp. because those saved often accumulate more care costs later on

Question 6

What is the 2 axis approach of political beliefs

Answer 6

Two axis approach:
either Liberal → OR Conservative
AND either Libertarian → OR Collectivist

(depends on how much you think state should intervene)

• Libertarian – the state should not interfere with individual autonomy unless someone else is coming to harm
  eg. Free markets, Capitalism
• you believe that people make their own choices for good (or for ill).
• Collectivist – more egalitarian state of affairs - people are yielded equal opportunities + wealth is redistributed partially by progressive taxation/wholly by state action on salaries or company profits
  
  • Marx, Lenin

Question 7

What is distributive justice

Answer 7

• Active seeking and promoting equality
• Wealth redistribution/unconditional basic income
• Social justice – everyone in society deserves a chance
• -Today, is a pursuit of most centrist/leftist political parties in the democratic world

Question 8

Categorise population health interventions using the Nuffield Ladder of Bioethics

Answer 8

Eliminate choice – e.g. compulsory isolation of patients with infectious disease
↑
Restrict choice – e.g. remove unhealthy ingredients from foods
↑
Guide choice through disincentives – e.g. taxes on cigarettes
↑
Guide choices through incentives – e.g. tax breaks for buying bikes for going o work
↑
Guide choices through changing the default policy – e.g. menus with healthier option as default
↑
Enable choice – e.g. free fruit in schools
↑
Provide information – e.g. 5 fruits and veg a day
↑
Do nothing/monitor the current situation

Question 9

Deploy strategic thinking in specifying a policy objective and an approach to effecting change that recognises the implications of politics on health policy - who are the stakeholders and partners?

Answer 9

Effecting change – strategic/tactical thinking (strategic = aims = destination + Tactical = objectives = journey)

right message, right person, right time
(message - different approaches of influences)
- Stakeholders and partners
=Stakeholder = an organisation/individual with an interest
=Partner = subgroup of stakeholders who are central to the success of an aim
- Know who they are, if they are supportive, and what they can do
Solution = Coalition and collaboration = groups of stakeholders working together for a shared goal = compromise is key

Question 10

difference between incremental change and transformative change in coalitions

Answer 10

• Incremental change – step by step, as slow as the slowest decision maker (default)
• Transformative change in root + branch, typically fast

Question 11

define 1. power and 2. authority in terms if strategic thinking

Answer 11

1. Power
   The ability to exercise one’s will over others
2. Authority
   The ability to influence people + outcomes
   Medical profession based on authority more than power

Question 12

What is social justice

Answer 12

“Society should treat all equally well who have deserved equally well of it…”
social justice: the idea that everyone should have their fair chance.

• Seeks to promote fairness in the allocation of resource
• Has become mainstream in western politics today
• Is important for decision-making in public health

Question 13

What is the thought experiment of Plato’s shadows on the wall in his Allegory of the Cave

Answer 13

Plato’s Allegory of the Cave is a thought experiment from his book “The Republic” that examines the reality of perception and the need for empirical evidence.

Question 14

2 definitions of politics

Answer 14

What we describe as Politics – with a big P – which relates to political parties and the philosophy of government. It’s driven by politicians – typically-elected, decision-makers who take countries forward.
But we also talk of politics – with a little p – as being that process of us gaining or applying power in our local group or organisation.

Question 15

government role

Answer 15

• security
• to protect its citizens from external threats.
• to promote unity and fairness

Question 16

What is the single axis approach to political ideology

Answer 16

Centrist view
either 1. Liberal (left leaning)
2. conservative (right leaning)

Question 17

What is the harm principle

Answer 17

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”

Question 18

key points

Answer 18

Key points
a. For centuries political theorists have argued over the extent to which population
interests conflict with individual liberties, and related to that, the extent to which
government should constrain individual freedoms.
b. Utilitarian principles have long-governed allocations of funding for public services
(including health care), but other principles (such as distributive justice) may also be
necessary to protect the most vulnerable.
c. Politics describes how power is exercised. Medical students and doctors often lack
power but may possess authority to influence the outcome of decision-making and
events.
d. The Nuffield Ladder of Bioethics is a graduated framework for categorising the extent
to which population health interventions potentially infringe on individual freedom.
e. Influencing policy is often a slow and incremental process that necessitates strategic
thinking, collaboration and compromise.