Five Ethical Values to Guide Health System Reform

December 12, 2017, Vol 318, No. 22, Pages 2155-2265

The JAMA Forum
Five Ethical Values to Guide Health System Reform
Lawrence O. Gostin, JD
The US health system is so mired in politics, with positions hardened by rigid ideologies, that we can’t even seem to talk with one another civilly about difficult tradeoffs. If the polity could agree on core ethical values to guide discourse, we would make hard health system choices based on which values we prefer and why. Herein, I offer 5 critical values for health system reform—universal access, equitable access, affordable access (cost), quality, and choice—explain the tradeoffs, and provide reasons why certain values should take priority. There will be disagreement across the political spectrum, but alternative visions should be justified by reasoned argument.