Refining and implementing the Tavistock principles for everybody in health care

摘要

The ethicist Will Gaylin argued that healthcare reform often fails because it attempts technical solutions to ethical problems. Agreeing with this position, the Tavistock Group tried to develop ethical principles that might be useful to everybody involved in health care. They were intended for those who are responsible for the healthcare system, those who work in it, and those who use it. This article describes the origins of the principles, discusses the thinking behind them, considers how they might be used, provides case studies, and reflects on where the venture might go now. The idea that it might be useful to develop ethical principles for everybody involved in health care stemmed from the recognition that much of health care is multi-disciplinary yet ethical codes usually cover only one discipline. The codes may thus be used as ammunition in interdisciplinary batdes rather than as tools to think about deep problems. We advanced the idea of developing ediical principles for everybody in the BMJ in 1997 and then convened a group to develop some principles. The Tavistock Group, a collection of people with long experience of health care and ediical debate, developed the principles, which they published in 1999. The principles are not evidence based and have not been validated in any scientific sense. We offer them with humility as something that might be useful, but which, like any innovation, could conceivably do more harm than good.