Money, morals and the conquest of mortality

Abstract

I have been asked to speak broadly about the ethics of healthcare, as a background to a discourse of healthcare reform. There seem to be good grounds to pursue reform; and yet there’s been so much that is good that has happened in the last 50 years. To take but one example, cancer survival overall has risen from 30% to 50%. Some malignancies, such as Hodgkin’s disease and some kinds of testicular cancer, are curable, even when they’re quite advanced. Prevention and early detection have changed the whole history of malignant melanoma, that most Australian of cancers. The genetic basis of a few cancers has been determined, and that may lead to preventive or even curative approaches. However, there is an obdurate residue that we cannot shift. Advanced bowel cancer is common and generally unresponsive. Lung cancer still has a poor outlook. We will all die of something, and strokes, heart disease and cancer remain the three most common causes. These are the sad facts that govern our lives, but my concern here is to talk about the social and political systems in which healthcare is embedded, and why progress in science and technology masks deep social and ethical problems.