I am reminded of two quotations which take this scenario from the sublime to the ridiculous. There was the reported remark in 1989 of the Department of Health and Social Services official in London who had recently transferred from the Foreign Office : "Dealing with doctors is even worse than negotiating with the French." Then there was the quotation from the NHS Management Inquiry of 1983 : "If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge ..."
I recognise that for many of you here today debates on the finer points of ethics is not necessarily an everyday experience. You bring your expertise to bear on the actualities of illness or disability and you are absorbed by the pressures of those tasks. However we live at a time when more and more of us are being compelled to confront serious questions involving ethical judgements about the 'why' and the 'how' of what society is all about. Health care is now a priority issue for society. Not only politicians but ordinary people doing ordinary things are making it so. In consequence within the restless sea of ethics questions about moral decisions to do with health care are confronting us at an every increasing rate.
The truth is surely this : our society has developed an inherent assumed right to demand from the caring professions a level of service, a transparency of delivery and an abundance of availability which is not always aligned to reasoned, responsible or informed criteria of demand. Things are being demanded of right without the same willingness to provide what is necessary to deliver those services. A society which is making those demands is equally living through a period when consumerism is erecting many temples in which worship is geared above all else to incessant demand, incessant access and incessant value judgements which emphasise rights above responsibility and self-advancement above corporate wellbeing. I recall the remark of Tony Blair in 2002: "Customer satisfaction has to become a culture, a way of life, not an added extra."
What makes ethical or moral comment on health issues today even more difficult is that there are few issues in this area which can be addressed in isolation or on traditional ethical principles alone. There over-shadows most of these issues the question of finance. Almost all major health authorities find clear problems when they look to their budgets. Here in Northern Ireland it is questionable if even the reforms planned under the Review of Public Administration are likely to make sufficient savings to counter shortfalls for Health Trusts. Whether we argue that under-funding or overspending is the reason, rationing will be a feature for years to come. Rationing as I hope to show later is basically a moral decision.
Let me assure you health funding is not just an issue in Northern Ireland. From Canada the writing of John Ralston Saul makes the argument that emphasis on the individual in society and laws about equality of opportunity are not a moral defence to the reality of inequality or the need to make provision as a society for our weaker or more vulnerable members.
