Finland-Health-Minister-DoH-Helsinki-20141111

Minister of Social Affairs and Health, Ms Laura Räty
50th
Anniversary of the Declaration of Helsinki
Pörssitalo, 11.11.2014 at 14 hrs → Subject to changes
Is there room for physician’s ethics in political decision-making?
Distinguished President of the Republic,
Your Excellencies, President of the World Medical Association,
Distinguished Archiatre, President of the Finnish Medical Association,
Distinguished Guests
It is a pleasure and honour to be here with you today to cele-
brate the 50th
anniversary of the Declaration of Helsinki. It is
excellent that our capital and my home town is also known for
this pioneering Declaration. The Declaration has paved the way
for the development of medical research ethics and – as we just
heard – it now provides the ethical basis on which international
agreements and national laws are founded, and it will be im-
portant in leading the way in the future, too.
The physician’s ethics, or more broadly, medical ethics, and po-
litical decision-making may, at first thought, appear to be con-
cepts that are rather distant from each other. I am myself both
a physician and politician, and so it is inevitable that I have to
think over how these concepts are combined in practice.
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An ethical way of operation has been, for thousands of years, a
part of the process of growing into the role of a physician and
working as a physician. Ethics is linked with the concepts mor-
als, right and wrong, a good life, values. Medical ethics, in turn,
deals with what are the values and principles of medicine and
how it is possible to make ethically sustainable choices in medi-
cine.
Among citizens and the media, an ethical way of thinking is sel-
dom linked to politics in an equally positive spirit and as a self-
evident fact as to medicine and research. It is true that there is
cause for criticism. But also policy-making is based on values,
and the decisions aim to improve the lives of citizens.
There are six main principles in medical and care ethics: re-
spect for life, respect for human dignity, self-determination (au-
tonomy), caring, justice (fairness) and maximizing of benefit.
These principles can be reflected against the political decision-
making that has been and is being carried out in Finland, on
one hand, at local government level and, on the other hand, in
central government policy.
The first principle is respect for life. In medicine we should try
to promote life and avoid measures that weaken life. From the
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point of view of clinical work this principle obliges to take care
that a patient’s life can continue as long as possible.
The issue of permitting euthanasia that has been debated from
time to time in this country is associated with this. Considered
in more depth, the principle of respect for life can also be
thought to encourage medical research so as to find efficient
treatments. [As the President of the Republic stated in his ad-
dress,] there have been good prerequisites for medical research
in Finland. We aim to develop them further by, for instance,
supporting the establishment of biobanks by means of legisla-
tion and by drawing up a national genome strategy by spring
2015. At the same time I must however say that I understand
those doctor colleagues who are worried about the financial re-
sources for Finnish medical research. This worry is justified.
The next principles are respect for human dignity and self-
determination. Every person has equal moral value, which shall
be respected in medicine. According to the principle of self-
determination a person has the right to decide on matters con-
cerning himself of herself, to act freely in a way he or she con-
siders appropriate, and to obtain assistance from others in or-
der to implement a decision. We in Finland have been pioneers
in implementing these principles in political decision-making
and development of the legislation on social welfare and health
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care. Respect for human dignity is one of the fundamental
rights laid down in the Constitution of Finland. Furthermore,
the Act on the Status and Rights of Patients, which has served
as a model for comparable legislation of many other countries,
was adopted in Finland at the beginning of the 1990s.
Our Parliament is considering a bill regarding the self-
determination of social welfare and health care clients. The aim
of the proposed law is to strengthen the clients’ and patients’
right of self-determination and to reduce the use of different re-
straint measures, such as limb restraints or preventing exit, in
the care of older persons suffering from dementia in social and
health services. The objective is more systematic activities and
care practices that underpin the patient’s human dignity and
right of self-determination. The patient’s freedom to choose the
health care unit where he or she wants to get treatment or the
doctor has not advanced here in Finland at the same pace as in
the countries with which we are used to comparing ourselves.
The fourth principle is care and treatment, according to which
medicine should promote people’s functional capacity and alle-
viate their sufferings, and simultaneously avoid doing anything
such that causes harm or suffering to a person. A physician is
responsible for helping a person in need of care. Also politicians
must act for the benefit of citizens and improve the lives of vul-
nerable people by all means available to them. The present gov-
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ernment has continued to work to reduce poverty, social exclu-
sion and inequality in this country. The preconditions for em-
ployment of young people, people with partial work ability and
people with disabilities, who are at risk of exclusion, are being
improved. The working group appointed by the Ministry of So-
cial Affairs and Health that has discussed the matter submitted
its proposal a couple of weeks ago (on 23 October). Even today,
a major number of people who previously had been excluded
from working life due to a disease, disability or developmental
disorder – and still are in many countries – have been integrat-
ed in Finland by society’s measures into the active, working so-
ciety.
The principle of justice (fairness) requires that all people are
guaranteed equal opportunities for obtaining the care and
treatment they are in need of. Since the available resources are
inevitably limited, those should be divided between the people
in need of them observing the principle of justice. A fairer ac-
cess to services is also one of the objectives in the reform of leg-
islation regarding the provision of social welfare and health
care.
The sixth principle is maximizing the benefit, according to
which people should be provided such care and treatment
whose health benefit in relation to costs is optimal. Both health
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benefit and cost-effectiveness are key words in health care to-
day. In summer a council for service choices in health care was
established in conjunction with the Ministry of Social Affairs
and Health; the council gives recommendations regarding
which services should be covered by the publicly organised or
financed health care. The purpose is to underpin the political
decision-making and the implementation of the EU’s patient
Directive in Finland. Citizens also need information on the
treatments available and on the criteria if a treatment is not
supported by public funds. From the perspective of a doctor
and politician it is ethically right to tell openly about those cri-
teria to the citizens.
In addition to the ethical principles I have mentioned, an essen-
tial principle in the work of a physician is confidentiality. The
basic condition for a good doctor-patient relationship is that the
patient can be confident that his or her information cannot be
accessed by others than the health care professionals that par-
ticipate in the care of the patient. Any delivery of information to
other parties is subject to the patient’s consent or authorisation
under the law. Today, there are many challenges for maintain-
ing the confidentiality, among others because of the increased
methods of communication. The use of social media is an every-
day phenomenon, and various issues are reported there. We
physicians must recognise our responsibility and see to it that
patient confidentiality is ensured irrespective of the media.
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Much to my pleasure, I have noticed that the World Medical
Association keeps up with the times: a few years ago it adopted
ethical guidelines for the use of social media. The Finnish Medi-
cal Association has adapted these guidelines to the Finnish set-
tings. It has come to my knowledge that the World Medical As-
sociation is also preparing a Declaration on ethical considera-
tions regarding health databases and biobanks. This theme is
most topical, and I hope both as a physician and politician eve-
ry success in that work so as to bring it swiftly to an end.
Maintaining confidentiality and data security have been the
guidelines even when developing the electronic health care ser-
vices in this country. The electronic prescription is already used
by all pharmacies and in public health care. The private health
care will introduce it by the end of this year.
Returning to the title of my address “Is there room for physi-
cian´s ethics in political decision-making?” my answer to this
question is, in the light of the examples I’ve mentioned: There is
and there must be. Politics is taking care of joint affairs, but al-
so coordinating many interests. Political decision-makers and
their supporters have their expertise and points of view on mat-
ters. For this support I’d like to thank the responsible and ex-
pert view represented by my profession. We, however, always
have to compromise. The stringent financial situation brings its
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challenges. Despite good will we cannot implement everything
that is good.
We in Finland are aware that all those conditions where people
are born, grow up, live, work and age contribute to wellbeing
and health. Therefore we consider that the different sectors of
society must in their decision-making evaluate the impact of
their decisions on wellbeing and health. Health in all policies has
been on the agendas of international forums at Finland’s initia-
tive for about ten years, and in spring this year the World
Health Organization (WHO) adopted a resolution on the issue.
Integrating health and wellbeing extensively into societal deci-
sion-making can bring concrete benefits to citizens. For in-
stance the systematic and consistent tobacco policy conducted in
Finland has reduced smoking, and the nutrition policy has im-
proved the composition of nutrition among the population. The
cardiovascular disease mortality in working-age men has fallen
by 80 per cent in 40 years. The improved level of education and
working conditions and the improved living conditions in gen-
eral have had a favourable impact on the population’s health.
When treating patients as a physician I have been well aware of
the responsibility I have for the health of an individual. As a
politician I have a broader responsibility to influence the popu-
lation’s health and wellbeing. I see this responsibility not only
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as a political but also as an ethical issue. We must all act ethical-
ly so that the citizens’ interests are taken into account.
The slogan of the Finnish Medical Association – my own associ-
ation – is: “For the patient’s best with physician’s skills.” I am
convinced also on the basis of my own experience that a physi-
cian can help a patient even in the field of politics – and a politi-
cian can help a patient without having medical education.
Health in all policies is our – physicians’ and politicians’ – joint
ethics.
Yes – there is room for physician’s ethics in political decision-
making.
Thank you.