Bahmanziari Najmeh, Mohammadi Seyed-Mehrdad, Takian Amirhossein, Arab Mohammad, Harirchi Iraj
PhD Candidate in Health Policy, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Affiliated Lecturer, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Chair of Public Health Law Group, The Institute for Legal Innovations, Tehran, Iran.
J Med Ethics Hist Med. 2021 Dec 8;14:23. doi: 10.18502/jmehm.v14i23.8183. eCollection 2021.
The policies of health systems are inspired by ethical priorities. A critical review of policies can reveal the ethical theories/justice schools behind them. This study aimed to identify the ethical theory(ies) underpinning the Iranian health system governance over the past 50 years. This was a qualitative study conducted in two stages during 2019. First, we identified and constructed the key concepts and distinctive notions of prominent ethical theories/justice schools. Then, we spotted and selected 24 strategic laws and policy documents in the Iranian health system governance during the past 50 years and analyzed their content to surmise their underlying ethical theory. The results showed that the dominant theory affecting the policies of the Iranian health system governance over the past 50 years was egalitarian liberalism and then objective utilitarianism and relativist communitarianism. Retrospective empirical application of ethical theories to health system governance is methodologically doable, and this application reveals the mood or priorities of the politics. Also, highlighting the underpinning ethical theories of health system governance as well as the gap between ambitions versus realization are insightful and may prospectively empower and strengthen egalitarianism.
卫生系统的政策受到伦理优先事项的启发。对政策进行批判性审查可以揭示其背后的伦理理论/正义学派。本研究旨在确定过去50年伊朗卫生系统治理背后的伦理理论。这是一项在2019年分两个阶段进行的定性研究。首先，我们确定并构建了著名伦理理论/正义学派的关键概念和独特观念。然后，我们找出并挑选了过去50年伊朗卫生系统治理中的24项战略法律和政策文件，并分析其内容以推测其潜在的伦理理论。结果表明，过去50年影响伊朗卫生系统治理政策的主导理论是平等主义自由主义，其次是客观功利主义和相对主义社群主义。将伦理理论追溯性地实证应用于卫生系统治理在方法上是可行的，这种应用揭示了政治的倾向或优先事项。此外，突出卫生系统治理的潜在伦理理论以及抱负与实现之间的差距具有启发性，并且可能前瞻性地增强和强化平等主义。
