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Medicine and Public Policy |

A Shared Statement of Ethical Principles for Those Who Shape and Give Health Care: A Working Draft from the Tavistock Group

Richard Smith, FRCP; Howard Hiatt, MD; and Donald Berwick, MD
[+] Article and Author Information

From BMJ London, United Kingdom; and Brigham & Women's Hospital and the Institute for Healthcare Improvement, Boston, Massachusetts.


Ann Intern Med. 1999;130(2):143-147. doi:10.7326/0003-4819-130-2-199901190-00009
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Health care delivery in many countries has expanded over the past 150 years from a largely social service delivered by individual practitioners to an intricate network of services provided by teams of professionals. The problems of increasing resource consumption, financial constraints, complexity, and poor system design that have emerged as consequences of these changes have exacerbated many of the ethical tensions inherent in health care and have created new ones. Many groups of professionals that give and affect health care have established separate codes of ethics for their own disciplines, but no shared code exists that might bring all stakeholders in health care into a more consistent moral framework. A multidisciplinary group therefore recently met at Tavistock Square in London in an effort to prepare such a shared code. The result was not a code but a more basic and generic statement of ethical principles. The intent and hope is that it will offer clear guidance for tough calls in real world settings. It is presented here not as a finished work, but as a draft to elicit comment, critique, suggestions for revision, and, especially, ideas for implementation.

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