Is Access to Health Care an Ethical Issue for Nurses?

By Patricia M Davidson, PhD, MEd, RN, FAAN

Core values for nurses include promoting health, preventing illness and alleviating suffering. Does this also include improving access to health care? I would say yes.

Across the world there is an increasing gap between the rich and poor. Interventions across the globe by governments are focusing on improving access to health care.

Apart from the ethical and issues related to a just and civil society, improving health care just makes good economic and political sense. Promoting social participation and health is a good recipe for a harmonious and just world.

Many nurses feel the pain and anguish of individuals unable to access health services either on the basis of factors such as cost or transportation.  But perhaps most distressing is when health care is perceived as unwelcoming, alienating or discriminating.

As a consequence many nurses engage in advocacy for their patients in a range of settings, from the community to the policy table.

Advocating for patients, their families and communities requires courageous leadership as commonly we as nurses face traditional and powerful forces.  Improving access to care requires challenging entrenched patterns and providers of service delivery.

So what does courageous leadership look like?  Wanting to make things better is a great start as well as questioning entrenched beliefs and working together for a negotiated purpose.

To me it is also about having a voice and providing a rationale and justified argument as to why inclusion and participation in society makes good sense to governments and other key stakeholders.

You will never do anything in this world without courage. It is the greatest quality of the mind next to honor – Aristotle


Patricia M Davidson, PhD, MEd, RN, FAAN
Dean & Professor
Johns Hopkins University
School of Nursing

Seminar Series: Nikola Biller-Andorno ‘What Is An Ethical ACO?’

pic_biller_andorno.jpgProf Dr med, Dr phil Nikola Biller-Andorno

Professor and Director of the Institute of Biomedical Ethics
University of Zurich 

What is an ethical ACO?

Accountable care organizations (ACOs) are expected to play a key role in the attempt to increase the cost-efficiency of health care delivery while maintaining or improving quality and equity of patient care. Performance measures and incentives are used as managerial tools to move towards these aims. The presentation will explore how these tools can be used in an ethically acceptable way, and outline framework conditions for an “ethical ACO”. 

Monday, February 11, 2013, 12:15pm – 1:30pm

W3008, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD

Open to All  |  Lunch Provided

Seminar Series: Innovative Approaches to Increasing the Supply of Kidneys

Dorry Segev, MD
Associate Professor of Surgery,
Johns Hopkins School of Medicine




Jeffrey Kahn, PhD
Robert Henry Levi and Ryda Hecht Levi Professor of Bioethics & Public Policy,
Deputy Director of Policy and Administration
Johns Hopkins Berman Institute of Bioethics


Monday, January 14, 2013, 12:15pm – 1:30pm
615 N. Wolfe Street, W3008

Open to All  |  Lunch Provided

Feeding The World Fairly

December 18, 2012

A Stavros Niarchos Foundation grant will fund planning by a multidisciplinary group of scholars at Johns Hopkins University for an ethical framework to address food shortages and maldistribution.

Fair access to good food is a challenge as old as civilization, and failing to meet it contributed to the fall of the French monarchy (‘let them eat cake’), Babylon, Athens and the Roman Empire. As the global populace climbs toward an expected nine billion by 2050, an $800,000 grant from the Stavros Niarchos Foundation will fund collaborative work by three divisions of Johns Hopkins University to develop ethical guidelines to help meet the challenge in our day.

“There is something profoundly wrong about a world in which nearly two billion people are undernourished while another two billion people are overweight,” says Ruth Faden, PhD, MPH, director of the Johns Hopkins Berman Institute of Bioethics.  Faden will jointly lead the project along with Alan Goldberg, PhD, from the Johns Hopkins Bloomberg School of Public Health and Robert Thompson, PhD, of Johns Hopkins’ Nitze School of Advanced International Studies.  Yashar Saghai, a post-doctoral fellow at the Berman Institute, will be project director.

“This collaboration among Johns Hopkins institutions will examine one of the fundamental obstacles to achieving global food security: profound disagreement about what it means to feed the world ethically,” Faden says.

The project leaders will recruit diverse experts and stakeholders from around the world to characterize differences in ethical assumptions and aims, and to search for moral common ground, Faden says. Participants will include those involved in high and low yield farming, agricultural technology and the welfare of animals, the environment and workers.

“We expect that there will be negotiation and conflict among competing interests, but all the players need to be at the table,” says Thompson. A working, weeklong conference is planned for 2014.

“The goal of this meeting is to produce a document of shared moral principles or commitments that will provide the understanding of the basic issues that must be included to identify fair or ethical food guidelines,” says Goldberg.

The Stavros Niarchos Foundation funds diverse non-profit organizations and projects around the world that have the potential for broad, lasting and positive social impact, according to the foundation. In the 1930s, Niarchos expanded his family’s grain business by thinking globally, buying the ships that transported wheat.

“Mark Twain wrote that hunger is the handmaid of genius; I do believe that if we bring committed people together and treat these issues with the gravity they deserve, we will find a way to narrow what are now broad differences of opinion on a profoundly important question: how to feed everyone, ethically. It is doable,” Faden says.


Media Contact: Leah Ramsay 202.642.9640