{"id":3923,"date":"2017-01-20T13:45:09","date_gmt":"2017-01-20T13:45:09","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/Finland-Health-Minister-DoH-Helsinki-20141111.pdf"},"modified":"2017-01-20T13:45:09","modified_gmt":"2017-01-20T13:45:09","slug":"finland-health-minister-doh-helsinki-20141111-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/finland-health-minister-doh-helsinki-20141111-2\/","title":{"rendered":"Finland-Health-Minister-DoH-Helsinki-20141111"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

Finland-Health-Minister-DoH-Helsinki-20141111<\/a><\/p>\n

Minister of Social Affairs and Health, Ms Laura R\u00e4ty
\n50th
\nAnniversary of the Declaration of Helsinki
\nP\u00f6rssitalo, 11.11.2014 at 14 hrs \u2192 Subject to changes
\nIs there room for physician\u2019s ethics in political decision-making?
\nDistinguished President of the Republic,
\nYour Excellencies, President of the World Medical Association,
\nDistinguished Archiatre, President of the Finnish Medical Association,
\nDistinguished Guests
\nIt is a pleasure and honour to be here with you today to cele-
\nbrate the 50th
\nanniversary of the Declaration of Helsinki. It is
\nexcellent that our capital and my home town is also known for
\nthis pioneering Declaration. The Declaration has paved the way
\nfor the development of medical research ethics and \u2013 as we just
\nheard \u2013 it now provides the ethical basis on which international
\nagreements and national laws are founded, and it will be im-
\nportant in leading the way in the future, too.
\nThe physician\u2019s ethics, or more broadly, medical ethics, and po-
\nlitical decision-making may, at first thought, appear to be con-
\ncepts that are rather distant from each other. I am myself both
\na physician and politician, and so it is inevitable that I have to
\nthink over how these concepts are combined in practice.
\n2 (9)
\nAn ethical way of operation has been, for thousands of years, a
\npart of the process of growing into the role of a physician and
\nworking as a physician. Ethics is linked with the concepts mor-
\nals, right and wrong, a good life, values. Medical ethics, in turn,
\ndeals with what are the values and principles of medicine and
\nhow it is possible to make ethically sustainable choices in medi-
\ncine.
\nAmong citizens and the media, an ethical way of thinking is sel-
\ndom linked to politics in an equally positive spirit and as a self-
\nevident fact as to medicine and research. It is true that there is
\ncause for criticism. But also policy-making is based on values,
\nand the decisions aim to improve the lives of citizens.
\nThere are six main principles in medical and care ethics: re-
\nspect for life, respect for human dignity, self-determination (au-
\ntonomy), caring, justice (fairness) and maximizing of benefit.
\nThese principles can be reflected against the political decision-
\nmaking that has been and is being carried out in Finland, on
\none hand, at local government level and, on the other hand, in
\ncentral government policy.
\nThe first principle is respect for life. In medicine we should try
\nto promote life and avoid measures that weaken life. From the
\n3 (9)
\npoint of view of clinical work this principle obliges to take care
\nthat a patient\u2019s life can continue as long as possible.
\nThe issue of permitting euthanasia that has been debated from
\ntime to time in this country is associated with this. Considered
\nin more depth, the principle of respect for life can also be
\nthought to encourage medical research so as to find efficient
\ntreatments. [As the President of the Republic stated in his ad-
\ndress,] there have been good prerequisites for medical research
\nin Finland. We aim to develop them further by, for instance,
\nsupporting the establishment of biobanks by means of legisla-
\ntion and by drawing up a national genome strategy by spring
\n2015. At the same time I must however say that I understand
\nthose doctor colleagues who are worried about the financial re-
\nsources for Finnish medical research. This worry is justified.
\nThe next principles are respect for human dignity and self-
\ndetermination. Every person has equal moral value, which shall
\nbe respected in medicine. According to the principle of self-
\ndetermination a person has the right to decide on matters con-
\ncerning himself of herself, to act freely in a way he or she con-
\nsiders appropriate, and to obtain assistance from others in or-
\nder to implement a decision. We in Finland have been pioneers
\nin implementing these principles in political decision-making
\nand development of the legislation on social welfare and health
\n4 (9)
\ncare. Respect for human dignity is one of the fundamental
\nrights laid down in the Constitution of Finland. Furthermore,
\nthe Act on the Status and Rights of Patients, which has served
\nas a model for comparable legislation of many other countries,
\nwas adopted in Finland at the beginning of the 1990s.
\nOur Parliament is considering a bill regarding the self-
\ndetermination of social welfare and health care clients. The aim
\nof the proposed law is to strengthen the clients\u2019 and patients\u2019
\nright of self-determination and to reduce the use of different re-
\nstraint measures, such as limb restraints or preventing exit, in
\nthe care of older persons suffering from dementia in social and
\nhealth services. The objective is more systematic activities and
\ncare practices that underpin the patient\u2019s human dignity and
\nright of self-determination. The patient\u2019s freedom to choose the
\nhealth care unit where he or she wants to get treatment or the
\ndoctor has not advanced here in Finland at the same pace as in
\nthe countries with which we are used to comparing ourselves.
\nThe fourth principle is care and treatment, according to which
\nmedicine should promote people\u2019s functional capacity and alle-
\nviate their sufferings, and simultaneously avoid doing anything
\nsuch that causes harm or suffering to a person. A physician is
\nresponsible for helping a person in need of care. Also politicians
\nmust act for the benefit of citizens and improve the lives of vul-
\nnerable people by all means available to them. The present gov-
\n5 (9)
\nernment has continued to work to reduce poverty, social exclu-
\nsion and inequality in this country. The preconditions for em-
\nployment of young people, people with partial work ability and
\npeople with disabilities, who are at risk of exclusion, are being
\nimproved. The working group appointed by the Ministry of So-
\ncial Affairs and Health that has discussed the matter submitted
\nits proposal a couple of weeks ago (on 23 October). Even today,
\na major number of people who previously had been excluded
\nfrom working life due to a disease, disability or developmental
\ndisorder \u2013 and still are in many countries \u2013 have been integrat-
\ned in Finland by society\u2019s measures into the active, working so-
\nciety.
\nThe principle of justice (fairness) requires that all people are
\nguaranteed equal opportunities for obtaining the care and
\ntreatment they are in need of. Since the available resources are
\ninevitably limited, those should be divided between the people
\nin need of them observing the principle of justice. A fairer ac-
\ncess to services is also one of the objectives in the reform of leg-
\nislation regarding the provision of social welfare and health
\ncare.
\nThe sixth principle is maximizing the benefit, according to
\nwhich people should be provided such care and treatment
\nwhose health benefit in relation to costs is optimal. Both health
\n6 (9)
\nbenefit and cost-effectiveness are key words in health care to-
\nday. In summer a council for service choices in health care was
\nestablished in conjunction with the Ministry of Social Affairs
\nand Health; the council gives recommendations regarding
\nwhich services should be covered by the publicly organised or
\nfinanced health care. The purpose is to underpin the political
\ndecision-making and the implementation of the EU\u2019s patient
\nDirective in Finland. Citizens also need information on the
\ntreatments available and on the criteria if a treatment is not
\nsupported by public funds. From the perspective of a doctor
\nand politician it is ethically right to tell openly about those cri-
\nteria to the citizens.
\nIn addition to the ethical principles I have mentioned, an essen-
\ntial principle in the work of a physician is confidentiality. The
\nbasic condition for a good doctor-patient relationship is that the
\npatient can be confident that his or her information cannot be
\naccessed by others than the health care professionals that par-
\nticipate in the care of the patient. Any delivery of information to
\nother parties is subject to the patient\u2019s consent or authorisation
\nunder the law. Today, there are many challenges for maintain-
\ning the confidentiality, among others because of the increased
\nmethods of communication. The use of social media is an every-
\nday phenomenon, and various issues are reported there. We
\nphysicians must recognise our responsibility and see to it that
\npatient confidentiality is ensured irrespective of the media.
\n7 (9)
\nMuch to my pleasure, I have noticed that the World Medical
\nAssociation keeps up with the times: a few years ago it adopted
\nethical guidelines for the use of social media. The Finnish Medi-
\ncal Association has adapted these guidelines to the Finnish set-
\ntings. It has come to my knowledge that the World Medical As-
\nsociation is also preparing a Declaration on ethical considera-
\ntions regarding health databases and biobanks. This theme is
\nmost topical, and I hope both as a physician and politician eve-
\nry success in that work so as to bring it swiftly to an end.
\nMaintaining confidentiality and data security have been the
\nguidelines even when developing the electronic health care ser-
\nvices in this country. The electronic prescription is already used
\nby all pharmacies and in public health care. The private health
\ncare will introduce it by the end of this year.
\nReturning to the title of my address \u201cIs there room for physi-
\ncian\u00b4s ethics in political decision-making?\u201d my answer to this
\nquestion is, in the light of the examples I\u2019ve mentioned: There is
\nand there must be. Politics is taking care of joint affairs, but al-
\nso coordinating many interests. Political decision-makers and
\ntheir supporters have their expertise and points of view on mat-
\nters. For this support I\u2019d like to thank the responsible and ex-
\npert view represented by my profession. We, however, always
\nhave to compromise. The stringent financial situation brings its
\n8 (9)
\nchallenges. Despite good will we cannot implement everything
\nthat is good.
\nWe in Finland are aware that all those conditions where people
\nare born, grow up, live, work and age contribute to wellbeing
\nand health. Therefore we consider that the different sectors of
\nsociety must in their decision-making evaluate the impact of
\ntheir decisions on wellbeing and health. Health in all policies has
\nbeen on the agendas of international forums at Finland\u2019s initia-
\ntive for about ten years, and in spring this year the World
\nHealth Organization (WHO) adopted a resolution on the issue.
\nIntegrating health and wellbeing extensively into societal deci-
\nsion-making can bring concrete benefits to citizens. For in-
\nstance the systematic and consistent tobacco policy conducted in
\nFinland has reduced smoking, and the nutrition policy has im-
\nproved the composition of nutrition among the population. The
\ncardiovascular disease mortality in working-age men has fallen
\nby 80 per cent in 40 years. The improved level of education and
\nworking conditions and the improved living conditions in gen-
\neral have had a favourable impact on the population\u2019s health.
\nWhen treating patients as a physician I have been well aware of
\nthe responsibility I have for the health of an individual. As a
\npolitician I have a broader responsibility to influence the popu-
\nlation\u2019s health and wellbeing. I see this responsibility not only
\n9 (9)
\nas a political but also as an ethical issue. We must all act ethical-
\nly so that the citizens\u2019 interests are taken into account.
\nThe slogan of the Finnish Medical Association \u2013 my own associ-
\nation \u2013 is: \u201cFor the patient\u2019s best with physician\u2019s skills.\u201d I am
\nconvinced also on the basis of my own experience that a physi-
\ncian can help a patient even in the field of politics \u2013 and a politi-
\ncian can help a patient without having medical education.
\nHealth in all policies is our \u2013 physicians\u2019 and politicians\u2019 \u2013 joint
\nethics.
\nYes \u2013 there is room for physician\u2019s ethics in political decision-
\nmaking.
\nThank you.<\/p>\n"},"caption":{"rendered":"

Finland-Health-Minister-DoH-Helsinki-20141111 Minister of Social Affairs and Health, Ms Laura R\u00e4ty 50th Anniversary of the Declaration of Helsinki P\u00f6rssitalo, 11.11.2014 at 14 hrs \u2192 Subject to changes Is there room for physician\u2019s 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 […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/Finland-Health-Minister-DoH-Helsinki-20141111.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/3923"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=3923"}]}}