Social Epidemiology and Bioethics

The social epidemiology of illness demonstrates that sickness does not fall equally upon rich and poor, men and women, or upon black and white. Distributional inequities are more than simple political and economic problems— they have an ethical dimension as well.

Bioethicists need to pay greater attention to issues of justice and equity at a political level; that is, to the ethical dimensions of political decisions. As the allocation of scarce resources becomes a public issue of greater salience, the underserved will need advocates. The championing of individual patient rights that marked bedside bioethics in its formative years needs to be extended to the class of uninsured and underinsured patients as healthcare grows in importance on the national political agenda.

As its scope of inquiry expands, bioethics may have the opportunity to play a greater role in policy making. However, there is a danger here as well. So long as bioethics is focused on the bedside, both the subject matter and the texts appropriate to it are limited. Once the links between class, race, gender, and illness are illuminated, the boundaries of bioethics become murky. The doctor-patient relationship may be fraught with moral complexity, but it is a rather neatly defined, bounded whole. This is not so for the entire distributive system of society.

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