Education And Debate

Refining and implementing the Tavistock principles for everybody in health careCommentary: Justice in health care—a response to Tavistock

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7313.616 (Published 15 September 2001) Cite this as: BMJ 2001;323:616

Refining and implementing the Tavistock principles for everybody in health care

  1. Don Berwick, presidenta,
  2. Frank Davidoff, former editor, Annals of Internal Medicineb,
  3. Howard Hiatt, professor of medicinec,
  4. Richard Smith, editor ([email protected])d
  1. a Institute for Healthcare Improvement, 375 Longwood Avenue, Boston, MA 02215, USA
  2. b Wethersfield, CT 06109, USA
  3. c Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
  4. d BMJ, BMA House, London WC1H 9JR
  5. Centre for Health Services Research, University of Tennessee, Memphis, TN38163, USA
  1. Correspondence to: R Smith

    The ethicist Will Gaylin argued that healthcare reform often fails because it attempts technical solutions to ethical problems.1 Agreeing with this position, the Tavistock Group tried to develop ethical principles that might be useful to everybody involved in health care.26 They were intended for those who are responsible for the healthcare system, those who work in it, and those who use it. This article describes the origins of the principles, discusses the thinking behind them, considers how they might be used, provides case studies, and reflects on where the venture might go now.

    Summary points

    The problems of health systems are in the last analysis ethical. Who will live, who will die, and who will decide and how?

    The ethical codes of individual professions may be divisive rather than helpful

    The Tavistock principles are intended to provide an ethical compass for all those involved in health care, including patients and owners of health systems

    The principles cover rights, balance, comprehensiveness, cooperation, improvement, safety, and openness

    Experience of using the principles is limited and not always encouraging; research is under way on how to implement and “validate” them

    Origins of the principles

    The idea that it might be useful to develop ethical principles for everybody involved in health care stemmed from the recognition that much of health care is multidisciplinary yet ethical codes usually cover only one discipline.2 The codes may thus be used as ammunition in interdisciplinary battles rather than as tools to think about deep problems. We advanced the idea of developing ethical principles for everybody in the BMJ in 19972 and then convened a group to develop some principles. The Tavistock Group, a collection of people with long experience of health care and ethical debate, developed the principles, which they published in 1999. 3 4 The principles are …

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