Axioms for governing health systems

BMJ 2005; 330 doi: (Published 28 April 2005) Cite this as: BMJ 2005;330:1032
  1. Jeffrey Braithwaite (, director
  1. Centre for Clinical Governance Research, University of New South Wales, Sydney

    Many important human endeavours crystallise their wisdom into one or more, and usually several, axioms. Why are there no axioms for governing the health system? Axioms are the fundamental underpinnings of social movements, academic disciplines, or intellectual pursuits. They postulate self evident principles within a logic that everyone accepts.

    Such propositions are typically used to remind members of obligatory values, to teach a lesson, or perhaps to prove a point. Although they have various commandments, the world's religions, for example, profess to the multitude something like, “Attend to matters spiritual, learn the sacred ways, and apply their principles in your life.” Environmentalists hold to their own indispensable tenets about the stewardship of nature, the core of which approximates to “The earth is all we have, and its resources must be sustainably nurtured.” Medicine's prime axiom is short, piercing, and famous: “First, do no harm.”

    The idea of the axiom originated in mathematics. Axioms in mathematicians' hands are very strictly expressed, typically as formulas encoding unimpeachable truths without the need for further proof. This type of Euclidean rigour is relaxed in other disciplines, but the force behind it—that specificity in axioms is vital—is retained.

    Thomas …

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