Broadening the Bioethics Agenda*
Bioethics has focused principally on ethical issues arising in clinical medicine. When it has addressed justice or equity, it has focused on access to health care and on defending a general moral right to health care. This dual focus on establishing a right to health care and on health care rather than health has left bioethics largely silent on two issues of fundamental importance for a full account of justice and health. First, the focus on establishing a right to health care has contributed to a failure to address difficult issues in developing ethical standards for equitably prioritizing limited resources in health care. Second, the focus on inequalities in access to health care has ignored the much greater impact of social determinants of health, in particular socioeconomic class and inequality, on health and health inequalities. Bioethics must broaden its agenda.