Patient-centred health service


A chara, – Kenneth Mealy’s article “Truly patient-centred health service demands harsh medicine” (Opinion & Analysis, December 31st) is a timely rallying call for a national conversation about what type of health service we, as a society, would like.

He emphasises the need for doctors to consider broader societal needs beyond those of a single individual or cohort. This is relevant where the interest of individual patients may conflict with the interest of the larger population. For example, doctors may advocate for funding new high-cost drugs benefiting a small number of individuals. This can come at the cost of funding other services which provide longer-lasting benefit to a larger population group.

These are complex ethical issues that require open and meaningful engagement by doctors and the public. The value of Sláintecare is that it takes a whole-population approach to improving our health and social care services and aims to involve the public centrally in its work.

Kenneth Mealy draws a parallel between the politics of Irish healthcare and a theory known as “the tragedy of the commons”. To imagine healthcare in Ireland as a “commons” given the dominant consumer-commodity paradigm is a considerable stretch but may be worth the effort.

In 2009 Elinor Ostrom became the first woman to win the Nobel Prize in economics for her work challenging the “tragic” commons theory. She demonstrated empirically how members of a community could self-organise to access and sustainably manage a common resource without top-down regulation.

Maybe we can run with this notion of healthcare as a commons and it need not be a tragedy at all. – Is mise,


Léim an Bhradáin,

Co Chill Dara.