Niklas Ellerich-Groppe

Division of Medical Ethics, Department of Health Services Research, University of Oldenburg

Whilst there is increasing discussion about the intergenerationally fair organisation of the healthcare system in the future, the historical development of the healthcare system plays only a minor role in these debates. Consequently, the question of what legacy past generations have (or should have) left to present and future generations in the practices, institutions and structures of the healthcare system remains largely unaddressed. Moreover, although the (appropriate) transmission of assets, institutions and structures is regularly discussed elsewhere as ‘legacy’, the analytical potential of this concept for medical ethics has so far been little discussed.

The aim of this paper is to explore the potential of the concept of ‘legacy’ in medical ethics for shaping a healthcare system that is intergenerationally just.

First, an analysis of the term ‘legacy’ is presented, in which a systematic breakdown – based on the concept used in cultural studies – of its individual conceptual elements and the corresponding moral implications is carried out. The formal definition, according to which a collective passes on the totality of tangible and intangible cultural assets, is then applied to the German healthcare system using three case studies from different fields. With regard to the legacy of ‘medical experiments’ under the Nazi regime (research ethics), traditional cultural practices and role models in healthcare (clinical ethics) and solidarity-based healthcare funding (public health ethics; social policy), the possibilities and limitations of applying the concept of ‘heritage’ to medical ethics, and the corresponding moral implications, are illustrated. Whilst the concept is helpful, for example, in defining the content and scope of the legacy and in determining the relevant rights and obligations, defining the moral agents who bequeath or inherit this legacy proves to be a challenge.

In the concluding discussion, the concept of ‘generations’ is proposed as a means of addressing this problem; this concept has already proved its worth in other contexts of application – for example, in discussions on historical justice. Thus, despite all its shortcomings, ‘legacy’ ultimately proves to be a category with considerable analytical potential, which lies primarily in the temporal contextualisation of issues in medical ethics.