Medical Ethics PHIL 148 @ Binghamton University, Sum 11

27Jun/110

Debate Summary- Health Care & Justice

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The idea of whether administering limited medical resources out to patients on a first come, first serve basis is a very controversial one. It can be attested both ways very honorably. Here are a few reasons people have argued that this method of distributing resources is unfair. For one it can be argued that these are important medical resources and therefore should be distributed to those in need of it, not simply to those who are in line for it. Many of these individuals may not necessarily need them but simply want them. Medical resources should be treated with a higher regard, it is not a materialistic want, such as an iPod and for some it can be matter of life and death. The question of autonomy also came about in the form of challenging a person’s right to a limited resource simply because they were in line first. The moral and utilitarian thing to do in this case would be to honor a person’s need for a resource first before their want. It was also made clear that this is a situation in where inequality is unavoidable and if anything encouraged because some people have a higher need for the limited resource then others and therefore their need should be met first regardless to who came in line first. If hospitals treat these resources in any other way then unfairness is dealt to those with a more severe need then others. One may also find themselves arguing that instead of the method of first come, first serve, severity should be the deciding factor of resources. How severe a patients need is a more just way of distributing resources then going by a chronological protocol. A utilitarian would justify this entire argument by saying that giving at least minimal treatment to all is what is moral. Denying someone stitches for something as serious as a gunshot wound would be completely immoral if the reason was because that resource was already given to someone who came earlier then that patient when instead their need could have been satisfied without consumption of that limited resource.

Taking into account the several reasons that the first come, first serve method is not favored amongst people, there are also numerous reasons one may be pro this decision. For instance it can be said that a medical institutions duty is to provide care and resources necessary for good health out to its patients. However, some resources are limited and therefore a fair and orderly method is necessary to distribute these resources equally. It is up to physicians and practitioners under their Hippocratic Oath to perform at their best abilty to get a patient healthy and to look out for their well being first and utmost. It does not make sense for a doctor to simply not treat a patient that is currently under their care with the best medicine possible simply under the assumption that a future more severe case may come along. If that case never comes, then there is a loss of that limited resource along with complete dissatisfaction of treatment by both patient and doctor. This is a very un-utilitarian way of doing things because there is displeasure going around from all sides. Many feel that it is a hospitals duty to respect fairness and therefore respect a patients place in line, if you may, for receiving a resource for it is their right and they deserve the opportunity to be treated fairly. Another argument is that several resources are limited and have a short life span. If we want to put these resources to use in the most utilitarian and moral way possible then they should be distributed to those who come first to claim them. Doctors cannot be held back under the assumption that a more sever case may come along. The life span of the resource may simply dwindle away while the doctor waits for a fictional patient to come around while a real patient in need of their care is already present. Both for and against first come, first serve can be argued heavily. It is simply up to our health care system to determine who makes the more insightful assertion.

26Jun/110

Case Study Summary- Health Care & Justice

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Maddy is a 25-year-old woman who works and goes to school part time but unfortunately is plagued with Crohns disease.  This disease has also led to the development of two kidney stones; however, she denies any surgical procedure because of her inability to fund it.  The ethical perspectives all have something to say about this particular case.

Kantian deontology believes that some physicians should do whatever they can in their power to help Maddy out.  Whether it be by doing the work for free or by lowering the cost of the procedure, it still needs to get done in order to fulfill a duty.  Ross’ duty of beneficence also plays into this as well.  Essentially, doctors should be performing this out of the good of their hearts in order to make for a better world.  Maddy also has a prima facie duty of self-improvement and that duty is more vital than her duty towards anyone else’s inconvenience.  Utilitarianism suggests that we don’t waste resources on one individual.  The main premise here is whether helping Maddy out will be beneficial on a larger scale; is Maddy’s treatment going to positively affect the world.  The main agreement with utilitarianism is that by helping Maddy out, resources aren’t being used as they should be.  They are not being used efficiently and can be used on a bigger scale to help out more people; essentially, maximum utility of resources are not being attained.  In one aspect however, utilitarianism can be attained.  If Maddy were to receive this treatment and move on with her life, she would then be able to finish school and receive her master’s in the field of health care.  With this education under her belt, she would then be able to help out society.  So if looking at the situation from this point of view, a greater good can be attained.  In general, there is a difference between the present and the future.  In the present, utilitarianism would not agree since resources aren’t being used as efficiently as possible.  In the future, utilitarianism will agree since Maddy’s education can benefit society.

Virtue ethics would find some venue in order to have Maddy receive her procedure.  Her father could take her in to help her out with the bills.  Her friends could help her out financially with her medical expenses.  She could receive financial aid from the institution she is studying.  Maddy might be able to find another job that would give her some health benefits.  Since Maddy has invested so much time and effot and clearly isn’t a lazy individual, virtue ethics would side with Maddy and somehow enable her to receive the medical attention that she deserves.  Care ethics stresses the relationship that has been established between Maddy and her physician.  If the physician was abiding by the moral standards of care ethics, the physician would see to it at that Maddy is taken care of.  Whether the physician performs the procedure at a discounted rate due to her situation or whether he/she somehow enables her to receive some sort coverage for her medical expenses, the physician must do all in his/her power in order treat Maddy.  In the end, when all is said and done, the relationship between patient and physician is the most important part of care ethics, and the only way a healthy, trusting relationship can emerge is if the physician finds a way to perform the procedure on Maddy and see that she becomes healthy.

 

 

 

 

26Jun/110

News Article Summary- Health Care & Justice

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One article talks about a 59-year-old man who has been working as a delivery man for CoCa Cola for 17 years.  Unfortunately, an economic downturn caused him to lose his job along with all health insurance and benefits.  With carpal tunnel syndrome and arthritis afflicting him, he decides to rob a bank in order to go to prison and receive medical attention.  First of all, it is ridiculous to think that a man would rather give up his rights as a citizen of this country and perform such an act in order to obtain health care in prison.  It just shows how a good chunk of citizens are not being tended to properly in this country.  Some solutions to this problem would be different types of health care systems that are utilized in different countries in the world.  One suggestion is to follow Britain’s lead in giving all people some sort of basic health care, and from then on, people would pay as they go.  If they want additional services, they would have to pay for them; however, people will never be satisfied with just getting a minimum.  Any minimum still might not be considered to be good enough by the people.  Another alternative would be the health care system that is practiced in Canada in which a doctor is pre paid with a one time fee to cover patient’s care for a specified time.  Only problem with this is that the patient would be stuck with the doctor, and the doctor might not provide the best care since the patient is already locked in.  A bigger conflict that is addressed with this article is whether prisoners should receive health care or not.  Should they receive some sort of basic care?  Any sort of care is a burden on tax payers, essentially law-abiding citizens.  This article definitely brought some problems in providing health care that the country needs to address.

 

The second article talks about the different sort of health care systems that have been established in other countries.  A majority of people believe that the bundling system is the best one.  Since it makes all of the medical staff work together and efficiently, patients receive the best care that can be provided in the fast time possible.  It gets rid of unnecessary visits that just places more money in the doctors pockets for no reason.  Efficiency coupled with quality care push the bundling system to the most preferred by the class.  The readjust risks program which covers about 80 diseases restricts the care too much and allows for too many issues to arise.  If a disease is not on the list of “80,” problems can arise as to whether or not care should be continued.  The quality of care system places too many resources into the tracking of treatment and results.  That money could be better spent.  A final thought to think about is that no matter which health care is decided on, will everyone be completely satisfied?  Unfortunately, the answer is no.

 

24Jun/1111

Morality of limiting resources

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It is moral for government/private hospital to provide limited resources on a first come first serve basis. Resources are anything that can help an individual get better, but in terms of limited resources I believe these are the crucial and less available things that patients need to continue their lives. For instance receiving any form of organ/ performing any type of surgery.  Think about a little girl who needs a heart transplant and then is placed on a waiting list for a year. Finally her name was at the top of the list and a suitable match was found, but then the heart was given to someone else; how would that child feel knowing that heart was suppose to be given to her and not someone else. I do believe that having the system of first come first serve is effective and orderly.

Deontology views moral life in terms of duties, obligations and what is the right thing to do. To be moral one has to perform actions that are required by moral law and thus this action has a good intention and is done for the sake of duty.  It also emphasizes the quote “Do unto others as you’d have done unto you.” Ross sates that an action is right not because it bring about good consequences but because it is an act that fulfill duties. When these government/private hospitals are limiting resource they are simply doing their duty which is to take care of their patients and provide them with the necessary equipments/ resources that they need to get better. So if there aren’t enough resources for every patient these hospitals are still performing the task/ duty of being an institution that provides health care to its patients. In addition for Ross one has a prima facie to what is right, for example the hospitals have a prima facie duty to provide resources but they also have a prima facie duty to be fair. Knowing that their maybe circumstances when everyone may not get the resources they need, giving health care resources in an orderly is better because at least there are people who are getting the help they need and it is done fairly.

Virtue of ethics is the moral character of an individual; the feeling one gets to help another person. It states that we do what is good in a way to see what is good. Indeed the hospitals are helping their patients; they are giving their patients the resources that they need, acting from the goodness in their hearts. Utilitarianism deals with the maximum happiness; it raises the questions of how much and what kind of happiness each person receives. Mill believes utilitarianism to create the overall good of a certain situation, thus in this situation limited resources can be seen as an overall goodness since people are receiving whatever treatment they need. I believe act-utilitarianism is best linked to this situation; the hospital is faced with this tough decision and has a choice to make so they decide limiting resources on a first come first serve basis is best. Act utilitarianism states that when faced with a decision between A or B we have to consider the consequences of each of the actions and then see which one will create more pleasure/ happiness. In addition justice is giving an individual what he/she deserves; including having one’s right respected and to be treated fairly. We do live in a society where people prefer fairness in any form of area. First come first serve see to it that each patient is treated fairly and for this is believes it is the best solution.

24Jun/118

It is Immoral

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It is immoral for hospitals or the government to limit resources on a first come first serve basis. By treating citizens in need on a first come first serve basis, the government or the hospital is disregarding their moral responsibility as structures for care in the eyes of many ethical perspectives. I believe resources should be used based on severity of the injury, illness, or situation. For instance it is fair to say that a person dying from gunshot wound is more severe than a laceration on someone’s leg. Both procedures require sutures and anesthesia. These resources should be used to sustain a life, over a leg and many ethical thinkers would agree.

Egalitarians would also disagree that treating patients on a first come, first serve basis would be just because this system of equality of treatment based on time denies certain patients a bare minimum of care. We can define the bare minimum of care for a gunshot wound victim to be; care to close up the wound. If we were following the unjust system and there are no more sutures left to close the wound then this system denies the patient of the bare minimum. In fact it is possible that care of any sort can be denied, if the resources are unavailable, to patients and therefore it is unjust. If we based the system solely on severity the bare minimum care could be met easily. Wounds that are in dyer need of stitches would get them and those that would be able to heal with a band-aid or bandage wouldn’t use stitches. Secondly, Egalitarians would find this system of treatment immoral because it is excluding and unfair to a portion of people. Egalitarians find that moral acts are ones done that keep the treatment equal for all. If only the first few people can be treated because they limit the resources for them solely, than the people who come into the hospital later cannot receive any treatment.  Egalitarians would agree that severity would be the best way to use resources because treatment for the injury would be based on a scale that treated everyone the same for the same severity of injury. For instance somebody with a gunshot wound at 9 am would receive the same treatment as some one who came into the hospital at 9 pm. If these two patients had been treated based on a first come first serve basis it is possible that the second victim would receive improper/or no treatment because all of the resources had been used up prior by lower level severity cases and therefore those two victims would not be treated equally even though they should be because they have the same injury. If they were treated on the terms of severity it is highly likely that the second injured patient would be able to receive the same proper medical care. Using severity to spread the resources equally proportional to the level of severity, just like it is known that taxing on a proportional scale would satisfy an egalitarian. One is treated the same as the other in proportion.  By treating patients based on severity level you are standardizing a basic minimum as well. You are saying that the lowest level severity patients will use the least amount of resources, which gives the bare minimum, and then scale the amount of resources to be used accordingly. This provides equality throughout the levels of severity and throughout the system. For instance, the gun shot wound patient at 9 pm would receive the same treatment as someone at 9 am using the same resources, including patient care, and doctoral attention. Someone who fell off of their bicycle would receive the same amount of attention but on smaller scale, 3 doctors do not need to diagnose how to fix a simple laceration on someone’s leg, but 3 doctors may need to figure out how to remove the bullet, close the incision, and the fastest safest way to go about it. So it’s all equally relative to the problem.

Utilitarians would also find it immoral to serve patients on a first come first serve basis. Utilitarians wish to maximize overall utility for the largest amount of people, therefore they would find this system immoral because it would not be satisfying this point. First, this system would not provide care for those who would need it after a certain time because the resources would be used before they could be applied to the later patients. Therefore these patients would not find happiness or satisfaction, or relief from pain. If the gunshot wound victim comes in at 9 pm and cannot receive treatment because there are no resources to treat him, he will be in severe pain and possibly handicapping his future. In a utilitarian view, the act of not providing care to this patient is immoral. Providing at least the minimal amount of care to anyone in need is seen as more justifiable than treating a few patients thoroughly. For instance, providing the gunshot wound victim with no care because he was admitted to late and the resources have all been used up is immoral. The resources should have been saved to treat such severe cases and spared on the cases that unnecessarily use the resources. For a utilitarian we can maximize resources this way as well. Providing the resources to patients in an organized manner based on severity would allow necessary resources to only be used in such cases in which they are desperately needed. For example using a bandage on a cut instead of stitches, we are able to save the stitches for someone with a gunshot wound, this maximizes utility of the resources. Also, the doctors are unable to provide the care for the patients who come later and are therefore unsatisfied. These doctors wish to fulfill their Hippocratic oath to do whatever they can to treat as many people as they can. By distributing the resources by severity you are allowing more patients to be served and more doctors feeling fulfilled. If we measure utility in satisfaction, then the first come first serve system is immoral because it creates more dissatisfaction than satisfaction.

The system first come first serve would be an unjust, immoral system. It would lead to more deaths, dissatisfaction and unhappiness. Patients in need of life-sustaining treatment would be unable to receive it because of limited resources.  Patients and doctors would be dissatisfied with their level of treatment for patients that come when resources have run out.  Unhappiness would plague the system because everyday more and more unhappy people would remain that way without being treated properly. Utilitarians and Egalitarians agree that a basic minimum to provide resources must be provided for the system to be morally right and if it were based on time this minimum could not be provided for all in need. Therefore, severity is seen as the fairest way to organize and distribute resources because it creates this minimum for everyone.

 

 

24Jun/1110

Debate: Health Care & Justice (Yes)

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Question: Is it moral for the government or individual hospitals to provide limited resources on a first come, first serve basis?

Yes, I believe it is moral for the government or individual hospitals to provide limited resources on a first come, first serve basis.  Well first off, I feel that it is necessary to define what exactly "limited resources" are.    I believe limited resources include measures and procedures that utilize more than the usual time and money.  For example, a heart transplant is something I would refer to as a limited resource.  Besides measures and procedures, a limited resource can be an organ as well; some examples would the heart and the kidney.  A limited resource can also be a vaccination of some sort in order to prevent the flu.  Keeping this in mind,  I believe that the government or hospitals are morally sound in providing these limited resources on a first come, first serve basis, because the people that they are given to actually need them.  If a patient is next on the waiting list for a heart transplant and a heart is found, then that patient deserves to undergo the operation and obtain his/her new heart.  If only 1,000 vaccinations for the bird flu are available, then the first 1,000 to show up at the doctor's office are entitled to receive them.  Some may argue that what if another individual who needed it more comes later and finds that they are not available.  They would say it is wrong to give the vaccinations to the last 100 people who were healthier, and instead, the vaccinations should have been saved for dire cases.  This may have some truth; however, what guarantee do we have that the last 100 people wouldn't have contracted the flu if they hadn't been vaccinated.  What if the last 100 lives had just been saved from the vaccination?  How do the government and hospitals decipher whether the treatment or procedure should go to the patient who presently really needs it or the future patient who may really really need it?  Both institutions are comprised of only human beings that are just trying to fulfill their daily obligations in their occupations.  These people are not gifted with the ability to foresee future patients and then use that future knowledge to withhold treatment for patients in the present who don't necessarily need it as much as the future patients do.

Let's take a look at ethical perspectives.  Kantian deontology states that people have duties whether they be perfect duties or imperfect duties.  The hospital's perfect duty is look after its  patients.  In this case, the hospital's perfect duty is to administer the limited resources to those that need it in the first come, first serve basis.  By doing so, the hospital's actions are considered to be moral.  The hospital also has an imperfect duty to think about future patients who the limited resources might benefit more than the present patients; however, by transgressing this imperfect duty, morality is still sustained.  Virtue ethics values the character of the individual.  When a physician is administering limited resources to patients on a first come, first serve basis, he is displaying virtue ethics.  The physician is caring for the patient by doing all in his/her power to restore him/her back to health and so is morally carrying out his job.  He/she knows that the patient is need of the limited resource.  The patient is next to receive whatever treatment or procedure that he/she is entitled, and so the physician administers the limited resource to that particular patient to the best of his/her ability.   By this, the physician has the right actions coupled along with the right intentions which is a mantra that is preached in virtue ethics.  Care ethics tells us that the health care professionals need to administer to both the psychological and physical needs of a patient.  In this case, the psychological needs are dependent on the physical needs of the patient.  The physical needs of the patient is dependent on the limited resource that that patient is entitled to in order progress towards a healthier being.  By providing these limited resources to patients on a first come, first serve basis, the physician is carrying out an important stipulation in care ethics.  Utilitarianism states that resources should not be wasted and should be used efficiently.  These limited resources are going to individuals who need them in order to carry on with their lives and won't be wasted.  By holding onto these resources and saving them for future patients rather than administering them to present patients who need them and are entitled to them now, there is actually a high chance of the resources going to waste which is frowned upon in utilitarianism.

The best analogy I can think of is a queue for the restrooms in a restaurant.  Sometimes, the line is long and is filled with people who need to use the bathroom for various purposes.  Yes, some people may need to do more important things than others; however, there is a line that has been established and needs to be respected.  Everybody needs to wait their turn on line so that some sort of order is maintained.  Let's say there's no queue to the restroom, should an individual think twice about using it if they have to?  Should that individual think that their purpose in the restroom is not as important as someone else's future purpose might be, so they should wait for the next individual to use the restroom under that assumption?  Absolutely not.  If that happened, then the individual would be standing outside the restroom all day and would never go in.  Nothing would be accomplished.

 

 

24Jun/1114

Debate post: Is it moral?

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Question: Is it moral for the government or individual hospitals to provide limited resources on a first come, first serve basis?

 

I don't think it's moral for neither the government nor individual hospitals to provide limited resources on a first come, first serve basis. I think that "first come, first serve" makes the implication that these resources are wants that are to be consumed by the people who are first in line to receive them. Rather, these resources are needs, and there are many people out there who need them. Take, for example, a situation in which there is a special medication that treats the flu in 24 hours, but is limited to 1,000 doses. The flu ranges in severity, as it can be insignificant to some and fatal to others. Some people may want the medication in order to be rid of the flu sooner so that they can finally get out of the house and enjoy the sun. Others may need the medication in order to live another day, as their immune systems are very weak (perhaps they're infants or the elderly) and they are at risk of dying. 2,200 people (600 whose lives are in danger) were seen by various doctors in one day, and 2,200 requests for the medication (all with date, time,  and severity included) were reviewed. Would it seem right for the hospital/government entity (again, this is only an example) to distribute the medication to the 1,000 patients whose times were soonest?

 

Take a second to consider the kinds of things that are distributed on a first come, first serve basis. A store would sell it's stock of 1,000 iPods to the first 1,000 customers in line. A person selling 50 video games would sell to the first 50 people willing to buy. Should medical resources be on the same level as these things? These are superficial wants, and health care is a need, as it is crucial in living a healthy life. Taking somewhat of a utilitarian perspective, giving these limited medical resources to the first people "in line" wouldn't be a right approach, as there would be people who don't necessarily need the resources as much as others, but receive it anyway. That would surely shorthand many people who would need the resource more than others, and have grim results as opposed to distributing the resources on a needs basis. Even if that needs basis doesn't help everyone with a need (perhaps there are more needy than there are resources), it is a better approach than just handing the resources out to whoever was first to put their hand out.

 

Where does one's autonomy come into play? It can be argued that the people who are first "in line" for something have a right to it, and I would agree. I would also agree that in some situations, people can have a greater right to something than another. For example, someone who is suffering from a disease has a greater right to specific treatments than someone who thinks they might be at risk of that disease. This should be the norm for all medical resources, including those who are limited. With respect to autonomy, needs should be of greater importance than wants. Please, share your thoughts on how you feel autonomy affects this situation, if at all.

 

Equality is another thing to be considered in this situation. Surely, working on a needs basis does not allow for equality, as some people are given priority over others. However, the only way to achieve equality in this situation would be to give the resources to all, and that is impossible as the resources are limited. Also, not everyone is on equal standing in terms of health, as some are worse off than others. In situations such as this one, it only makes sense that there is inequality, as there are people who truly need the resources and people who don't really need it.

 

 

23Jun/117

News Article 6/23 Sam Ahmed

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http://qn.som.yale.edu/content/can-international-perspective-help-create-value-based-health-system
The healthcare solution has become a very hot topic for debate in the United States.  The main issue seems to be largely focused on the amount of insurance coverage and the access to care.  Many people believe that Universal coverage may be the most logical and effective solution to this debate.  Many European nations as well as Canada have instituted these types of systems and it makes sense that the United States would try to learn from them.  For example, the most recent health care reform is similar to the Netherlands where “a recent insurance mandate has resulted in over 98% coverage…”  Swedish healthcare is also universal and for the most part publically funded.  Though these systems seem to work for these countries, they still face the similar problems the United States healthcare system does.  Ultimately, no one country has figured out the perfect solution.
Though finding an easy solution to the health care debate seems impossible, some countries have recently proposed ideas that may lead to an eventual solution.  Germany, for example, is instituting systems that “readjust risks”.  It will incorporate “up to 80 chronic conditions” for full plan reimbursement.  This reimbursement will be based on estimated costs for the care of a given condition.  This would shift the focus from providing health care to all patients to providing health care to patients who need it the most.  For insurance rates, Germany takes a stance that would anger a more Libertarian point of view in that rates are income based.  Those with higher income must pay more for health coverage.
The Netherlands have instituted a system that bundles the prices of potential health care into one lump sum rather than providing partial coverage on some parts of the procedure.  The Diagnosis Treatment Combination or DBC for short includes all treatment activities including any post treatment consultations or x-rays.  The Dutch system also allows for clients to negotiate rates with insurers which allows for potentially flexible rates.  Providing one single payment also eliminates the potential for unnecessary additional services.   This system will provide somewhat of a free market for health care as those with the most economically friendly DBCs will attract the most patients.
In Sweden, there health care system is based on the quality of the treatment.  They have institutions which track the results of each treatment up to 3 months after the procedure has been performed.  The idea here is that by publically posting results of treatments at given hospitals, then patients will be able to select where they want to seek health care based on an unbiased opinion from private registries.  Health care providers are not forced to present information to these registries but never the less almost all providers participate.
These are just three of possibly many reforms being taken around the world for the health care system.  It would be effective for the United States to take these efforts into consideration as they continue to reassess health care.  I believe that a true solution will need to take the positives of the myriad of health care systems around the world.

Which reform do you find to be the most effective?
Do you see any of these reforms working with the United
States?

What ethical perspectives are present in the institution of
these reforms?

22Jun/1129

Case Study: Health Care & Justice (Utilitarianism)

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Defined by the ethical implications of the concept “majority rules,” utilitarianism offers a form of justice that stands for the “actions that maximizes the overall good” of any situation. In this case we are presented with a 25 year old lady who is said to be suffering from a condition called Crohns diseases. The effects of this illness, as a result of her bad eating and lifestyle habits, have landed her in the hospital where she is informed of another devastating news. It appears that Maddy also has kidney stones and that is what is responsible for her abdominal pain. Aware of her options, Maddy is now faced with a decision that could result in a drastic change in her life. Does she adhere to the doctor’s advice or does she follow her own?

A utilitarian reading this case study would rather she follow the latter (in following her own judgment)! Should she decide to fulfill the latter in going forth with her own judgment, Mandy would surely be relieving herself as well as the healthcare system of any “burden.”Because she is medically uninsured, Maddy would have had to pay for all medical expenses including the medical surgical procedure herself.  As you can see, this is trouble for someone who is seriously ill and currently earning very little. Proposing to not go through with the surgery procedure from a utilitarian point of view would, therefore, prevent this dilemma and would even save her from the excess stress (stress that can only worsen her current condition). Condoning this act will also benefit the health care system in the sense that it wouldn’t be forced to cover the expenses that Maddy fails to pay. In the end this works out for the greatest good in the sense of having satisfied both parties. The health system would be protected from the burdens of “payment” while Maddy, in addition to this, would also be spared a stressful lifestyle following the surgery (the stress would come from trying to figure out the payment situation).

Some may argue that Maddy’s need for surgery outweighs the effects of the cost on her life or the health care system but a utilitarian may argue the opposite.  Stress, indirectly, played a major role in the “worsening” of Maddy’s condition when she had to juggle between a job and school. If she decides to go through with the surgery, Maddy stands the possibility of being “stressed out” again and that can cause her to be in a state that is far worse than where she currently is right now.

At this point, the only sound resolution would be to get an insurance. She should speak to her physician or someone else that she trusts about finding an insurance policy that is just right for her. OR she can work out some kind of arrangement with her physician; say… to pay of the medical bills in small increments every week or month until it is all paid off although, I’m not so sure how that would work out or if it’s even possible at all. However, proceeding to follow one of the three suggested options about Maddy’s condition will be sure to grant her the best possible care, in the eyes of utilitarian laws.

 

What other alternatives from you assigned prospective can you provide for Maddy in this case?

 

22Jun/1124

Case Study: Health Care and Justice

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Maddy is a smart, hardworking girl. She has not been given a lot of help with her schooling and has had to struggle on her own. On top of all that she must deal with the side effects and expenses of Crohns disease, a chronic inflammatory disease of the gastrointestinal tract. Due to her disease, Maddy must be careful not to overwork or overstress herself as it may induce flare ups. This is hard to do considering she must work while going to school and must worry about being able to pay all of her bills. After being malnourished and dehydrated, Maddy has suffered from two infection-causing kidney stones because she has not been able to pay for her Crohns medication. She refuses the required surgery because she does not have health insurance and she cannot pay out of pocket.

The health care system is not what it should be, but there are politicians and activists trying to correct that. Maddy deserves to have health care and she deserves to have the treatment that would allow her to continue school and continue to work. Now some, such as a utilitarian, may disagree with this view. The utilitarian may say that Maddy should not receive health care because that would be taking it away from another person who has a more serious condition. It is true Maddy’s condition is not life-threatening, however, that would mean that Maddy is being used as a means to an end. This idea goes against the very nature of deontology.

If the doctors wanted to help Maddy by doing the work pro bono, Kantian deontology would see that as the best decision because that would mean that the doctors are performing a duty out of good will. They are following the moral law by treating Maddy. Another approach would be to appeal to a health care committee to see if Maddy could receive health care based on their personal and professional recommendation. Rossian deontology would have a similar approach to this situation. Ross would argue that the physicians have a “prima facia” duty to help Maddy, either by doing the work pro bono or by giving her a large discount on the procedure.

There are a few duties that Ross states that would apply here: duty of beneficence – the duty to help others, duty of non-malficence – a duty to avoid harm to other people, and a duty of justice – a duty to make sure people get what they deserve. Anyone of these duties can take precedence over the other but all would agree that Maddy deserves treatment without the stress of paying for the costly procedure. The doctors have a duty of beneficence to help Maddy. They have a duty of non-malficence to prevent Maddy’s condition from getting worse. The large sector of health care cannot look at each case and decide who really deserves free medical care or not. If it did then I’m sure this controversy of our health care program would be alleviated much quicker. Maddy is someone who deserves medical care. She is a hardworking student that pays her own bills and is diagnosed with a serious and costly disease but for whatever reason she has not been provided with health care. Therefore, it is the doctor’s duty of justice to make sure she is treated, either by doing the work pro bono, giving her a large discount on the procedure or by appealing to some sort of health care committee to see that Maddy gets the health care she deserves.

20Jun/1132

Week 04>Quiz (Substitute)

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As was bound to happen at some point, there has been a technical glitch that destroyed this week's quiz.  [This was part of the reason why progress reports went out so late yesterday.  I was busy recovering other lost data.]  So, we are going to try a different activity this week.

Assignment: Post at least one question, on a reading from this week, in the comments below.  Start by stating the reading you will be drawing on and then formulating the question.  Know the answer to your own question. Try and ask questions about key concepts or arguments.

Example: [From Buchanan - Justice: A Philosophical Review]

"What is Rawls' "difference principle?"

When you have posted your question, answer at least one question by another student.  You should try and answer a question that has not yet been answered, unless you think the answer given is wrong. Feel free to help each other out and discuss answers and questions.

Grading: If you write a question and answer a question, you get full credit.

Question Due: 3pm

Answer Due: Midnight

19Jun/1134

Lecture 06/20>Health Care and Justice

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There are two main issues in the question of justice and health: access and right to health care and health care rationing. Within each of these issues, we are searching for the appropriate balance between moral issues.

Today’s week is focused on justice. But justice varies depending on how one chooses to balance the various ethical concepts and perspective. If autonomy is the most important of the ethical concepts, then justice would be the schema that best preserves everyone’s autonomy. If equality is the most important of the ethical concepts, then justice would be the schema that best preserves everyone’s equality. Of course, all of these schemes ask further questions: What kind of autonomy matters (physical, economic)?  What should be the basis of equality? What efforts can be made to achieve the baseline of justice?

There are two main issues in the matter of health care and justice: access and rationing. Access asks what right all individuals have to health care, if any, and what measures can be morally justified to guarantee that right. Rationing concerns the limited health care resources and how those resources should be distributed. Rationing is related to access because if resources are not available, then there is a question of how access can be granted. Rationing might act as a constraint on what kind of access is available to each individual, whether that lack of access is moral or not.

Take the libertarian position as a starting point. Libertarians take autonomy to be the highest good. Specifically, they define autonomy in terms of an individual’s economic activity. So, for libertarians, economic autonomy should be preserved for all individuals. This means something very specific: individuals have the sole right to the products of their labor. Depending on the severity of this position, this can range from no taxation to minimal taxation. Regardless of the severity, the libertarian position on health care access is that it should be dependent entirely on an individual’s economic goods. Even if an individual had a right to health care access, this access could not be provided by any of the means society has established because it would mean unfairly taking the fruits of another person’s labor. This matters because social redistribution should only take place when the wrong is caused by a social system itself. So, redistribution for health care access cannot be provided by the system unless the health harm is caused by the system. If the harm is caused by an individual it should be rectified by the individual and if it is caused by nature, then there is no one’s responsibility to rectify the situation. [This does not rule out donations and charity by private individuals, but this should never be forced. It might be moral for a libertarian to help another, but it is always immoral for the government to force individuals to help one another.]

The egalitarian position is very different. It favors equality in a wider sense than the libertarian conception. While the libertarian speaks of equality in moral terms, but claims that difference comes from economic status, the egalitarian thinks that equality is defined in terms of social goods. The most common egalitarian position is that individuals should be guaranteed a basic minimum—this is usually spoken of in terms of human rights. According to some egalitarians, access to basic health care is a moral right that all humans have. Depending on the form of egalitarianism (cosmopolitanism or state-centered), one’s individual moral duty to help attain this basic level of health care may extend to those in one’s community or to those on the other side of the world. [Those who support the latter argue that our way of life is based on exploitation of other’s on the other side of the world. Because we play a part in causing suffering there, we have a moral duty to help guarantee basic health care.] Because economic goods are not the sole good, it makes sense for egalitarians to have some level of redistribution of wealth to guarantee these certain goods.

As you might note, however, these two positions do not necessarily speak to the obligations of individuals. Libertarianism states that it is immoral for governments to take individual goods and egalitarianism states that this redistribution can be moral, but this does not speak to the matter of individual moral responsibility. The question now comes, then, regardless of government involvement, what moral obligation does an individual have to provide access to health care? And, if there is a moral obligation to help others, then does it make sense to have a government system that assists individuals in helping others? Of course the major problem with the last point for libertarians is that such a system would involve taxation, a necessary evil in all government programs.

Further, even if we can establish the need and morality of a minimum of health care, what does this minimum constitute? Is a minimum simply general checkups, vaccinations, and routine treatments, with no further help beyond that? Is a minimum full access to any needed health care procedures on top of regular checkups (which might serve to identify needed treatment)? The answers to these questions depend on what moral standpoint one takes and what one takes to be morally relevant (libertarianism and egalitarianism serving as two examples of what is morally relevant or justifiable).

Rationing makes the question of access even more difficult. Society does have a limited amount of resources which can be put towards health care, be this supplies, time, or personnel.  It seems that none of the options that are available seem to provide a best case solution. For example, eliminating insurance may ultimately cut down on unnecessary costs, but, on the other hand, it may also be extremely unfair to those who are in bad economic straits. Still,  insurance—and at a greater level government sponsored health care—put a greater financial burden on society as a whole. Presently, if poorer individuals do not have access to medical treatment, their treatment tends to be delayed until they are in the emergency room. At which point, the cost ends up on society anyway and the cost is much higher than it would have been had society been providing basic medical care from the start.

From all of these reasons, utilitarianism would generally seem to lean towards providing at least some form of minimal health care. On the other hand, we might take the hardnosed approach that what is better is allowing the sick to die off without treatment and prevent and burden on the system. Deontology may say that we have a duty to provide for our fellow human beings. Yet, it might also claim that forcing an individual to help is immoral. Virtue ethics might say that individuals have a moral duty to maintain their own health and that if they are unable to do this then they should be allowed to die (as mixing with such individuals would be damaging to other’s character). Alternatively, virtue ethics might hold that it is the job of society to educate and properly raise individuals to be able to care for themselves. Finally, care ethics might say that we each have duties of care to those around us and that we should care for and provide for those with which we have a relationship. Yet, it is not clear that care ethics would have anything to say about government’s role or those who are unfortunately outside of healthy, appropriate human relations.

Given all of this, the question of what is just in health care is not always attached to what is moral for the individual. Many of the moral theories we have worked with do not provide any clear cut answers on what role justice should play in health care (but then, when do they provide a clear cut answer?). To find an answer, you must be able to decide what you take to be morally relevant, what you take to be the correct ethical perspective, and determine how to balance the ethical concepts.

Key Concepts:

  • Egalitarianism
  • Libertarianism
  • Justice
  • Equality

Some Questions to Consider:

  • What do you think utilitarianism would have to say about access to health care? Deontology? Virtue ethics? Care ethics? What would they each have to say about rationing?
  • Which of this week's readings tend towards libertarianism?  Which towards egalitarianism?
  • Why is economic status considered so important for many? Should economic status impact our moral duties?
  • Is morality an individual action or can/should it be societal? Who bears moral responsibility?