Blog period 4
Background
One of the cases presented in the Brody and Engelhard reading is that of 48-year old Mr. A, who was recently laid off from his job (297). Both he and his wife were able to find new jobs, but without health insurance benefits. Mr. A is diagnosed with an inguinal hernia and is deemed too well-off to be treated at the county hospital. However, he is too poor to pay for the surgery himself, so his doctor sends him away, telling him to wear a truss and to come back to get the surgery once he can pay for it.
Dilemma
The dilemma lies in the question of whether or not the right response was to simply send Mr. A away without really alleviating his situation. A diagnosis and instructions for management were given, but ultimately, only surgery can treat the hernia. At this point, the hernia is probably simply a source of discomfort for Mr. A, but if left untreated, the hernia will not only induce more pain, but it can also be life-threatening, as it can lead to intestinal damage (“Untreated Hernia”) (Wint).
Reflections
Looking at the principles of beneficence and nonmaleficence alone, it might seem clear that the only correct course of action is to operate on Mr. A now and worry about the payment later. After all, the hernia is causing Mr. A harm, and sending him away without a more permanent treatment could potentially lead to his death. Looking at the principle of justice might suggest the same course of action: if Mr. A had not, as John Rawls might put it (McCormick), been a victim of the social lottery and had not been laid off or if he had been a wealthy man who could afford the payment, he would not have been sent away as he was.
However, resource allocation must be taken into consideration. Any time a hernia repair surgery is performed on a patient, time and resources are taken away from other people who also need potentially life-saving procedures. Many times, the resources are simply allocated to those who can afford it. However, as Beachamp and Childress listed under the capabilities theory, everyone should “[Be] able to live a normal life without dying prematurely or existing in a reduced state making life not worth living” (259). In this case, the hernia can be treated, the life can be potentially saved, and quality of life can be restored. Although resources might be limited, a patient should not be removed from consideration to receive treatment simply because he or she cannot pay for it.
Asking Mr. A to put off the surgery might not be feasible. The longer he puts off the surgery, the more pain and problems he will have to endure, and that might lower both his productivity at his current job and lower his prospects at finding a new one with insurance. More importantly, waiting longer puts him at risk for life-threatening complications.
I feel like the most appropriate direction in this situation, favoring the principles of nonmaleficence, beneficence, and justice with factors on both sides balanced out, involves scheduling the surgery and maybe even working out a payment plan now rather than waiting until later, when the hernia would get bigger and repair and recovery would be even more difficult and possibly more expensive. It seems that Mr. A and his wife are hard-working people who were trying to make the best out of a suboptimal situation, and after Mr. A’s surgery, he would be better able to work or find a higher paying job and can work towards paying off the hospital bills with the pain and potentially life-threatening situation taken care of.
Sources
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. 259. Print.
Brody, Baruch A., and H. Tristram. Engelhardt. Bioethics: Readings Cases. Englewood Cliffs N.J.: Prentice-Hall, 1987. 297. Print.
McCormick, Thomas. “Principles of Bioethics.” Bioethic Tools. University of Washington, 1 Oct. 2013. Web. 01 Apr. 2015. <https://depts.washington.edu/bioethx/tools/princpl.html>.
“Untreated Hernia.” Untreated Hernia. No Insurance Surgery, 2014. Web. 01 Apr. 2015. <http://www.noinsurancesurgery.com/hernia/untreated-hernia.htm>.
Wint, Carmella. “Hernia.” Healthline. N.p., 20 June 2012. Web. 01 Apr. 2015. <http://www.healthline.com/health/hernia#Overview1>.
When looking at the principles of bioethics, if we follow nonmaleficence and beneficence the only correct response is to perform the surgery and worry about the payment later. The longer Mr. A waits for the surgery, the more harm is placed on his well-being. So, if we are acting in the manner of bioethics, we need to put his well being and doing no harm above payments. While the payment places a strain, it would be hard to retroactively look back, should Mr. A’s condition become so severe or he dies, and justify knowing he was sick and not acting on it. I believe that if we follow the principles outlined, we need to perform the surgery.
There are several directions that we could take this dilemma, but the most striking issue to me is simply how often this kind of scenario probably occurs. Of course it is easy to argue that the patient should be able to receive treatment despite his lack of insurance and means to pay for it, but this simply may not be a realistic option. If everyone who needed, and without adequate funds to pay for, a particular treatment or procedure was provided with this care, there would be countless repercussions. Unfortunately for Mr. A and other patients alike, the healthcare system tends to function more as a business at times, claiming that there is nothing that can be done for patients like Mr. A. This in my opinion is unacceptable. I agree with the point made by Beauchamp and Childress that Caroline referenced in her post that everyone should be able to live a life without dying prematurely or in a state that makes life not worth living. This is a basic concept of human life. However, it is realistically difficult to conclude that all patients without proper means of payment for certain care that they need should still be able to be treated without paying. In an ideal world, maybe, but certainly not when or where economic competition exists so prevalently.