Background:
In “Access to Health Care,” Brody and Engelhard analyze several different models of healthcare that exist in the world such as the British National Health Service. Even in a developed country like the United States, people are not always able to receive the medical care that they require. For example, the CDC estimates that, in 2013, 5.9% of people in the United States did not receive the care that they needed as a result of high costs.
Dilemma:
At the end of their discussion, Brody and Engelhard present several cases that involve people struggling to obtain medical care. In Case A, Brody and Engelhard describe a patient, Mr. A, who has been diagnosed with an inguinal hernia. Since Mr. A has been disqualified from receiving surgery at the county hospital due to his income, he and his wife cannot afford the procedure. The dilemma in this scenario includes the doctor suggesting that Mr. A wait for a better job or save up money as opposed to operating on Mr. A despite the financial issues.
Discussion:
One aspect of this situation to consider is whether the doctor is violating the principle of nonmaleficence by suggesting that Mr. A postpone the surgery. Nonmaleficence revolves around not inflicting harm or evil (Beauchamp and Childress, 151). As per the Mayo Clinic, without treatment, the hernia will most likely cause the patient pain, and it may also lead to intestinal damage. Therefore, by not performing the surgery, the physician is directly inflicting harm since Mr. A will suffer until he is operated on. Ultimately, the physician is violating the nonmaleficence principle by refusing to do the surgery, so he should operate on Mr. A despite the financial complications.
Another point to discuss is that the symptoms from the hernia may also lower Mr. A’s chances of receiving a better job or saving up more money as the physician had recommended. If that turns out to be true, then Mr. A will never be able to afford the procedure, and the hernia may only get worse. This suffering that Mr. A will have to endure only due to financial reasons relates to justice. Beauchamp and Childress present the definition of distributive justice: “The term distributive justice refers to fair, equitable, and appropriate distribution of benefits and burdens determined by norms that structure the terms of social cooperation” (250). If one assesses the situation from the justice perspective, then the doctor should make the decision to perform the procedure.
It is important to clarify that I certainly do not believe that Mr. A should be operated on for free by the surgeon. Resources are clearly used in order to treat Mr. A, and he should be held responsible for paying for the procedure. However, a payment plan could be designed to ensure that Mr. A instead pays over a longer period of time. For instance, the case mentioned that the family had two cars, so one car could be sold to finance the payment plan. There can be multiple approaches towards creating a payment plan that Mr. A and his wife would be comfortable with. Furthermore, after the procedure, Mr. A’s health is likely to improve, so he may also be able to obtain a better job more effectively. Ultimately, the doctor should operate on Mr. A despite the financial issues, which can be resolved over a longer period of time after the procedure.
References:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. Print.
Brody and T. Engelhard, “Access to Health Care,” Bioethics: Readings and Cases
CDC. “Access to Health Care.” Centers for Disease Control and Prevention. N.p., 20 Jan. 2015. Web. 03 Apr. 2015. http://www.cdc.gov/nchs/fastats/access-to-health-care.htm
Mayo Clinic Staff. “Inguinal Hernia.” N.p., n.d. Web. 03 Apr. 2015. <http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/basics/complications/con-20021456>.
Source for image: http://www.wohlsenconstruction.com/assets/uploads/projects/Phoneixville_Hospital_-_Operating_Room.jpg
Dmitriy, you make a strong case for Mr. A’s right to the surgery! Although I personally believe that the physician should either perform a pro bono surgery, identify another surgeon who can perform a pro bono surgery, or have Mr. A and his family contribute a reasonable percentage of their income, I do not believe that we can entirely blame the physician for being unjust or maleficent. Mr. A’s disqualification from the surgery is a product of the structural violence inherent in our healthcare system. The physician in this case is dependent on the county hospital’s resources, where the costs of even items like gloves and toothbrushes are exorbitant. Thus, I believe the physician would be surpassing his role expectations if he covered the surgery’s costs out of his own pocket.
Beatrice, I completely agree with your stance that Mr. A should receive the surgery with it not being out of the physicians pocket, and that Mr. A is a victim to the structure of the healthcare system, not the physician. However, I do not believe that Dmitriy meant that the physician should cover the costs; he just suggested that the physician could have offered a more flexible method of payment, catering to his lack of financial resources. But again, I completely agree with the fact that physician should not cover the surgery out of pocket. There is an unlimited amount of other costs that need to be covered in the hospital, and Mr. A’s surgery should not be one of them.