As is the case in many developed nations in the world, it is a generally accepted concept that all people should have equal opportunities to succeed. In the paradigm of health, it is often intuitively assumed that in order to achieve equal opportunities amongst all people, there must be universal healthcare offered to everyone as well (Sreenivasan 21). However, Sreenivasan works to challenge this intuitive connection we often make. He analyzes the argument for universal healthcare being a necessity for justice by looking at two primary connections that must be accepted in order to make the conclusion true. The first premise is that we must accept that fair health is needed in order to get a fair share in a certain population (Sreenivasan 22). The author is careful to note the parameters for this assertion in saying that fair share is relative based on the population you are looking at. The second connection that must be made is that healthcare must be equated to health (Sreenivasan 22). The author mentions this in his argument, but the problem is not so much the first premise. In fact, he argues that the argument falls apart with the second premise.

When asserting the intuitive statement that better healthcare leads to better health outcomes, the assumption is made based on the idea that healthcare is the only socially controllable factor (not biology or random chance) that can account for a lack of equality in health outcomes, and therefore in opportunities (Sreenivasan 23). On paper this may be true, but it would be foolish to believe that healthcare is the sole social determinant in health outcomes. A perspective that is more and more on the rise in recent years is the role of socioeconomic stress in health. In a study done by Whitehall, it was shown that socioeconomic stress was a greater determinant in health outcomes compared to healthcare availability. Whitehall looked at a population that was consistent in living environment and other potential confounding factors. He then looked at the mortality rates of people in certain defined employment grades. It was shown that, despite everyone having free healthcare, there was a graded mortality rate as employment status went down (Sreenivasan 24). In another study, it was shown that it is not so much the actual value of the income for a given group or the actual job that makes a difference. It is actually the disparity in the income levels and employment grades present in a given population (Adler 62). Sreenivasan alluded to this when he talked about the relative nature necessary for the first premise to hold true.

The purpose behind Sreenivasan’s argument was to show that the commonly accepted justification for universal healthcare as a form of justice is flawed. He makes it clear that he still supports universal healthcare, but thinks there needs to be a better justification for it (Sreenivasan 21). I would argue that his argument is enough of a support to say that universal healthcare is not where resources need to be allocated. Socioeconomic stress is a huge source of chronic stress for populations across the world and if our aim is to seek justice through the provision of equal opportunity, then socioeconomic stress needs to be what we as a society are working to ameliorate. It has been shown that in nations (even with a low GDP compared to the US) that have a smaller disparity between high and low income groups tend to have better health outcomes (Adler 62). Closing an income gap is by no means easy, but it is arguably one of the best ways to ensure better health outcomes for all members of a population. Therefore, by the premises established by Sreenivasan, seeking to ameliorate socioeconomic stress is the best way to provide justice, not universal healthcare.

Works Cited

Adler, N. E., and K. Newman. “Socioeconomic Disparities In Health: Pathways And Policies.” Health Affairs 21.2 (2002): 60-76. Web. 9 Apr. 2015.

Sreenivasan, Gopal. “Health Care and Equality of Opportunity.” Hastings Center Report 37.2 (2007): 21-31. Web. 8 Apr. 2015.

When confronting major decisions in life, many of us find a sense of comfort when we know that those decisions are in our hands. But what can be said about the case of confronting death? Confronting death is the most important decision someone can make in his life, simply because, should an individual choose death, there will be no more decisions made from that point on. Death is such a big decision that many would argue it is not appropriate to only allow the patient to make the decision. Some would say that any patient in the state of mind where death is the best option should have the decision made by his attending physician. So then the question becomes this: who chooses whether or not a patient can be allowed to die in the face of extreme situations?

I mention the point about extreme situations to set a context from which this discussion comes from. I am not referring to a young girl feeling like her life is over because she is in a fight with her best friend. I am referring to the extreme cases of when someone is near enough to death that fighting to stay alive might actually not be worth the struggle. This was the case for Dax Cowart. Dax was part of an explosion that killed his father and left him with severe burns on 2/3 of his body. The treatment he underwent was excruciatingly painful and he did not want to face it anymore. He also knew that even if he survived the treatment, there would be several very real struggles to face regarding physical limitations. Because of all of this, Dax asked his doctors to just let him die (Cowart and Burt 14). His physicians, however, refused his request. They even brought in two psychiatrists to try and have him deemed incompetent so they could proceed. Even though the psychiatrists both determined him to be competent, however, they still proceeded with treating him (Cowart 14).

After surviving the treatment, Dax is now a practicing lawyer who speaks out on the situation he was in (Cowart 14). He shares his experiences so that others don’t have to go through the paternalism that he feels like he faced. This is something he would be unable to do if he had gotten what he wanted. The dilemma here is: does it matter that Dax’s future after the explosion reason enough to have disregarded his wishes and violated his autonomy? Ironically, he is a practicing lawyer who has found purpose in life in sharing about how his doctors should have let him die.

In times of distress, oftentimes we as humans can be shortsighted and don’t see the future that is beyond a major obstacle. In this case, though, the obstacle was excruciating pain so great that Dax would never wish it on even his worst enemy. To him, it didn’t matter that he could have a future where he could find purpose in life again. All he knew was that he had no desire to continue on in that kind of pain. Dax makes an interesting point in saying that people have a right to control their bodies, which also means they have a right to say whether they should go on living or not (Cowart 16). This runs into a lot of issues, however, because this implies someone in the midst of deep emotion can take his life and there is moral evidence that supports that action. I would have to agree with Dax, though. Ultimately, under the principles of autonomy, a person’s life is his to control and therefore, even death is his decision to make.

This is not to say that someone should be allowed to make a flippant decision to take his own life. Instead, much discussion needs to take place that would lead to a calm and purposeful decision to allow someone to end his own life. As a result, I also agree with Dr. Burt when he argued that he just needs time to be able to do his job as a caretaker (Cowart 19).

Ultimately, there needs to be an open dialogue between patient and physician where open communication allows them both to make the best decision possible for the sake of the patient (Cowart 19). This may mean letting the patient make the decision to die or it may mean letting the physician have a shot at providing treatment for the patient. Either way, it does mean that the patient needs to forgo some level of autonomy in order to have this open dialogue (Cowart 24). In this case, neither party is undermined because the patient will be able to make the final decision and the physician will be able to do his job and act as a care-provider.

Works Cited

Cowart, Dax, and Robert Burt. “Confronting Death: Who Chooses, Who Controls.” The Hastings Center Report 28.1 (1998): 14-24. JSTOR. Web. 18 Mar. 2015.

For the case of Mr. M, he was a patient who suffered from a severe case of vasculitis. Mr. M presented into the intensive care unit with severe respiratory failure. Mr. M had a very poor prognosis and when his physician informed him of this and asked him about the course of action he wanted to take, he said that he did not want any extraordinary measures to be taken in order to preserve his life. Upon hearing this, however, Mrs. M was extremely upset and insisted on Mr. M changing his mind. As a result they had a discussion during which Mrs. M was visibly upset. They spoke in a foreign language so the physician did not know of what was being discussed. However, it seemed clear from body language and emotional gestures that the discussion was coercive. From that point on, Mr. M agreed to have extraordinary life-saving measures taken and Mrs. M directed much of the treatment decisions. This, of course, puts the physician in an uncomfortable position because Mr. M’s autonomy is being compromised (Ho 128).

The dilemma in this case is that Mr. M is losing his sense of autonomy in the current situation. Ho defends the need for autonomism by saying that the patient (in this case Mr. M) is the one who is most knowledgeable and most invested in his own personal state (Ho 129). In addition, Ho defines the implications of autonomism as being the “rejection of the image of patients as passive care recipients and the suspicion against manipulative and/or paternalistic influence anyone may have on patients’ decision-making process” (Ho 129).

While the implications listed are definitely important, unfortunately that does not always lead to the best outcome for the patient. In this case, it is debatable that having Mr. M’s wishes defied would even provide a better outcome, but there are cases where patients may feel as if they are without hope, but because of life-saving decisions from physicians, they were able to rehabilitate to a healthy state. For Mr. M, however, it seems that he knows his prognosis is poor and that he is only inflicting on himself more pain and suffering by continuing treatment.

Another issue I have with Ho’s definition of why an autonomous person should be able to make his own decisions. Her assertion is based on the assumption that the patient knows what is best for himself. However, this is not always the case. Physicians are trained to see patients go through incredible stages of depression and hopelessness. For the patient, however, when he or she is in that state of hopelessness and despair he can’t make decisions based on his well-being because he is too focused on his current pain and suffering. This might be the case for Mr. M.

In this case, it is hard to draw the line for how much Mrs. M can have a say in Mr. M’s decision. We can’t know of his future and how he will end up if he makes it out of the hospital and therefore it may be in his best interest to continue to receive treatment. However, in order to preserve his state of being an autonomous being, he does have to be able to make his own decision. I think the best course of action would be to ask Mrs. M to leave and for him to make his decision without her presence. Afterwards, should he decide to refuse extraordinary treatment, Mrs. M should be asked to stay out of his room until she can maturely accept his decision and understand his wishes.

Works Cited

Ho, Anita. “Relational Autonomy or Undue Pressure? Family’s Role in Medical Decision-making.” Scandinavian Journal of Caring Sciences 22.1 (2008): 128-35. Web. 19 Feb. 2015.

A topic that is wrought with controversy in the present age is the topic of abortion. In the context of bioethics it is necessary to define what it is about the topic that seems so right or wrong.

Consider Kate’s case. Kate is a 17-year-old young lady who is 8 weeks pregnant. She is legally emancipated, works 30 hours a week and is still in high school. She has no family support and is no longer dating the ex-boyfriend who got her pregnant. Still, she is maintaining a 4.0 GPA and she has received a full-ride scholarship to attend a prestigious university (Rosell). Kate has stated that she doesn’t want to be a mom right now, but she also has undergone negative experiences with adoption and does not want to have her baby go through that. Therefore, Kate wants to get an abortion (Rosell).

The case is one that must be taken from different perspectives. All moral and religious beliefs aside, it seems like it makes the most sense to go through with the abortion because we have Kate’s wishes and even of her background. It may be useful, however, to analyze the situation through the perspective of moral status. For Kate, she obviously displays human properties in that she displays intelligence, memory, and moral capacity (Beauchamp, Childress 68). Also, even though she is only 17, she has displayed exceptional cognitive ability (Beauchamp 71) that seems unhindered by the hardships she has faced in her lifetime. In addition, she has also shown herself to be a moral agent (Beauchamp 74) in that she states she doesn’t want her baby to go through adoption because of what she is certain the baby will face. She has also revealed herself to be one who can experience pleasure and pain (Beauchamp 75-76) as she has recounted before the suffering she went through in the adoption system. Finally, the physician established a relationship with her a long time ago, because the case mentions that she has always gone to the medical establishment in question and now there is a moral obligation to help her that is on the physicians in this case (Beauchamp 79-81). Through every theory, we know that Kate has moral status. Judging by this alone we see that we need to act in Kate’s best interest.

But what about her unborn child?

The fetus is in its 8^th week of existence. At this point, the heart is developing and even beginning to beat at a regular rhythm. In addition, the nerve cells and brain are developing as well (Fetal Development). By many definitions, the fetus is already living. Yes, by many of the theories the fetus seems to have lower standing as far as moral status compared to Kate (seems less human, lower levels of cognition, not a moral agent, less sentient, and no established relationships), but to say that the fetus is afforded a lower moral status than Kate based solely on the 5 theories of moral status would be ridiculous and perhaps even arbitrary.

So the problem becomes one where Kate and her unborn child both have moral status and therefore have rights to moral protections, but carrying out the best interest or desire of each seems impossible (assuming that only the options presented are viable).

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 6th ed. New York: Oxford UP, 2009. Print.

“Fetal Development.” Medline Plus. National Institute of Health, 30 Sept. 2013. Web. 28 Jan. 2015.

Rosell, Tarris. “Abortion Rights And/or Wrongs.” Case Studies. Center for Practical Bioethics, n.d. Web. 29 Jan. 2015.