In this reading, the authors start off by discussing how different countries deal with healthcare, and ultimately ask to what extent, and at what cost ought a society to provide equal healthcare for all.

Healthcare in America accounts for around 18% of the total GDP, comparatively lying around 7% for the United Kingdom. On top of that, it was also discussed in this reading that while over 95% of the UK’s population has access to health care (99% in Germany), only 90% of US citizens have that same access. In regards to portion of GDP and percentage of the population accounted for, the score currently sits at 2-0, and it is not in America’s favor. However, while it is a widely accepted fact that the United States is still lagging in terms of Healthcare when compared to Europe, this does not necessarily mean that us American’s are losing on all fronts.

A piece of evidence presented that elaborates on why Europe is not “all that” is the example regarding how the United Kingdom went about balancing costs and healthcare. While the United Kingdom may spend less on healthcare than the United States or Germany, it comes at the cost of quality of care, and the UK essentially reduced these costs by “erecting barriers” to their citizens in regards to higher technology treatment. Not only that, but patients are often discouraged from certain “high cost or higher technology interventions” that clearly would provide the patient with greater benefits. So why does America pay so much for healthcare? Simply put, it is because America wants to provide their citizens with the opportunity for the best healthcare possible. While there are less people who have access to these opportunities when compared to the United Kingdom, those that do have more doors open to them. Unfortunately the comparison between the two is not black and white, and the question now is whether or not it is ethical for the United States to turn their back on 8-11% of Americans in the hopes of providing the majority with better, and higher quality healthcare.

While I believe that every person should have the right to healthcare, I feel that the benefit outweighs the costs when said benefit is better all around healthcare. The United States relatively speaking provides a slightly lower number of people with a high level of healthcare, and I feel that that triumphs over providing a slightly higher number of people with lower quality health care.

Also I would like to mention a common counterargument that can be made to support the superiority of healthcare in Europe (or rather the inferiority of American healthcare) in that American’s are not healthier, and do not live longer than Europeans. Even this statement, while statistically supported, cannot truly determine the quality of American or European healthcare systems because that point relies on the assumption that healthcare is the only determinant of a person’s health. In reality healthcare provides a long list of benefits for any person that qualifies, but the health of an individual at the end of the day is heavily reliant on genetics, diet, violence, and the list goes on. That being said, healthcare can only do so much, and ultimately there are a lot of health determinants that are well outside anyone’s control.

Below is an image which further proves my point that American offers a higher level of health care treatment

Below is another statistical analysis that shows that there are many different determinants of health that are not reliant on healthcare

Works Cited:

Brody and T. Engelhard, “Access to Health Care,” Bioethics: Readings and Cases

http://b-i.forbesimg.com/theapothecary/files/2013/11/CONCORD-table12.jpg (image1)

http://media.economist.com/sites/default/files/imagecache/full-width/images/2012/04/blogs/graphic-detail/20120428_WOC086.png (image 2)

In his article, Ackerman addresses the topic of autonomy, and discusses how non-interference is often classified as the key feature in respect for personal autonomy. Ackerman rejects this claim, and argues that in order to truly respect a patient’s autonomy, a doctor must go beyond the lines of mere honesty and proper instruction.

A person’s autonomy is not set in stone, and has the potential to fluctuate depending on whether or not there are impeding constraints. Starting with the most obvious of constraints, there is no argument that the effects of a patient’s illness can alter their viewpoints and perspectives, or even render them as incompetent if such illness is severe enough. In PBE, Beauchamp and Childress argue that there are three criteria for autonomous actions; intentionality, understanding, and lacking controlling influences. In the case of a patient who is suffering from a debilitating illness, there is a clear pathway for the first two aspects of the theory to be violated, and while these two criteria are easy ways for a doctor to be morally sound in evoking paternalism, I believe it is the third criteria on noncontrolling influences that poses the biggest issue for doctors and the concept of non-interference in regards to patient autonomy.

Illnesses and the side effects that go along with them, while not always straightforward and parallel among patients are essentially simple ways for a healthcare physician to assess a person’s autonomy and determine whether intervening should be necessary. For example, if the patient underwent severe trauma to their frontal lobe, the brain region known for being in charge of executive decision making, the doctor should be fast to intervene and exert a certain air of paternalism. All that is required of the doctor in this case is a thorough knowledge in the medical field. Figuratively speaking, my neuroscience textbook could have come to the same conclusion. Unfortunately, determining one’s level of autonomy is not solely based off of physical and health constraints, but also social and psychological constraints. A patient could be physically healthy, but if influenced by their family or friends enough, there’s no telling what decision they could come to. Similarly, if a patient has psychological constraints such as depression, fear, or anxiety, that could also lead them into making influenced decisions. While these constraints would violate Beauchamp and Childress’ third criteria of autonomous action, should the doctor be so quick to disregard the patient’s autonomy, or should the doctor work towards restoring that patient’s autonomy before using their power advantage to take control of the situation? In regards to this question, I have to take the side of Eric Cassell in The Healer’s Art where he determines the most destructive aspect to the sick to be their loss of control, and it is the doctor’s duty to return that control to the patient.

The question now lingers, how can doctors return control to a patient? I can tell you definitively that non-interference is not the answer. In order for a doctor to be able to return control to a patient, the doctor needs to go far beyond the role of technician and information database, and must move into a totally different realm of doctor patient interaction. This entails that the doctor, while not expected to know every detail about their patient’s life and character, should have a decent way of gauging how their patient is thinking and feeling, and altering treatment and/or the dispersal of information accordingly. For example if the doctor is dealing with a timid fearful patient, he should be expected to speak in a friendly manner and be careful not to further scare the patient, especially if the patient fears life saving surgery.

In conclusion, while a patient’s autonomy and ability to maintain control should maintain a number one priority when being dealt with, it would be ironic to say that the means to achieve this is through non-interference. If doctors practiced medicine solely on the basis of providing their honesty and accurate information, we would already have robots taking over the jobs of physicians. However, there are many cases where only through a doctor’s interference can a patient maintain their own autonomy in the face of controlling factors, and might also be the reason your doctor isn’t an M.D C.P.U.

Works Cited:

Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982)

Beauchamp, Tom L., and James F. Childress. “Respect For Autonomy.” Principles of Biomedical Ethics. New York: Oxford UP, 2013. 101-41. Print.

Cassell, Eric J. The Healer’s Art. Cambridge, MA: MIT, 1985. 44. Print.

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Background

In 1984 William Schroeder became the second man in the world to receive an artificial heart transplant after suffering from terminal arteriosclerosis, and being largely bedridden after a massive heart attack. While everything may have seemed to be going fine post-surgery, within a few months Schroeder had suffered two hemorrhages, and went on to die on the 11th of November, 1985. Important to this case is the fact that the Humana Hospital, where he was admitted, agreed to pay for the $15,500 artificial heart system, while also supplying Schroeder and his entire family with free accommodations within the hospital, and on top of that, providing the patient with a specifically designed house tailored to his medical needs should he become well enough to leave the hospital. There is no denying here that Schroeder is, in a sense, a very expensive patient.

Dilemma and Discussion

The issue with Schroeder’s case, and with patients in similar rare medical circumstances, is that their medical expenses are staggeringly high compared to most procedures available. To make this issue even bigger, there is only a minute portion of the population that would ever be affected by his condition (50,000 in US, 5,000 in Canada). Now the question begs, is it worth it to allocate resources towards such procedures that would only benefit a small number of people? Or would that money be better allocated elsewhere, where the needs of the many would outweigh the needs of the few?

Medical care no doubt improves our lives, but there are numerous other types of social goods that can improve the lives of many, maybe to an even greater extent than medical care can. Discussed in the reading is the difference between “needs” and “wants”, where health is considered a basic need, and “wants are inessential to human flourishing, but add quality to our lives”. In regards to needs, I am in accordance with what was said in the reading, but regarding their definition of “wants”, I have a few things to say.

While I agree that wants add quality to our lives, I disagree whole heartedly that wants are “inessential to human flourishing”. Studies have shown that an enriched lifestyle filled with wants, play a crucial role in brain development. To quote a specific study, rats were placed in either a nurturing environment, or a deprived environment, and it was shown that these rats turned out to have epigenetic differences and grew up to either be anxious (deprived) or calm rats (nurtured). The deprived rats also had a significantly higher stress response later in life. This study shows pretty clearly to me that wants definitely have the potential to allow for human flourishing. Who’s to say cultural institutions and churches don’t have as vast, or greater an impact on human flourishing than that of medical institutions?

Conclusion 

While it is clear that procedures like the one listed in this case are costly, and the money used would no doubt have the potential to save more lives if allocated differently, I believe that if money is put into procedures like this now, there is more hope in the future for it to become a regular routine life-saving procedure. The reading mentioned that at a point in time the pacemaker was considered extravagant, and now it has improved the condition of millions of lives. Artificial heart transplants might currently seem extravagant, but if resources are allotted to it now it has the potential to become a regular procedure that saves many lives, but it will not have a future if it is never invested in. On top of that, I also believe that cultural institutions and “wants” carry almost as equal weight in improving our lives, and while I believe medical care investment should receive more weight, our “wants” should not be dismissed so quickly.

Works Cited

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview Press, 2014. Print.

Powledge T (2011). “Behavioral epigenetics: How nurture shapes nature”. BioScience 61 (8): 588–592.

“Behavioral Epigenetics.” Wikipedia. Wikimedia Foundation, n.d. Web. 22 Feb. 2015.

Pictures

http://learn.genetics.utah.edu/content/epigenetics/rats/images/Pup.jpg

http://www.papworthhospital.nhs.uk/docs/images/our_services/transplant/Total_Artificial_Heart_and_Human_Heart.jpg

One of the most heavily debated ethical issues in contemporary society is the extent of rights an unborn child truly possesses. In this case study, we read about a woman “G” who has a prior history of abusing glue and various other solvents. “G” already has three children who have disabilities, and was pregnant with another child at the time the Winnipeg Child and Family Service Agency sought injunction to force “G” into a treatment facility against her will in order to protect her unborn child from what they deemed an unfit mother. After initially being taken into treatment against her will, higher courts ordered the her release from treatment facilities. Let the record also show that while “G” did have a past record of solvent abuse, she had been clean at the time, and gave birth to a healthy baby.

The major moral issue that this case addresses is whether it is fair to take basic human privileges from the mother, in favor of the unborn fetus’ human rights. Sniffing glue is not illegal, and neither is drinking or smoking, but there is no denying that these types of abuses can pose some serious health risks to an unborn child. The hard part is not in deciding what is right or what is wrong, but rather deciding who’s claim to human rights carries more weight: the living mother, or the unborn fetus. From a moral standpoint, it is undoubtedly wrong for a pregnant mother to abuse her body, but from a societal and legal standpoint, who is anyone to deny the mother of her basic human rights? What if the pregnant mother decided she wanted to start training for a marathon? As ludicrous as the idea sounds, it is fully within her rights, even if it does put strain on the growing baby in the womb. Does that mean the mother is unfit to take care of a child, and does this justify legal intervention? There are clearly conflicting rights here between the right to self determination on the pregnant mother’s side, and the right to life on the part of the fetus. Many argue however that the latter right should not even be considered, because the question looms as to whether a fetus can or should even be considered as a living person, and if not, if that fetus then has a claim to basic human rights and privileges.

In my personal opinion, which is open to dispute, I find the mother morally flawed in her decision to abuse solvents while pregnant, but in terms of the law I do not see a violation, and feel that she is well within her human rights even if it is at the expense of her baby’s health. I do believe that treatment, however, could prove to be extremely beneficial to her and her children, but not something that should be forced upon her.

– Alexi Msays

Works Cited 

Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.

Picture:  http://pages.jh.edu/~jhumag/0407web/wholly/p21drug.jpg