Inequalities in health care access are apparent. They warrant a response from the community. We all run the risk of becoming ill during the course of our lives. Brody suggests that how able we are to address these crises is just chance of a social lottery. Beauchamp and Childress state that based on the principle of need that essentially social resources including healthcare should be distributed according to need. This is in line with distributive justice earlier described by them: that is fair distribution of burdens and burdens determined by norms that structure the terms of social cooperation. This is done in line with the principle of non-maleficence: if the person will be harmed without it they should be distributed to said individual. I would like to challenge this notion. There are instances in which this is not applicable. For instance if a person seeking transplant if found to be non compliant they can be removed from a transplant list regardless of need. With regards to the principle of non-maleficence, implanting into a non-compliant individual does more harm.

Cases like B and C are easier to agree upon with regards to material principles of justice. They are issues of financial resources. If we can agree that healthcare should be accessible to all, the question lies to what extent do we mean accessible? With cases like Ms. B this question is exemplified. In her case transportation was a factor as to why healthcare couldn’t be accessed. It is important to note that it is her five-year-old son is the one suffering in the situation. A child this age lacks the ability to make autonomous decisions and care for himself. It is his parent’s job to provide this care, and in some cases the state’s responsibility as well through social services. The case suggests that her issues with providing healthcare to her son could be mitigated if she had a car. So does the public then have a moral obligation to provide a vehicle to her?

The fair opportunity rule in essence states that social benefits of life should be distributed equally. People should not receive social benefits based on undeserved features. The fair opportunity rule can be used to minimalize the effects of life’s lotteries through the rule of redress. Justice can only be achieved by this measure when life’s lotteries stop being the basis for distribution of recourses. Increasing accessibility to social benefits such as education and health care could increase autonomy of individuals who live lotteries have not been in favor of.   On the other hand this becomes problematic because some social benefits are scarce and a flooded market can be problematic. It could be argued that Mrs. B has been systematically socially disadvantaged from birth. Sharecroppers often live in rural areas, which are economically and socially isolated. She probably lacks both the recourses and time involved with taking her child to the hospital via the bus. With regards to the principle of justice and to minimalize harm, she should then be given a car. However, I think it is impossible to provide a service like this to every individual. Further I do not believe that society has a moral material obligation to provide vehicles to people. This frame point of material principle is very tricky. Where is the cut off? Do we make special cases for special people and populations? Is that just? As Brody mentions, it is sometime hard to balance social goals with individual rights. Maybe this it would be good to look at how countries with higher-ranking healthcare systems address problems of access of rural populations.

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

Sanctity of Life Vs. Quality of life: Teri Schiavo

            The cases this week made me draw from one of the most well known cases in “the right to die” realm. It is clear that the line between killing and letting someone die is a very blurred one ethically. Is becoming, in essence, a sideline spectator more morally justifiable than aiding in an act? What constitutes assistance with regard to nonmaleficence? Does this all boil down to semantics? The difference between quality of life and a life quality is also important to take into consideration. Sanctity subscribers would argue that life is life regardless of condition. (Thomas) While others in the quality camp would argue that life quality is marked by certain qualifiers. (Thomas)  In the Koch article there is an interesting line with regard to surrogate perception. “The external determination of a diminished or unacceptable life quality is often not shared by the person whose life is being judged” (Koch). This is a truly disturbing thought because one is forced to question the line between discrimination against disabled persons via bias and fear, and a life that is unacceptable to the person. On one hand is maleficence and the other nonmaleficence.

Background:

Teri Schiavo was a young vibrant woman until 1990 when she suffered a heart attack that left her anoxic, completely oxygen deprived. The significant amount of brain damage led to a coma, which her doctors later updated to persistent vegetative state. (Perry 2005) Cumulous amounts of physical and speech therapy was tried with no success.  Teri had no living will. After eight years her husband decided enough was enough and that Teri’s feeding tube should be removed, however her parents did not agree. Thus began a legal battle that would not conclude until 2005. This battle went all the way to the United States Supreme Court.

            Who should act as a surrogate with regards to the principle of nonmaleficence? Teri’s husband says that his wife would not want to continue to exist in this state, and that since her state had not improved in fifteen years she should be allowed to die via starvation. Her family argues that it is a violation of human rights to purposefully starve a person, and that this decision preyed on her disability in line with some of Koch’s thought.  Also that it was a violation of their Catholic faith to be euthanized via nutrient deprivation.

Course of Action:

            With regards to nonmaleficence, I agree with the decision eventually came to by the supreme court to remove Teri’s feeding tube. Teri had been in a vegetative state for fifteen years her husband is the one that should be granted surrogacy. Her husband if deemed to be competent, in good standing with Teri prior to the accident, and not motivated by something else would have the best idea of her wishes.  He would have the best idea if there is anything left in Teri’s life that she values, which constitutes quality of life (Thomas). Her brain activity suggested that she had been brain dead for a while now. With regards to maleficence there is very little harm being done by removing her feeding tube and letting nature take its course. Her parents argument that nutrient deprivation is against their religion is valid, however it can be argued and supported with text that this is just allowing her body to take its natural course. Also since she had no real choice in the matter her soul would be spared from judgment.

Sources

Perry JE, Churchill LR, Kirshner HS. The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives. Ann Intern Med 143:744-748 (2005).

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014.

To what extent should society have an interest in protecting the health and well being of the fetus? Although the cases are quite different I do see a basis for comparison between The case of Ms. G and an outside case. This case involved a pregnant Indian woman, Savita Halappanavar, who was vacationing in Ireland. She encountered significant medical distress. The only way to save her life would have been to terminate her pregnancy, which was essentially nonviable at this point. However, her doctors informed her that in Ireland, due to Catholicism, as long as there was a fetal heartbeat there could be no abortion. Now this is not entirely true, the mandate actually states that if there is significant danger to the mother’s life the pregnancy may be terminated. It is important to note that life is not equivalent to health in this case. There are variances in how medical health professionals define and danger to life and a danger to health (Berer,2013). This is a problem with specificity that is directly impacting health outcomes.  Savita Halappanavar did not survive and died of septis three days later.
There are multiple dilemmas here.   Just as in the Ms. G case other people are imposing on autonomy. Savita tried to argue with her doctors that this was not her will, and that further she was not Catholic or Irish so they should not treat her as if she was. The other side of this is that if the fetus would have been born it would have rights to autonomy as well. So should society protect those rights now?  The moral principle of non-malevolence and benevolence are also relevant. There is significant harm being done to her because doctors are refusing to terminate her pregnancy. However, with respect to the fetus some would argue there is harm being done by terminating the pregnancy. Whose well-being are we chiefly concerned with?
Ultimately the decision to protect the health and well-being of the fetus led to the untimely demise of Savita Halappanavar. Although it is easy for us to discount this as the fault of a medical and law system steeped in the Catholic faith, I have to wonder if this is the far end of the slippery slope: taking autonomy away from women with respect to their bodies. Significant harm, death, was done to her by denying her treatment that could have saved her life in a failed attempt to save her non-viable fetus. I believe that the Canadian justice system made the right decision in the case of Ms. G.  The Canadian Royal Court ruled that societies duty to promote the health of the fetus does not come at the expense of human rights (Thomas), while Savita’s doctors decided the opposite. This case made global news and has sparked legislators in Ireland to debate abortion public health policy.

Berer, Marge, Termination of pregnancy as emergency obstetric care: the interpretation    of Catholic health policy and the consequences for pregnant women,    Reproductive Health Matters , Volume 21 , Issue 41 , 9 – 17, 2013.
Thomas, John and Wilfrid Waluchow. Well and Good: A Case Study Approach to    Biomedic Ethics. 3rd ed. Broadview Press Ltd., n.d. Print.