There is no denying that we live in an unbalanced society, where the allocation of wealth and resources greatly varies across populations. And unfortunately, this comes into play in regards to healthcare as well. In “Access to Health Care,” Brody and Engelhard raise important points on how health care ought to be distributed versus how it is distributed. It is first and foremost important to note that a perfectly distributed society is not possible—at least in today’s society and government—and that different levels of wealth and resources will always exist. However, the debate of how those resources should translate to everyone’s necessary need of healthcare is a different story. Thus, as Brody states, “To what extent and at what cost ought a society attempt to provide equal health care for all?”

Brody presents us with three case studies. In Case A, the main issue is financial access to resources. Should Mr. A be denied surgery because he can’t pay for it, or should the physicians be upheld strictly to their duty to provide help and service to all who need it? For Case B, the main issue is physical access to resources. Mrs. B needs transportation to effectively make use of her right to healthcare, and so her access is very limited. Here, we have to evaluate if it is fair for Mrs B—and consequently her son—to be stripped of healthcare due to location and inaccessibility. Case C, in my opinion, tugs at the heart strings the most, as it entails making personal sacrifices to ensure the access to health of a loved one. Here, we must evaluate the justice in asking someone to divorce a spouse or lose access to Medicaid.

For Case A, financial resources have and always will be an inequality in healthcare. It is fair to require payment for healthcare when healthcare requires cost to perform, such as a surgery. However, Mr. A should not be denied all-together because of his current financial status. Should his condition worsen quickly and dramatically, the physicians could face a situation where they forewent treatment before and are now faced with a more severe situation, which I believe is not ethical. There should be alternative options here, such as a payment plan, contracts, and policies to help people in Mr. A’s situation receive healthcare. I do not think it is just and right for society to deny someone right to healthcare fully, as it is a necessity to life.

For Case B, the issue is physical access to healthcare. The question posed here is: Should one allow such inequalities in access to health care resources? In the case of Mrs. B, she could take action to relocate closer to health facilities if needed, should the son require persistent healthcare. Here, the ball is more in her court than society’s. If the demand is not there for a healthcare facility where she lives, then she must make the play. The cost/benefit for the community to place a healthcare facility in her home location is not feasible.

For Case C, different governments and policy makers might approach this situation with varying perspectives. However, based on the readings and class discussions on utilitarianism and libertarianism, it breaches all ethics to require one to let go of their right to marriage for their right to healthcare. Those two rights should be independent on one another. Society is not justified to interfere in that manner. Their job is to provide healthcare, which should be done independently of personal matters, particularly marriage.

In each case, different issues of justice and resource allocations arise. However, each case describes situations that occur all the time today. Our healthcare system is flawed and our justice system is varied, which provides loopholes for each scenario. However, society ought to make valid attempts to find ways to provide healthcare for all, in manners that don’t require one to compromise their other obligations and morals to do so.

Works Cited

Beauchamp, Tom L., and James F. Childress. “Justice.” Principles of Biomedical Ethics. 2001. 249-67. Print

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

Case 8.3 centers around Sue Rodriguez, a Canadian citizen living with ALS. At the time of this case, she was thought to have a life expectancy of between two to 14 months. According to the prognosis, she would soon lose the ability to swallow, speak, walk, and move without assistance, and could eventually lose the ability to breathe without the aid of a respirator. Knowing this, Sue asked to preemptively take measures to request means to end her own life using physician assistance, but with her own hand, once she stopped living life to her standards of quality and happiness.

The dilemma in this case is whether or not physician-assisted suicide should be legal, and under what terms this legality should exist. In Sue’s case, the courts denied her request for assisted suicide, stating that the laws are in place to protect the vulnerable, and that human life must be respected (Thomas 184).

There are multiple approaches to this dilemma. The first is the approach taken by the Canadian Government—that assisted suicide breaches human life standards. The case states the argument that assisted suicide is unnecessary because there is pain management and care techniques to help one live happily, and that assisted suicide conflicts with a physician’s duty to help heal, not to help kill.

However, there are also many arguments as to why Sue should have been allowed to perform assisted suicide. First, Sue was autonomous when she made these requests. She was competent, and thus should not have her autonomy stripped from her. She is also on the path to death. In my opinion, everyone has different standards of what makes his or her life worth living, and a government can’t define exactly what those standards are for you. Should an autonomous and sick person request means to end one’s life when it reaches a state that is not up to his or her standards, and should they request to do it by their own hand, that is their decision.

An important aspect to this case is that Sue would have ended her life with her own hand. This parallels the Oregon Death with Dignity Act, which states that a physician may not physically end the patient’s life, but may write a prescription for a lethal medication at the patient’s request and the patient must decide to use the drug. This takes the “killing” aspect out of the equation, since the physician is not the person physically ending the patient’s life—the patient is. Furthermore, according to Beauchamp and Childress, keeping in mind the patient’s best interest is critical: “(Killing) is unjustified when it deprives the person who dies of opportunities and goods. However, if a person freely authorizes death, making an autonomous judgment that cessation of pain and suffering through death constitutes a personal benefit rather than a setback to interests, then active aid-in-dying at the person’s request involves neither harming nor wronging” (Beauchamp and Childress 182). They also state that denying a patient such requests might be disrespect (B & C 183).

While both sides of the argument are valid, Sue’s autonomous decision—and her willingness to end her life with her own hand—should have been respected, and do not fall out of line ethically once her quality of life diminishes.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2013. Print.

Thomas, Tom L., and Wilfrid Waluchow. “131-138.” Well and Good. 3rd ed. Broadview. Print.

Nurses and doctors in emergency and trauma situations often walk a fine line of how to most effectively uphold their duty of causing no harm to the patient. While it is their duty to be honest with patients, they reach a crossroads when that honesty could do more harm than good.

The dilemma in “Case 3: Emergency and Trauma Nurses: When to Give Bad News” is when it is necessary to tell the truth to a patient in situations where delivering this news might jeopardize a patient’s health, or possibly even life. In this case, Amira’s partner Casey dies in the car crash, but the doctors are faced with a dilemma when she asks how Casey is doing. Amira is in very poor health and may not survive herself, so by telling her that her partner has died could put her body in such distress that it could possibly lead to her death as well.

On one hand, some nurses might argue that their first and foremost duty is honesty to the patient. According to an article in the Ghana Medical Journal, “a doctor who withholds information from a competent patient… violates the ethical principles of autonomy, beneficence and nonmaleficence.” By intentionally withholding information, the nurse is acting with intentional deception—a form of paternalism. And in turn, this reduces the patient’s autonomy.

On the other hand, other nurses could argue that in trauma cases like Amira’s, beneficence trumps autonomy. The nurse’s goal is to protect the health of the patient and to keep her alive, and by telling her this information, they are not displaying nonmaleficence or beneficence because it would do no good to the patient in dire need. It is also important to recognize that Amira might not be in a competent state; she is likely in a state of shock both physically, psychologically, and emotionally, and is also likely receiving drugs to alleviate the pain and prepare her for surgery.

Therefore, in trauma cases like these, I believe each situation must be contextualized in order to make the correct decision. If the patient is stable (and thus, the nurses have already upheld their duty to the health of the patient) and competent, then the nurse does need to uphold his or her obligation to tell the truth and deliver the bad news. However, if a patient is in a dire emergent situation (for example, near death and about to enter surgery, like Amira), lacking full competency, and the information would cause harm to the patient’s chances of survival, the duty remains to the health of the patient, and the information can be withheld until the patient is more stable.

Works Cited:

Yeo, Michael. “Case 3: Emergency and Trauma Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics. 232-242.

Edwin, AK. “Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is It Ever Justified?” Ghana Medical Journal 42.4 (2008): 156–161.

In the case study “Research Involving Alzheimer’s Patients,” St. Mary’s Nursing Home Director Ann Wilson rejects Dr. Sandra Selleck’s request for subjects for her clinical trial on a new Alzheimer’s drug. Ann quickly jumped to the conclusion that she would not permit a clinical trial that uses her elderly patients as “guinea pigs,” “exploits” her patients, could increase their vulnerability (Thomas 116). While I can sympathize with Ann’s quick snap decision, barring her patients from even being considered for a study, and not allowing them to use their personal autonomy or freedom to decision making could potentially cause more harm than the study itself.

According to the Centers for Disease Control, over 70 million American citizens will be considered elderly by 2030—a growth that is unprecedented in history (http://www.cdc.gov/aging/data/stateofaging.htm). This closely relates to Alzheimer’s because the symptoms of the disease first appear after age 60 and the risk increases with age, the CDC says. Current CDC statistics state that the number of people with the disease doubles every five years after age 65, and this number is projected to rise to 14 million—a three-times increase—by 2050 (CDC, http://www.cdc.gov/aging/aginginfo/alzheimers.htm). These statistics are important to highlight the ever-increasing need for new drugs and remedies to cure or alleviate Alzheimer’s. Dr. Selleck’s study has been approved by her Hospital Research Ethics Board, so it has been cleared ethically and structurally.

The dilemma in this case is the debate of whether elderly patients, particularly those whom are potentially of lesser competency, should have the right to make their own decision to participate in the trial. In Ann’s eyes, they are vulnerable because of their condition and elderly state, and should not be made more vulnerable or taken advantage of due to their mental capacity. In Dr. Selleck’s eyes, this trial takes the necessary precautions to ensure all subjects are fully approving the trial, and is an important trial to hopefully reduce the prevalence of Alzheimer’s in the future.

The concept of institutionalism is vital to making an informed ethical decision in this case. For patients in an institution like a nursing home, they may feel pressures to conform, contribute, and please those in charge of them—particularly for the elderly due to their traditional positions in society (Thomas 118). Because of the ageist society we live in, elderly are viewed as helpless, possibly burdensome members of society. In Ann’s viewpoint, participating in the study would further exploit them and make them feel more helpless. However, removing their ability to consent for themselves reduces their autonomy—which is already limited due to their place in an institution. Ethically, the patients—old or not—have a right to make an informed decision for themselves. And while some may argue that since the patients aren’t all mentally competent, the three guidelines that Dr. Selleck states (1. Patient must provide written consent. 2. Patient’s closest relative must provide written consent. 3. Health care staff must not object), allows third party opinions to be heard (Thomas 116).

For those in institutions, keeping autonomy high is of utmost importance. For elderly in particular, having their personal freedoms stripped after living a life with them is challenging. Thus, even allowing a patient the chance to make their own decision is better than having the decision made for them.

 Works Cited

“Alzheimer’s Disease.” Centers for Disease Control and Prevention. N.p., 25 July 2014. Web. 21 Jan. 2015.

“The State of Aging and Health in America.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, n.d. Web. 23 Jan. 2015.

Thomas, John, Wilfrid Waluchow, and Elisabeth Gedge. Well and Good. 4th ed. N.p.: Broadview, n.d. Print.