In the article “Health Care and Equality of Opportunity”, author Gopel Sreenivasan posits that the argument that ones’ right to health suggests that they should have access to healthcare, is flawed; equal opportunity does not require universal access to healthcare. In one supporting argument he uses to defend his thesis, Sreenivasan argues that even if access to health care is held constant, socioeconomic status seems to strongly contribute to the distribution of health (Sreenivasan, 24). This suggests that universal healthcare may not be the solution to the problem of health, but rather, other social determinants may greatly influence health and we need to look deeper into these other issues and try to come up with other solutions to the problem of health. In the Whitehall study, mortality rates and cardiovascular prevalence were investigated in British men ranging from ages 20 to 64. All of the subjects were stably employed, lived in the same region of greater London, and had free access to health care provided by the NHS. The subjects were divided into 4 cohorts as defined by the British Civil Service: administrative, professional/executive, clerical, and “other” (Sreenivasan, 24). The interesting findings in this study showed that after nine years, clerical civil servants had significantly lower mortality rates than the “others”, and the mortality rate for professionals is more than a third lower than that for clericals. Following the trend, the mortality rate for administrators was in turn a third lower than that for professionals (Sreenivasan, 24). The results strongly support the idea that socioeconomic status makes a contribution to the distribution of health.

Energy should be devoted to improving the social determinants of health and not so much emphasis should be placed on universal healthcare. Yes, access to healthcare is very important, however, there are other factors including race, gender, and social status that prove to be problems of fair opportunity (Beauchamp, 264). The ethical principle of justice is the underlying issue in Sreenivisans’ article. Justice in this case is referring to the equitable allocation of health. Unfortunately, not everyone is treated the same. For example, minorities, women, and the poor, all have significantly compromised health in comparison to their counterparts. Social factors thus prove to have negative effects on health, and if justice were being served on the race, ethnicity, and social status levels, disparities in healthcare would cease to exist.

I believe it is important to understand why these health disparities even exist. Unequal access to quality health care  is one very important one. But there are other important factors, including education, and living and work environments. Race and income are also often correlated to important health risk factors, like smoking, being less active, and obesity. To me, equal opportunity looks like placing Whole Foods supermarkets in neighborhoods where there are food deserts, limiting the amount of alcohol stores in poorer neighborhoods, and having access to great public schools. I believe these will definitely help to diminish health disparities and they serve a greater purpose than simply providing equal access to healthcare.

Works Cited

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

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.

Patient Dax Cowert was critically injured in a propane gas explosion that very deeply burned two-thirds of his body causing him to be physically blind and unable to use his hands. For more than a year in treatment, Cowert demanded that he not undergo the painful treatment for his burns and that he would rather die. The major dilemma underlying this case is paternalism versus patient autonomy. Should the doctors respect the autonomy of the patient or should they exercise paternalism that is the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates’ supposed best interest.

The best decision in this case would be to listen to the patient, but not just leaving it at that. It would be wise for the physician to seek out the underlying reasons as to why the patient wouldn’t want to go through with a procedure that would potentially be of great benefit to them. The act of discourse and reasoning with the patient could be very useful in helping the patient come to terms with their prognosis and allowing them to see alternatives to their situation. As discussed in this case, at first Cowert did not want to undergo the treatment. Given much analysis as to why this was so, it was determined that Cowert believed that he wouldn’t be able to lead a meaningful life anymore in comparison to when he was able-bodied. Cowen would be able to think about his condition differently if he was familiar with disabled-bodied people who were blind or had missing limbs. It is still possible to live a meaningful life with a disability. Unfortunately, many able bodied people don’t believe they would be able to live a life of purpose. Cowert was able to overcome his fear and even went on to pursue a law degree.

The other side of this dilemma looks at patient autonomy. What would have happened if the doctors listened to Cowert and granted him his wish to die? Cowerts’ life would have ended prematurely. He would not have went to law school and become something great. Cowert clearly wanted to stop his treatment because he did not see the use in continuing treatment if he would just be prolonging a life where he was miserable and saw no hope for himself. This is where the physician must intervene and help the patient realize that they could still lead a great life. It is thus very important for the physician to develop a trusting relationship with their patient in order to get through to the patient successfully.

Works Cited

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015. <http://www.jstor.org/stable/3527969>.

“The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” – (Fox13Now)

Case Discussion:

The major moral dilemma in this case study deals with whether or not the father should receive more evasive yet more successful treatment for his severe depression even though he declined receiving Electroconvulsive Shock Therapy (ECT). The ethical issues is exacerbated when the next-of-kin, the patients’ son, has been informed of the positive as well as the negative effects of receiving ECT, however still denies the treatment for his father which could drastically improve his father’s medical condition. The psychiatrist is faced with the ethical dilemma of respect for patient autonomy versus non-maleficence. Should the psychiatrist allow the patient to revel in this very deep depression where he has attempted to commit suicide or should the psychiatrist override the wishes of the patient and administer the procedure regardless of if the patient or his next-of-kin consents? If the psychiatrist doesn’t intervene, then the father could possibly commit suicide, which goes against the ethical principle of non-maleficence; it is the duty of the psychiatrist to not harm the patient. One can argue however, is the psychiatrist really harming the patient if the patient chooses to commit suicide? The psychiatrist is also expected to respect the decisions of the patient. The patient is an adult and has made the previous decision to receive antidepressants. If the patient is able to make that choice, then he should also be able to make the choice that he does not want to undergo ECT.

(www.nevcoeducation.com)

My Response:

This is a very difficult dilemma to attack. However, if I was the psychiatrist in this position, I feel like I would have no other choice but to honor the decision of the patient and his son. Sometimes medical professionals can be selfish in their pursuits of solely wanting to make sure that a patient lives because no one wants a patient to die on their watch! If a patient dies, then the medical professional will feel like a failure. The psychiatrist should try his/her best to assure that the severely depressed patient causes no harm to himself and should just patiently wait the four to six weeks for the drugs to take effect.

Current Event:

The case discussion has brought up a very interesting point. What is the difference between this depressed patient and “the cancer patient who initially agrees to surgery but who now refuses chemotherapy? How can we acknowledge the right of patients to refuse potentially life-saving treatment in the one case but not in the other? (Thomas, 129-130)”. In a recent news report, a court case ruled that Cassandra C, a17-year old minor, would be forced into chemotherapy against her consent. The court said that Cassandra’s attorney failed to prove that she is mature enough to make her own medical decisions. If the girl was not a minor or successfully proved that she was mature enough to make a decision regarding her health then she would have been able to, under the law, refused chemotherapy. Cassandra’s mother approved of her daughters’ decision and exclaimed to news reporters that “The biggest thing people don’t understand is: this is not a death sentence. It’s not a suicide. It’s about rights.” This can be applied to the ECT case in that the patient, who is an adult, made a decision that should be respected by the medical staff. If cancer patients could ultimately have autonomy over their health decisions, then why can’t the depressed patient have that same autonomy?

Works Cited

Thomas, John and Waluchow, Wilfrid. Well and Good. Canada: Broadview Press, 1998. Print.

“Teen Forced into Chemo Treatments, Mother Supports Decision to Refuse.” Fox13nowcom. N.p., 07 Jan. 2015. Web. 29 Jan. 2015.

“Teen’s Forced Chemo May Continue, Connecticut Court Rules – CNN.com.” CNN. Cable News Network, n.d. Web. 29 Jan. 2015.