Background:

              Over the past couple of centuries, numerous countries have proposed the implementation of healthcare systems with a socialized approach. The United States of America has had lengthy debates over implementing a socialized medicine program. Currently, citizens of the United States of America have the opportunity to receive either Medicare or Medicaid if requirements for one of the programs are met. “Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities” (Medicaid.gov). Medicaid is geared toward the lower-income portion of the population that may not be capable of affording private health insurance. “Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease” (Medicare.org). Medicare, on the other hand, is designed to support the health of the elderly portion of the population that may require additional healthcare.

In B.Brody and D. Engelhard’s article, Access to Healthcare, there are three cases presented. Each case depicts an episode in which an individual is in a predicament over healthcare costs and/or accessibility to ample healthcare.

Case A refers to a man who needs surgery at some point in the future. The surgery is not urgent. The problem that the man has is that he cannot afford the surgery, and the company that he works for does not provide health insurance benefits.

Case B refers to a mother whose child is sick. The child needs to see a doctor about a high fever, but the doctor is effectively inaccessible. The journey would be too far and take too long to make it to the doctor.

Case C refers to an elderly couple. The husband is beginning to show symptoms of Alzheimer’s disease, and is in need of additional nursing care. The couple cannot afford to both keep their house and to send the husband to a nursing home. A lawyer tells the wife that the best financial and legal option is to divorce the husband and claim all assets. Once completed, the husband would comply with Medicaid guidelines.

Dilemma:

              In all three of these cases, shortcomings of America’s current healthcare system are presented. The question to be answered here is “to what extend at what cost ought a society attempt to provide equal healthcare for all?” (B. Brody and T. Engelhard, “Access to Health Care,” Bioethics: Readings and Cases).

Conclusion:

              The sanctity of human life plays a major role in this dilemma. Is it morally just to not provide a portion of the population with accessible and high-quality healthcare? In my opinion, everyone is entitled to healthcare by their basic human rights. If someone does is not provided healthcare, they could die from a simple bacterial disease that in modern times, we can combat with just a few doses of antibiotics. This costs society just a few cents per dose, and yet saves lives. Society cannot justify not providing healthcare for all because if they do not do so, the poorer portion of the population will have no access to healthcare, and pass away from illnesses in which we have proven cures. Society is harming individuals that do not have healthcare.

Recently, America is moving towards healthcare reform in which a socialized medical approach will be instituted. President Obama has established the Affordable Care Act in order to help expand coverage, lower healthcare costs, and enhance the quality of care for participants. The implementation of this Act allows anyone who desires health coverage to acquire health coverage.

With this recent implementation of healthcare reform, all three cases will be resolved. In case A, the man can now afford to purchase a subsidized healthcare plan in order to afford surgery. In case B, the mother should be able to see a closer doctor because she no longer needs to go and visit a charity doctor. In case C, the health insurance prices could be lowered so that they are affordable for the elderly couple. Just like with any legal reform, there are individuals that are left out of the benefits. While this does not solve the problem of inaccessible healthcare for the entire population, this reform does benefit a significant number of individuals and is a step in the right direction for the morality of the United States healthcare system.

In conclusion, as a society, we have an obligation to ensure the health of our entire population. The sanctity of life is paramount. No matter the cost, society ought to attempt to provide equal healthcare for all.

Works Cited:

http://medicaid.gov/affordablecareact/affordable-care-act.html

https://www.medicare.gov/

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

http://goodtoknow.media.ipcdigital.co.uk/111/000000d5c/b9e6_orh220w334/elderly-couple-dementia-relationship-grandparents.jpg

https://dss.sd.gov/img/behavioralhealth/motherson.jpg

https://waxingtofull.files.wordpress.com/2012/01/horsey-healthcare-socialized-medicine1.jpg

Background of Assisted Suicide

              For many, assisted suicide is a very sensitive topic. Some believe that suicide itself constitutes a form of a crime, while others believe that assisted suicide is a lawful act that should be legalized in the entire United States of America. In Is Suicide Murder by William Mikell, Mikell states that, “In English law…the deceased [one who committed suicide] is here punished with forfeiture, not for the crime of taking his own life” (JSTOR). On the other hand, the opposite point of view must also be taken into account. Although America does not currently legalize assisted suicide in all fifty states, America stands with the belief that all of its citizens deserve utmost freedom. Would assisted suicide not provide the preeminent standard of freedom? “Supporters of legislation legalizing assisted suicide claim that all persons have a moral right to choose freely what they will do with their lives as long as they inflict no harm on others” (SCU).

The Case

              In this week’s reading, we have an ALS patient in the initial stages of the disease that wishes to be allowed the opportunity to commit suicide on her own volition when the time comes that she feels fit. The dilemma is that with ALS, the patient passes away when all organs fail to keep functioning and the heart stops beating. The patient’s solution to this problem is to ask to be provided with a device that she can have attached to her so that when the time comes, she can commit the action herself. In order to lawfully attach a device of this nature, Sue Rodriguez, a Canadian citizen, went to the Canadian court system to help her legalize this form of suicide. The courts denied her the allowance of this method of suicide. As a result, Sue when on to an anonymous doctor and had the doctor perform assisted suicide. Gloria Taylor, as second patient with ALS appealed to British Columbia’s court, and this time, the court could not make a decision, so appeals are currently in progress today.

Conclusion

              The main concern with this particular dilemma is that as humans, we “have an obligation to relieve suffering of our fellow human beings and to respect their dignity” (SCU). If a patient is incarcerated to a hospital bed with a terminal illness that is extremely painful, as humans, how can we morally justify allowing the patient to go through the extreme amount of pain?

Alternatively, we also have the moral principle of non-maleficence. As humans, we are expected as moral beings to minimize harm as much as possible. By assisting in a suicide, the reduction of harm is completely ignored.

In the end, the dilemma comes down to one question: Should we harm for morals (assisted suicide, or not harm for another form of morality (non-maleficence)? What ought we to do?

The answer is not concrete for every case, but must be analyzed separately, case by case. In this particular case, in my opinion, in order to minimize the suffering the patient will be incurring, assisted suicide should be allowed. Let’s remember that the patient is the one suffering and the one committing the act of suicide. We ought to allow the patient to decide the morally justified ground of themselves in this case.

Infamous ALS Patient

              Stephen Hawking is an astrophysicist with ALS. When he was diagnosed, he was told he had merely two years to live. That was in 1963. Hawking lives today, 52 years later, having given so much to this world.

Works Cited

http://www.jstor.org/stable/1109529?seq=1#page_scan_tab_contents

http://www.finalexit.org/assisted_suicide_laws_united_states.html

http://www.scu.edu/ethics/publications/iie/v1n1/suicide.html

http://www.hawking.org.uk/

Background

              In this article, the use of a placebo in a clinical setting is discussed through three separate cases. The first case references a 45 year old man that has suffered from diabetes and hypertension for numerous years. The man “underwent a second leg amputation. Severe pain following the surgery was treated…” The post-surgery pain was treated with proven medical techniques, but was unsuccessful in abating the pain. Hospital staff administered injectable saline that “had been used as an effective painkiller, and that they anticipated that it would help his pain…” The saline helped with his pain, which was just a placebo.

The second case refers to a 40 year old male complaining of diarrhea and abdominal cramps. This is a result of gastroenteritis. In desperation (and lack of medical knowledge and overall sense), the spouse of the man demands that her husband receive “a shot of penicillin in the butt”.

The third and final case addressed in this article discusses a 32 year old mother that is suffering from agitated depression. She is being treated with hypnotherapy. After a bad experience with the hypnotherapy, the patient refuses further treatment. The psychiatrist prescribes 25mg of a medicine that is only proven to have results with doses of 200-300mg. The patient begins to improve with this 25mg dose. (Lichtenberg, Heresco-Levy, Nitzan)

Dilemma

              In research studies, placebos are used frequently in order to gauge a control group versus a treatment group. When dealing with research, subjects are not consulting their physician looking for a proven cure, but rather an experimental fix. Alternatively, when patients visit their physician, they come in order to receive improvement on their illness. The job of the doctor is to prescribe the correct and proven medication to aid in the health improvement of the patient. The dilemma with using placebo is a clinical setting is whether a doctor should be able to give his patients a pill or a procedure that has the possibility of working on a psychological level as opposed to the doctor being required to supply the patient with the scientifically tested and proven treatment that is certain to cure the ailment of the patient.

Discussion

              There are numerous ethical considerations to ponder while analyzing the issue of clinical use of placebos. For every case, alternate considerations will be present, so each case must be looked at individually.

In case 1, since the hospital has exhausted their analgesic options, the only route left for staff to administer is a placebo. Since there are no scientifically proven alternatives left to attempt to administer, the next best option is to try a placebo. The placebo has no drawbacks in this case because it is the only treatment option left.

In case 2, no treatment options have been attempted. There are two placebo examples present here. The first is presented with the doctor. When the doctor says that he is certain that symptoms will subside within the upcoming 24 hours, the patient has in their mind the placebo effect that they will indeed improve condition in the next 24 hour period. The second placebo effect present in this case is that the wife is convinced that the only viable and cogent treatment is the penicillin that only treats bacterial infections. The penicillin would have rendered useless as antibiotics is not a treatment for gastroenteritis. “There’s no effective treatment for viral gastroenteritis (mayoclinic.org).” The wife’s insistence on the antibiotic administration forces the husband to also have the placebo effect in which he thinks he needs the penicillin to improve in health.

In case 3, again the doctor appears to have exhausted all possible proven treatments. The next option is to administer a placebo and see if symptoms persist.

Overall, the clinical use of placebos must be analyzed case by case because, of course, every case is different. In general, if the doctor has utilized every other possible proven treatment, then the doctor ought to prescribe a placebo in an attempt to see if symptoms persist or cease. Furthermore, if a patient has not tested all viable treatment options, the doctor ought to not prescribe a placebo until all other options have been tested. The doctor ought to do this because “The one thing of which we can be absolutely certain is that placebos don’t cause placebo effects.

Placebos are inert and don’t cause anything (Moerman DE, Jonas WB).” This statement may not be entirely valid, but the point is that placebos are not as effective as the correct treatment. “I don’t believe that the use of placebos is immoral or unethical. In reality, it seems that the medical profession’s lack of understanding and utilization of the mechanism of the placebo in the healing process is tragic, shortsighted and cowardly (wrf.org).” It may be easier for physicians to approach placebos and say that they do not work, but evidence proves that if used, placebos do work between 30%-60% of the time (wrf.org). As long as a patient is receiving the most beneficial treatments prior to administration of placebos, doctors ought to utilize placebos when no other viable treatment is present.

Works Cited

1. “The ethics of the placebo in clinical practice” by P. Lichtenberg, U Heresco-Levy, U Nitzan
2. http://www.mayoclinic.org/diseases-conditions/viral-gastroenteritis/basics/definition/con-20019350
3. Moerman DE, Jonas WB. Deconstructing the placebo effect and finding the meaning response. Ann Intern Med 2002; 136:41-6
4. http://www.wrf.org/alternative-therapies/power-of-mind-placebo.php
5. http://familyrights.us/images/pills101/
6. http://thedoctorweighsin.com/physicians-surveyed-gloomy-about-healthcare-reform/

In nearly every occupation an individual could be involved in, moral issues are bound to arise. Whether a schoolteacher at an elementary school, or a Major League Baseball player, ethical quandaries regarding one’s character will be tested.

In this particular case, multiple moral issues are presented. The foremost, and ostensibly the most obvious dilemma, is whether or not Ashley should voice her opinion regarding the best situation for the newborn baby. In an ordinary case with a mother giving birth to her baby, the mother clearly receives full custody over caring for the infant. Alternatively, in this case, the mother has been deemed by the hospital administration to be of inadequate character and responsibility to care for the baby. Thus, the decision was made to place the baby into Children’s Aid care. There is an enormous amount of pressure on Ashley to agree with what the hospital has decided to do with the baby because Ashley is an inexperienced nurse shadowing Joan—a veteran nurse who seems to be competent in her job. Clearly the hospital expects Ashley to follow closely to Joan’s actions both while caring for patients physically, and while making ethical decisions. Contrarily, in the Code of Ethics for Nurses in the Provisions of the Code of Ethics for Nurses with Interpretive Statements, Provision 2 states, “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” (Page 8, Code of Ethics for Nurses). Additionally, Provision 3 from the Code of Ethics for Nurses states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” (Page 8, Code of Ethics for Nurses). These Provisions from the Code of Ethics for Nurses require Ashley to voice her opinion on the situation to her coworkers. On the other hand, if Ashley speaks against the actions of her employer, the hospital, she risks losing her job, and maybe even her career.

Another moral dilemma presented in this case is the decision of who should care for the baby. This is more of a question of which individual or organization is most suitable for the job. Judging by the fact that the mother, Deborah, has a long history with drug use and has been involved in the sex-trade for approximately five years, it is a tough argument to say that Deborah is prepared for motherhood. Furthermore, just two years earlier, Deborah gave birth to a child that child protective services took custody of and cares for. There is a precedent here. Since child protective services has already deemed Deborah an unsuitable guardian for her first child, the same decision of incompetence will be determined for her second child. This is because Deborah relapsed back into drug use and sex trade after having her first baby stripper from her. Additionally, the newborn child is an innocent being; the child deserves the best of possible circumstances to grow up in. Whether the best situation for the child’s upbringing is with adoption, with Deborah, or with an alternative upbringing situation, the decision must be made in which situation the child will be raised.

In regards to the first dilemma regarding Nurse Ashley’s silence, it is difficult to speak up when you are aware of the possible consequences of doing so. Still, Ashley should have voiced her concerns privately with Nurse Joan and the rest of the hospital staff making the decision. The party that should care for the child should be a reliable one. The mother cannot be relied on to care for the child. What if the mother relapses back into drug use? Who will be there to care for the baby? The only conceivable choice is to allow a reliable party (not the mother) to care for and raise the infant. I believe that the hospital has followed through with the moral action concerning the party that cares for the baby. This is the best response in this situation because, when it comes down to decision making, the most important factor to consider is the welfare of the baby.

Sources:

“Anonymous Mom: I Almost Called Child Protective Services On Myself.”Mommyish RSS. Mommyish.com, 8 Jan. 2013. Web. 21 Jan. 2015. <http://www.mommyish.com/2012/09/13/called-child-protective-services-657/>.

“Code of Ethics for Nurses With Interpretive Statements(View Only for Members and Non-Members).” Code of Ethics for Nurses With Interpretive Statements(View Only for Members and Non-Members). American Nurses Association, n.d. Web. 19 Jan. 2015. <http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html>.

“Lincoln University.” Fort Leonard Wood Campus. Lincoln University, n.d. Web. 21 Jan. 2015. <http://www.lincolnu.edu/web/fort-leonard-wood/fort-leonard-wood>.

McEssy, Cheri. “Older Nurses Asset to Healthcare System | Berwyn.” Older Nurses Asset to Healthcare System | Berwyn. Brightstar Care, 20 Mar. 2012. Web. 21 Jan. 2015. <http://www.brightstarcare.com/berwyn/2012/03/20/older-nurses-asset-to-healthcare-system/>.

Jonah Adler