Resources are limited in healthcare. Although the goal is to treat and save as many people as possible, in some cases it may not be economically feasible to do so. Resource scarcity leads to budgets on how much money can be allocated to certain programs, such as preventative care or research. Although the concept of allocation is accepted within health economics, problems can arise when people are competing for the same amount of resources and only some will be able to receive them. This leads into my question: is allocation ethical?

First, to help put allocation into context, let us create a scenario. Suppose two people are both in need of a heart transplant. One patient is a middle-aged man who damaged his arteries by consuming foods high in saturated fats and being inactive in his youth, while the other patient is a young old boy who was born with a rare condition at birth, causing his heart to fail. Also, let’s assume that the surgery has a high chance of a favorable outcome, meaning it will most likely be successful and the organ will not be rejected by the body’s immune system.  The decision that we now need to make is who will receive the surgery.

There are several issues with using allocation in this case. For one, who is to make the decision on who gets the surgery? Is there a policy in place, or an ethics review board that addresses cases of this matter? If there is no stable ground as to who should make the decision of allocation, then a nonpartisan decision may be difficult to achieve. Secondly, how is someone to measure effectively who gets the heart transplant over the other? In the Beauchamp and Childress reading, they present a case for cost-utility analysis (CUA). The objective of CUA is to come to a decision the creates the biggest possible health gains given the resources provided (Beauchamp 282). However, this way of coming to a conclusion is unethical in some cases, because it discriminates against those who are older and favors the youth, since they are predicted to live longer. Due to their youth, they have more to gain in life years from a life-saving treatment than someone who is older (Beauchamp 282).  Also, who is to say that the life years gained will be of an acceptable quality? Even if the young boy receives the heart transplant and his life years are extended, that is not to say his Quality of Life (QOL), will improve, and in some cases, may get worse.

On the other hand, there is a benefit to using the concept of allocation in healthcare. By making decisions that are based on who will receive the greatest benefit, the decision is free of pathos, which helps to eliminate potential bias in the decision. Another benefit of allocation is that is allows the hospital to save money, which may be put towards helping other patients. Also, since allocation can help health care professionals to make decisions, it can be used where it would be unethical to make a decision otherwise.

In conclusion, while I believe that there are several benefits to using allocation, I do not believe the benefits of using such a system overcome the potential harms. Groups such as the elderly will be discriminated against due to their low anticipated health gains from such a surgery. Also, using a standardized measure of health assumes that everyone’s ideal QOL would be similar. Everyone does not have the same mindset when it comes to their quality of health, and health care professionals should take note of that. If allocation is to be used in the future, it should be in situations where physicians and patients are aware of the possible benefits and risks involved, and are willing to accept the decision that is made by the appropriate health care professionals.

Sources:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York:  Oxford UP, 2009, 2013. Print.

Healthcare Rationing. Digital image. Cartoonstock.com. N.p., n.d. Web. 14 Apr. 2017.

Mandatory vaccinations have become an increasingly hot topic in the realm of health. Some patients and families argue that insurance companies and health care providers are becoming too paternalistic, and insist on a voluntary vaccination model, whereas the opposing argument is that mandatory vaccinations are leading to decreased prevalence of diseases in the population. Proponents of voluntary vaccinations cite evidence of other countries vaccination rates as proof of the success of a voluntary-based model. In this post, I will be advocating for the support of mandatory vaccinations and their effectiveness, as well as addressing the vaccination rates of other countries.

One of the reasons for the support of mandatory vaccinations is that they prevent the risk of greater harms. For instance, many low-income families may not have access to quality medical care. They may have access to the basic standards of care, such as vaccinations and general prescriptions, but they are not in a position to afford things such as expensive medications for chronic diseases. By making vaccinations mandatory, the risk is decreased for at-risk populations contracting a disease such as the measles, and therefore, lowers their overall cost of care. Although it should be mentioned that certain risks are associated with the use of vaccines, the rate of injury is small and is outweighed by the possible benefits.

Secondly, mandatory vaccinations are seen as cost-effective. Health organizations, such as the World Health Organization and Center for Disease Control, generally have to make executive decisions on whether to promote the use of a certain vaccine or not. One of the variables they use to assess the strength of a decision is the cost, which is used in calculating the cost-benefit analysis (CBA). As Beauchamp and Childress discuss, the CBA “measures both the benefits and the costs in monetary terms” (231). The CBA can be used to factor out variables such as the ethical or moral values associated in making one decision over another. This way of reasoning could be used in demonstrating to patients that the costs to themselves are greatly reduced when they receive vaccinations compared to when they do not.

Thirdly, mandatory vaccinations are seen as the best option in the United States in terms of results. Several proponents of alternative forms of compulsory immunization make the claim that other countries who engage in alternative immunizations, such as through education, have similar rates of immunization compared to countries who engage in mandatory immunization. The country they use in the vaccination reading is Australia, whose rates of immunization are around 90%. One of the issues I have with this way of thinking is the inherent assumption it makes that Australia and the United States are equal countries apart from their differences in vaccinations. This is a false assumption, as Australia and the United States differ in several ways, one major way being how Australia has universal health coverage, something the United States does not have. This could greatly impact the rates of immunizations in itself, regardless of whether Australia participates in alternative or mandatory vaccinations. Secondly, the claim could be drawn that a 90% vaccination rate is equal in terms of results in comparison to the United States vaccination rates. This is also false, since having a 90% vaccination rate would expose the United States population to a host of diseases that are currently kept under control, such as the measles.

In conclusion, vaccinations are not risk-free. Most decisions come with their own risk of complications, and as such, should always be taken to account. Vaccination may be seen as one of the greatest public health interventions, whereas some say their infringement upon patient autonomy must be considered. I believe that mandatory vaccinations are mandatory, however, I am not opposed to change. In the future, I would like to see a vaccination model that incorporates results with the ability of patient choice.

Citation:

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

Isaacs, D., Ha Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Paediatrics and Child Health 40.7 (2004): 392-96. Web. 24 Mar. 2017.

Communication is a key component of research. If there is not sufficient communication between both the researcher and the subject, then one party may misinterpret an action or statement from the other party. Let’s look at the case of the Nuuh chah nulth Nation to gain a better understanding of the issue. In 1981, a researcher named Dr. Ward conducted research and collected blood samples on the Nuuh chah nulth to examine if there was a genetic predisposition between the Nuuh chah nulth nation and rheumatoid arthritis. After research was conducted, no genetic predisposition was found. However, Dr. Ward continued to use the blood samples and data he previously collected to further his research on the history of First Nations. The Nuuh chah nulth were outraged and devised a council that would work to gather all of the data that was misused. Although it was years before the blood samples were returned to the council, the damage had already been done.

One of the main issues I would like to focus on is that the patients were not informed. After the Nuuh chah nulth openly allowed the researcher to enter their community and conduct research, they were exploited and not informed of the results as they were promised. The blood samples were then distributed throughout the scientific community for a variety of studies unrelated to arthritis, such as HIV/AIDS. These results humiliated the Nuuh chah nulth and left them in the dark about their lab results.

The problem with not informing the Nuuh chah nulth about the intent to use their blood samples for other purposes is that it destroys trust between the researcher and the research subject. The Nuuh chah nulth complied with the researcher and gave blood samples, because they hoped the information would allow them to learn more about their genetic history. However, when the researcher decided to change his mind on divulging information to the subject, and instead used the samples for other purposes, the trust between the subject and the researcher is damaged. Furthermore, when the Nuuh chah nulth obtained their blood samples back, they never received an apology from any of the parties involved. Because of this, the Nuuh chah nulth are less likely to allow another researcher to study their community.

As it turns out, there have also been other cases where patient information is misused or their privacy has been invaded. In 2016, it was discovered that some private health insurers may have gained access to patient information, such as which dentists they visited and how much they charged for a specific procedure. This could allow insurance companies to tailor their prices to make them more competitive. Although this is legal under HICAPS, the clause for the use of confidential information between private insurers and dentists, some policy workers are working to revise this legislation. In a more extreme case, a woman in Hawaii was able to access the medical records of another woman and reveal confidential information, such as the fact she was diagnosed with AIDS. Although the woman was charged and sentenced to a year in prison, one has to question the extent to which our medical information is available to the general public.

These are interesting questions to be addressed in health policy. Although I personally believe that information on patients should be used at their discretion, this is not always the viewpoint of physicians, researchers, or private insurers. By always confirming with the patient on whether their results are safe to be used, researchers can be limited in the scope of what they want to accomplish. This may deny them grant funding, prestige, or even higher incomes. However, if the patient’s privacy is not respected, then there may not be data to collect, and research would be halted altogether. Let me know what you think down below.

Citation:

Amaguin, Roman. “Hospital Employee’s Misuse of Personal Health Information: A Wake Up Call for Hawaii Employers.” Hg.org. N.p., n.d. Web. 24 Feb. 2017.

Bailey, Michael. “Private Health Funds Accused by Dentists of Misusing Patient Data for Commercial Gain.” Financial Review. N.p., 25 July 2016. Web. 24 Feb. 2017.

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

In medicine, there are those who think a traditional approach is best. They believe that medical problems should be treated with proven medical treatments. However, within the past few decades, there has been an increase in the use of placebos, which are treatments with no supposed medical benefits, in attempts to provide aid to the patient. In the reading by Lichtenberg, there were several cases in which placebos were used with different results. I will be drawing from the cases presented in order to formulate a case for why placebos should be considered ethical in medicine.

One concern surrounding placebos is the issue of effectiveness. There are concerns that placebos should not be used, because they provide little to no medical benefit to the patient. This claim can be argued against in Case 3 of the Lichtenberg reading, where a woman was treated for depression using a placebo. “Although a placebo was not intended to be used, it had substantial benefits to the patient, to the point where discontinuing use of the placebo would be considered unethical, and may even harm the patient in bringing about symptoms of depression” (Lichtenberg 553).

Questions have also been asked about the morality of placebos. A general rule of placebos is that in order for them to work, the patient has to be deceived into believing the medicine that they are being treated with is conventional medicine and has a proven medical benefit. This is one area where placebos fall short, as their effect is largely unknown to researchers, and many trials are being done to study why placebos work (Feinberg, harvardmagazine.com). However, the claim of deception may vary from case to case, as there have been cases where placebos have been openly discussed. Although this may be seen as counterproductive to the use of placebos, disclosing that a treatment is a placebo may not necessarily diminish its effectiveness (Lichtenberg 552). In the case with the 42-year-old man who had a case of gastroenteritis, the husband and wife asked the doctor for a placebo, after the doctor had already expressed his opinion that the issue would resolve itself in a couple of days (Lichtenberg 552-553). In some cases, even if a physician states a treatment is unnecessary, that does not mean the patient will not want to receive it in hopes of a better recovery.

The effect of disclosing treatment methods to the patient was also tested in a study by Ted Kaptchuk of Harvard University. In a pilot study published in 2010, two groups of subject were studied: one group was given no treatment, and another group was told they would be receiving placebo pills and that the pills could potentially have healing effects (Feinberg, harvardmagazine.com). Although further research needs to be done, the study showed that the group given placebo pills had significant improvements over the group given no treatment whatsoever. This improvement was so significant, it rivaled the improvements of groups that had been given the actual drug in other studies (Feinberg, harvardmagazine.com).

Another claim raised against placebos is that they are not deemed to be true medicine. Several proponents of conventional medicine believe medicine is based on years of research and has a measured benefit when given to a patient. Placebos are different in the sense that they are given the label of alternative medicine, which consists of things such as pills, needles, and saline injections. Placebos also have difficulty proving they are effective from a scientific viewpoint. However, if the treatment is effective for an individual patient, why shouldn’t they be used? People go to the doctor in the hopes of being healed and alieved of their symptoms. If placebos can accomplish this, what’s wrong with that? Wouldn’t it be considered unethical not to use the placebo, if there was a possibility of treating the patient when other methods were ineffective?

Citation:

Feinberg, Cara. “The Placebo Phenomenon.” Harvard Magazine. N.p., 03 Mar. 2014. Web. 03 Feb. 2017.

Lichtenberg, P. “The Ethics of the Placebo in Clinical Practice.” Journal of Medical Ethics 30.6 (2004): 551-54. Web. 3 Feb. 2017.

Placebo Effect. Digital image. WordPress. N.p., n.d. Web. 4 Feb. 2017.