The World Health Organization holds the ideal of a right to health, which includes the right to, “ access to timely, acceptable, and affordable health care of appropriate quality”( WHO: http://www.who.int/mediacentre/factsheets/fs323/en/). Here, the right to access extends to those with normal means and ability as well as those with defecates physical, economic, transportation, or informational resources. The United Nations document on the right to health also presents a similar view (UN: http://www.ohchr.org/Documents/Publications/Factsheet31.pdf). Also, both of these organizations, which lead the front in setting the standards of human dignity and rights, call for the access to resources such as sanitation, nutrition, and clean water, which form the underlying basis of health.

I believe that these idealistic, though not impossible, definitions of a right to health reflect Beauchamp and Childress’s egalitarian theories of justice. Also, they are reminiscent of John Rawl’s theory of justice that is applied to the right to health. It calls for the access by all members of society to, “an adequate, although not maximal, level of health care- the exact level of access being contingent on available social resources and public processes of decision making (Beauchamp 248). It is of note, also, that thought the WHO and UN have clauses which define a human right to health, no document of the United States of America calls for such a right.

Clearly, such lofty ideals are hard to meet within the constraints of social and economic reality. For example, Great Britain’s National Health Service is often highlighted as an equal and just form of health distribution. However, it does not respect the right to timely access since it discourages, “treatment sought on an elective basis through long queues,” and even more morally questionably, discourages the use of resources by those with more futile conditions (Brody). I believe that the National Health Service relies on the Utilitarian Theory of Justice in order to, “distribute justice as one among several problems of maximizing values.” (254 Beauchamp). Such a theory, however, is not compatible with the WHO and UN’s definition of a right to health. The National Health Service preserves justice by ensuring social welfare but does not ensure beneficence and non-malfeasance for all members of society since it discourages some elective surgeries that potential improve quality of life and has created a system of queues in order to discourage the pursuit of elective procedures.

Germany’s health care system does seem to embrace the egalitarian ideals that the WHO and UN hold since it’s, “comprehensive health-care system .. over 99% of the population is covered”(Brody). It ensures that almost every citizen has access to healthcare, thought not the maximal amount. This is how the German system institutes the utility theory of justice. It has three classes of care. Each one differs, however, mostly in only the setting of the care but not in the quality. For example, first class care provides a private room while in third class care, patients are in a general ward. Thus, all receive adequate care though perhaps not in the same type of setting. I think this model is a wonderful combination of the WHO and UN calls for universal care that also takes into account the utilitarian requirements of affordability and resource management. Currently, the United States is trying to achieve coverage of all its citizens. I think we, as a nation, would do well to see how other countries, such as Germany, are managing to balance different theories of justice to provide adequate care for all. Then, we too can be in accordance with the UN and WHO’s calls to respect all humans’ right to health.

http://www.who.int/mediacentre/factsheets/fs323/en/

http://www.ohchr.org/Documents/Publications/Factsheet31.pdf

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

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

Beauchamp and Childress’s preliminary discussion of beneficence distinguished between general and specific beneficence as well as the nature of role obligation and special relations. I found the example of the physician-stranger relationship to be a very interesting intersection among these distinctions. A doctor at the scene of an emergency represents, “a gray area between a role-specific obligation and a non-role specific obligation” (Beauchamp and Childress 206). A doctor inhabits a specific role, entailed by his or her special training and knowledge, but whether or not his or her beneficence is due to the general population or only to specific patients is a valid question. From the discussions of beneficence as well as discussions about the nature of physicians involved with in-flight emergencies, I maintain that the nature of the definition of beneficence makes it morally obligatory for a physician to take action in an emergency situation, even among strangers.

At stake here is Beauchamp and Childress’s position that a physician stranger is not, “morally required to assume the same level of commitment and risk that a prior contractual relationship with a patient or hospital would morally require” (206). This takes into account risk, which of course, a doctor may take into account both in an emergency situation as well as when caring for highly abusive or contagious patients. However, I think that doctors occupy a highly specialized role which brings with it a moral obligation to care for all people needing immediate care. This is echoed by the Hippocratic Oath, which posits that, “a doctor has a special obligation to all human beings” (Sheperd http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676316/). Especially in cases in which a doctor is the solitary medical caregiver during an in-flight emergency, there are few to no risks posed to the doctor’s well-being as long as he or she acts within the limits of, “ their qualifications and experience,” and ensures, “ consent and documentation” ( Sheperd). I think these provisions are relatively basic and demonstrate that a doctor’s role-specific obligation of acting beneficently is preserved at all times in an in-flight emergency scenario.

Five conditions were presented by Beauchamp and Childress in justifying whether or not a person X is obligated to rescue person Y. The condition most at stake in physician-stranger scenarios is condition 4, “X’s action would not present very significant risks, costs, or burdens to X” (202). Of course, there are emergency scenarios in which a physician would have to put his or herself at bodily risk in order to assist a stranger. However, even in a specific hospital setting, dangerous situations would require that health care professionals evaluate their course of action. In a hospital setting, it has been argued by Clark that the moral principle of beneficence and utility dictates that a physician assist despite risks since, “ training not only increases the value of the aid, it may also reduce the risk associated with providing it”(Huberhttp://www.tandfonline.com/doi/pdf/10.1162/152651604773067497 ). Since this argument can be made to justify involvement even in potentially dangerous, formal patient-physician relationships, it can also be applied in emergency situations.

Overall, the Hippocratic Oath, the example of an in-flight emergency scenario, and the argument by Clark that physicians are the least likely to be affected by risks of helping since they are indeed so highly qualified leads me to conclude that physicians are morally obligated to help all patients in all scenarios. Thus, the general versus specific moral obligation of beneficence does not apply to physicians in almost all cases.

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

Huber, Samuel & Matthew K. Wynia (2004) When Pestilence Prevails…Physician Responsibilities in Epidemics, The American Journal of Bioethics, 4:1, 5-11, DOI:10.1162/152651604773067497

http://www.tandfonline.com/doi/pdf/10.1162/152651604773067497

Shepherd, B, D Macpherson, and C M B Edwards. “In-Flight Emergencies: Playing The Good Samaritan.” Journal of the Royal Society of Medicine 99.12 (2006): 628–631. Print.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1676316/

Background

According to the National Trauma Institute, 30% of all life years lost in the United States is lost to trauma accidents. This is in contrast to the relatively smaller number, 16%, who are lost to cancer. In this case, Amira, her partner Casey, and their daughter Samantha, are victims of a crash that kills Casey and injures Samantha. Meanwhile, Amira is in very critical condition and needs to quickly enter the operation room in order to save her life. However, as she goes in and out of consciousness before surgery, she asks how her family is. After quickly telling Amira that her daughter will be fine, the nurses pause to consider if they should tell her about the death of her partner.

Dilemma

The case highlighted that one of the main moral dilemmas was in deciding whether the roles of the nurses as beneficent and non-maleficent outweighed the patient’s autonomy.  Also, I think, a case can be made that treating the patient justly is also important. It is possible that telling Amira the news that her partner is dead could hasten the deterioration of her present condition. This reality would support withholding the information in the interests of non-maleficent. However, in order to treat the patient justly and to respect her still intact autonomy, Amira must be told the truth

Conclusion

In this case, the nurses ought to tell Amira about the death of her partner as well as that her daughter is still alive. In this case, the patient is autonomous. Though her consciousness ebbs and flows as her physical condition changes, her personality and character are intact. By asking about her daughter and partner, even as her own body struggles to stay alive, she displays appropriate behavior. Thus, no case about incompetence can be made to validate disregarding Amira’s autonomy. Also, a nurse’s duty to be non-maleficent and only beneficent supports telling Amira the truth. Though telling Amira will cause her much sadness and distress, it also gives her peace of mind in knowing the truth. Also, telling her would keep her trust in the healthcare team intact and help prevent her from jeopardizing her own delicate condition after the surgery by refusing to comply with the healthcare team’s directions during her recovery.

A case can also be made for telling patients the truth in these tragic cases by looking at statistics. If 30% of deaths are from traumas, then it can be assumed that many situations like this occur. If in every situation like this, the patient was spared distressing news at critical times, then the patient’s right to autonomy would be continuously disrespected even when he or she is competent. Telling patients the truth is the best choice because it respects the autonomy of the patient and helps maintain the patient-health care relationship, which is grounded in trust. Trust is the root of justice, a principle which a competent patient has access to. The patient must already depend on the team to save her physical body. In order to remain just, the nurses must accept that Amira is entitled to have any and all information pertaining to the status of her family. Upon disclosing the information, the nurses need to be prepared to provide moral support and to help Amira focus on her role as her daughter’s caretaker.

Sources

National Trauma Institute page: http://www.nationaltraumainstitute.org/home/trauma_statistics.html

RD Moorhouse, A. and P. Khan “Case 3: Emergency and Trauma

Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics

Images from http://www.preparliament.com/wp-content/uploads/2013/12/scales-of-justice1.jpg   and   https://9to20.files.wordpress.com/2012/01/trauma_center_memorial_hospital_cost_of_violence.jpg

In this case, the director of the Nursing Home uses the authority of her role to take away the right of her patients to decide whether or not they choose to be part of a research study about an Alzheimer’s drug. It is of note that by making this choice, she is exercising her own autonomy while denying all her patients their own autonomy. The study itself has been deemed ethical by several review boards. Indeed, even to my own sensibilities, it appears to me that the three types of consent, from the patient, a relative, and finally from the director herself, thoroughly ensure that only voluntary, competent patients become a part of the study. A striking point made in the case discussion, “if a reasonably competent patient consents but the family member does not, does it not seriously violate the autonomy  of the patient? ” shows that even these safeguards reduce the patient’s autonomy (Thomas and Waluchow 113).  However, this reduction in the patient’s autonomy, in my opinion, is trivial compared to the complete removal of personal choice from each patient under the director’s decision to not allow the study at her institution.

After reading the case and considering the case discussion, another salient point to me was the roles of the common good versus the rights of the individual. In this case, the director is disregarding the common good (that of those who might benefit from a successful Alzheimer’s treatment) for what she considers the rights of her patients (the right to live an unbothered, peaceful life). The director is using her own individual morality to over ride a study deemed ethically sound by other institutions. Perhaps, in this case, the morality of the individual should bend to fit into the ethics of a study that could help many in society.

Another point the case discussion brought up is the role institutions have on our autonomy. In general, most people are part of institutions, such as schools and workplaces, at some point in their lives. Almost by definition, institutions must provide some types of regulation to ensure that chaos does not occur. However, social institutions that are able to provide individuals with the biggest sense of autonomy are the most successful (Reeve and Assor 111). In my opinion, if studies have shown that this is the case, then the ethical thing to do is to allow as much autonomy as is possible in social institutions. In this case, therefore, allowing patients to choose whether or not they should be a part of the study would reinforce and rebuild a perhaps lost sense of autonomy in elderly persons and therefore result in a better quality of life. In the case discussion, it is presented that patient’s seeking to find meaning in life by contributing to the study would be an unwanted outcome. However, to me, it seems like a result that further supports allowing patients to participate in the study. Indeed, many people who are fully competent and healthy participate in studies so that they can contribute to society. If contributing to society makes these patients feel more fulfilled and happy, then I argue that it is the director’s moral obligation to allow the patients and their family’s to make such a choice.

 Works Cited

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

Reeve, John and Assor, Avi. Do Social Institutions Necessarily SuppressIndividuals’ Need for Autonomy? The Possibility of Schools as Autonomy-Promoting ContextsAcross the Globe, ‹http://johnmarshallreeve.org/yahoo_site_ad min1/assets/docs/Reev e_ Assor2011_Chapter.1051322.pdf>