Background:

This week’s readings covered the idea of national or public health care. Public Health care, if one were to take a utilitarian point of view, according to Beauchamp and Childress is often argued to be beneficial to society as a whole as without a healthy work force  a nation cannot prosper. Thus to ensure that everyone has a fair chance to work a minimum level of health care is often provided to the public. Almost every “modern” nation has some sort of health care system in place for the masses. These programs are often funded by the tax payers money making this a very socialistic scheme despite most “modern” nations these days following a capitalistic model.  In a fully capitalistic society there would theoretically be no such service as if a person could not provide the necessary capital for health service then they would not be able to receive any. Thus a minimum level of public healthcare seems to be just.

Both a utilitarian and egalitarian view of justice fully support public health care.  Utilitarians arguing that the cost of health care is off set by the overall benefit it brings to society by healing those who cannot work, and preventing them from worsening. as well as giving a safety net which provides comfort. The egalitarians on the underhand support public health care because it distributes a universal right “equally” to the most people. However if one were to take the libertarian point of view the issue that this is infringing on peoples free choices comes up.  To a libertarian public health is unfair because you are given no option of choosing if you will participate or not. However according to Allen E. Buchanan rational libertarians would argue that public health care would still exist due to voluntary payments as the concept of beneficence would ensure this. The only problem is sometimes beneficence needs to be “coaxed” out of society for it to be realized.

Dilemma:

The problem we run into is the idea of enforced beneficence. Why if public health care is morally correct do we need to make taxation to pay for public health care? The first argument is that there is a prisoner’s dilemma at play. While it would be beneficially to society as whole to volunteer a minute amount of wealth and it could be done if everyone participated no one will participate. The reasoning being that since so many people are participating one persons contribution is so small they can skip out on this minimum payment and instead maximize the use of that funding for other beneficent deeds. However since everyone will think this and act in the way that gives the most beneficent. The minimum will not be reached. The second argument is that this public health care is the most important however only if I have assurance that enough people will fund this will I myself pay. Thus for both cases we need to enforce beneficence, but is it truly beneficence anymore and can we morally enforce this?

The second dilemma as brought up by the issue of minimum. Where do we draw the line for minimum health care. Beauchamp and Childress acknowledge that there is an ideal and a reality when it comes to providing health care. Thus the idea of minimum health care comes up, however the moment one states minimum the questions of how do we judge the value of a persons life, and who get’s to decide come up immediately.

Discussion

In regards to the first dilemma, I do not think beneficence can be enforced. Beneficence according to Beuchamp and Childress represents “ideal, rather than obligatory, conduct,”(204).  Also beneficent actions “generally do not provide reasons for legal punishment when agents fail to abide by them”(204). Yes, there is the idea of obligatory beneficence but those fall more closer to the principle of non-maleficence. If you do not follow the obligatory beneficence you are likely to incur harm upon another. This is what should be enforced, ie try to stop others from kill others if you know what they are planning. However beneficence represents what goes beyond that minimum moral duty. If that duty is enforced then it is no longer going beyond what is required, it is simply following what is expected of you. Furthermore if one does not fund healthcare in the enforced beneficence model one does face legal reprimand. This turns health care from being grounded into beneficence into more of a non-maleficence issue and make it a matter of justice rather than morality. To address the issue  of enforcement one can argue from the non-maleficence point of view. That public health care is needed because if we do not provide it we are harming and hampering not only those who cannot get it but those around them. For example if a person is sick and they cannot get treated then they are likely to spread that sickness to those around them. Thus for the safety of the whole there should be public health.  As for is public health just, all 3 views of justice presented in Beauchamp and Childress seem to have no problems with the idea of public health. It is only in implementation in which they differ.

This leads to the second dilemma of minimum level of public health care. There is no real moral justification one can give to reach minimum. Minimum infers a physical quantity that should be given to all. In this way this moves into a justice issue. What quantity that we define as minimum is just? For the utilitarian this would involve a cost benefit analysis. To do that one would need to measure the value of a life? In an article in the Globalist it is stated that according to the US Office of Management and Budget the value of an average human life is approximately 7-9 million dollars.  So we must begin factoring in race, income, social class, etc… into the whole utilitarian equation which goes down a slippery slope of further dehumanizing patients into just numbers. Thus the minimum becomes even harder to set as more factors need to be introduced. If one were to take an egalitarian point of view, then it would be to divide the amount of money allocated to public health care by the number of US citizens. Thus to be equal everyone get’s that amount, however since the number constantly fluctuates and the quality of health care varies a more complex formula would be required which would have to take into account location, age, and more. Again we find the minimum to be dependent on the variables. The libertarian model would be to have the rich with their obligated beneficence donate money and that money would be used to help those in need. However the issue of who is in need comes up as well, how do you define those in need? In the end I would argue there is no morally correct way to decide a minimum as it becomes arbitrary dependent on the  factors that is included in it’s making. Is this perfectly just and morally correct? No, but who makes the law is who decides the minimum, in that way public health care cannot become fully moral or just. We as a society can only try to reach that ideal.

Citations

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

Background:

In Why Doctors Should Intervene by Terrance Ackerman, the author brings up the idea that autonomy is compromised when one is sick. To him there is a premium being put on patient autonomy by the community which while good intentioned is ultimately flawed. This is because the current model of autonomy “fails to take account of the transforming effect of illness.”(14) This is not an attack upon the idea of autonomy rather an argument that the current model of autonomy that is legally taken is inadequate and potentially harmful by limiting to patient practitioner dynamic to merely a business transaction with the only responsibility is for the doctor towards autonomy is being honest.

Dilemma:

The dilemma presented in this paper is  straight forward on the surface but when taking a deeper look it becomes rather complicated. On the surface the only question we must answer is if sickness does compromise autonomy. If one were to disagree with Ackerman’s point of view, then the current model outlined by Beauchamp and Childress use for autonomy becomes valid and the argument theoretically ends there. We can take that barring mental, physically, or educational disability so long as the patient has intentionality, understanding, and non-control then they are autonomous and as a practitioner we should respect their autonomy. Of course this unto itself leads into the questions of where do we draw the line of understanding and competency. How do we define or test for understanding in patient and what if the patients beliefs are false? Does this remove their intentionality? Also we must ask when does a practitioner trying to help a patient become coercive and violate the non-control aspect.

A second set of dilemmas comes up if we do agree with Ackerman’s ideas on autonomy. If we are too assume that sickness does compromise autonomy we must ask ourselves how much does it violate autonomy and more importantly in what way is autonomy being compromised? Obviously there is pain and discomfort which may cloud judgement yet we take most people who have a cold to be  competent in terms of decision making and only if they are undergoing extreme pain does the question of autonomy even come up. Second it brings up the question of how to limit the power the practitioner has over the patient. If Ackerman’s ideas were to become the standard for the industry this could lead to massive abuse as the patient’s will become overridden by the practitioner’s decision. As much as we want to assume that no physician or doctor would abuse this relationship there is always the chance of this occurring and thus how to prevent such abuse is a problem that must be addressed.

Discussion:

I wish to discuss the second set of dilemmas as the first set of dilemmas has been discussed before and highlighted in more detail in previous case studies.

I personally actually do agree with many of Ackerman’s points. From personal experience sickness does affect one’s mood heavily. Even small sicknesses like the common cold tend to turn people irritable and unhappy do to the pain and discomfort caused by the cold. For more advanced diseases this effect is even worse. An irritable person is not a level headed person and thus is liable to make rash or unwise decisions. This to me means that we should take into account this factor.

The current model as Ackerman has pointed out states that regardless of mood or sickness the default is that we assume the individual to be autonomous and up to the task of doing the best for themselves until proven otherwise. This to me is dangerous as most things in society tend to require the opposite. A person must prove themselves that they are autonomous and competent individuals able to fulfill certain duties for a given task. Take for example the process to get into college or apply for a job. One does not simply tell a college or company by asking them to take them and pay them a small fee. They must prove themselves to the college or company that they can fulfill the duties required to them based on what they have done in the past. Being sick I feel should be dealt with the same way. Physicians have gotten to their position because they have proven they are competent and know what they are doing in regards towards sickness. A normal person does not have that level of training or education. Thus when making decisions towards curing sickness while focusing on patient autonomy while we are sick does not make sense as there is the double threat of lack of understanding and irritability. Thus we should place less importance and weight on patient autonomy and let the practitioner do the job he was hired to do.

This of course does not mean completely remove patient autonomy, but rather put it at less of a premium. As for where to draw the line on understanding education plays a key role. This education on what it means to be sick can be taught as the practitioners are taught thus if the patient is willing to learn more about their disease and treatment then by all means should they be helped by the practitioner in learning more. On how to judge understanding and how much autonomy has been compromised, this should be part of the curriculum in becoming a practitioner. As Ackerman puts it there is a “physician’s art” and to me that means as an art it can only be learned through experience. Thus physicians should be trained in a way that teaches this art. This may not seem scientific but for example professional cooks learn from experience on how to gauge when a meat is fully cooked or when a pastry is right. This is not measured or explained to in lecture only learned through experience and hard work. Society today place a premium on a methodical and scientific approach and there is a stigma on what cannot be explained yet there are many things that we do as humans that cannot be easily put into words and the physician’s art is one of them. This idea of education also applies to how we can limit the possibility of abuse as training for a physician should include teachings about limiting the abuse of the physician-patient relationship.

Citations:

Ackerman, Terrance. “Why Doctors Should Intervene.” The Hastings Center report 12(1982):14-17.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2009. Print.

Background:

In 1993 Robert Latimer killed her 12 year old daughter by carbon monoxide poisoning. He freely admitted his participation in this murder. His daughter had been diagnosed with cerebral palsy since birth and was physically and mentally handicap since the beginning. Due to her physical disability was forced to undergo a myriad of surgeries just to stay alive. Out of so called mercy he decided to end her life. Many in the jury that tried him agreed with his point of view and gave him a light sentence. However those who fight for handicap rights challenged this ruling.

Dilemma:

This case brings up a 2 major dilemmas. The first one is euthanasia, should euthanasia be allowed in the first place, and if so who get’s to decide when it can be administered. The second is protecting and respecting the autonomy of those who are handicapped. Should Latimer’s point of view be accepted and this case taken as a precedent then it brings up the question of who is qualified to judge another person life as too painful to live and who get’s to say when they should be euthanised. If others are allowed to decide for those who are handicapped then where is the line drawn and many fear a slippery slope leading to abuse against handicapped people.

Discussion:

In life there is a limit to fighting, sometimes there are fights that we cannot win. Part of being wise is knowing when to thrown the towel and give in as sometimes it just not worth fighting. Thus in my personal opinion euthanasia should be a perfectly legal. In this case Latimer’s daughter’s life was not a life worth living. Her being bound both physically and mentally into a twisted shell of a body that requires painful surgery just to keep going. Her life is not what I would call living, that is merely existing. Should she live to adulthood she would still be bound to her parents and be unable to do anything on her own. At that point she is worse off than a rock as she feels pain but can’t move, can’t think straight, and in essence can’t live a life worth living. The fact that she has no autonomy bring into the slippery slope argument but there are degrees to this and her condition definitely constituted an instance where proxy action is required.

This is a similar problem seen in cancer patients who must undergo painful chemotherapy which may prolong their life only of so long. In the name of preserving life they must live life under constant pain and yet in a poll given to Germany doctors, 50% of them declared they would not undergo the same procedures and rather just let themselves die happy. Thus euthanasia I think is something that should be handled on a case by base basis. Instead of trying to preserve life above all else, quality of life should be factored in and “mercy killing” be allowed. Instead of running away from the issue there should be a standardization or laws that generate criteria that the majority of physicians can agree upon. This should in turn would help combat the worries of the slippery slope where euthanasia may be used against the will of handicap dependent patients.

By setting up a defined set of laws or at least a basic framework that would help decide when euthanasia can be declared and bringing this issue out into the open those who would abuse will be forced to go through the law and protection would be provided for those who cannot stand up for themselves.

Citations:

Scurr, Martin. “Why MOST Doctors like Me Would Rather DIE than Endure the Pain of Treatment We Inflict on Others for Terminal Diseases: Insider Smashes Medicine’s Big Taboo.” Mail Online. Associated Newspapers, 14 Feb. 2012. Web. 26 Feb. 2015.

Often times in our modern society life is valued far more highly than it should be. This weeks readings had a case on informed consent. Where the complication occurred where a patient was asked for consent and her life was at risk yet refused to be treated. Yet regardless of the doctors advice, her deep seated beliefs caused her to refuse surgery. Normally that would be the end of that yet her family all gave consent and even called into question her competency. In this case I would argue to let her follow out her wishes, barring complications to the case such as mental illness or drug abuse, she was making a conscious informed decision with the doctor having informed her thoroughly about the procedure and her chances of survival without. If she wants to take her chances, I would say let her.

While this may seem cold, there is one truth in economics and that is there is scarcity. With 7 billion people on this planet and growing there is no shortage of human life. Here’s a fun fact, it takes $2.8 million per prisoner per year for Guantanamo bay. The average American household incomes is only 50,000. That’s 5-6 families worth of money per year we are spending on prisoners.

How is this related to consent? This case reminded me of another controversy regarding saving someones life against there will. When prisoners go on hunger strikes, they are force fed to keep the alive. One recent one is the Guantanamo bay force feeding sessions (http://www.theguardian.com/us-news/2014/oct/03/guantanamo-force-feeding-videos-released). Something that is against there will, without consent, and yet is done in the name of preserving life. So is life preservation so noble a goal anymore when it comes down to something like this and when it costs so much?