Access to Healthcare:

Healthcare is one of the world’s largest institutions. Everyone wants to be happy and lead healthy lives. But what does it cost to be happy and healthy? Trips to the local physician cost money, and can be expensive. If one cannot afford to make a trip to the doctor, he or she may remain ill, injured, or uncomfortable enough to reduce happiness. Humans are born with the right to health and happiness and should have equal opportunities to access healthcare in order to maintain this health and happiness. But what if they can’t? What if some are of victim to the social lottery and do not have sufficient funds to cover the costs of private healthcare to be healthy and happy? Public policies are developed to make sure that those who may not be able to provide the necessary funds to cover private healthcare can still receive public healthcare covered by insurance. This system works because while it helps those who suffer from the social lottery, it also helps those who suffer from the natural lottery – those with serious diseases and conditions that the average person will not experience on a normal basis. The system assumes that the average person will be spending significantly less money than the few that require the most funds. But to what extent should these patients with extremities be covered? We explore this question with the following 3 cases.

Cases:

Case A – A 48-year-old electrical engineer is laid off, and is no longer covered by health insurance. Upon developing an inguinal hernia, he is unable to receive surgery and cannot afford the procedure himself with the current mortgage payments. The county hospital disqualifies him from the surgery, as he is a homeowner with two vehicles. Is his situation justified to receive the surgery free of payment? It is hard to say. The county ruling of disqualification of the surgery may be a very questionable ruling. The cars he owns may be only worth one or two thousand each whereas if he owned one car for $100,000 then he might qualify for the fact that it is only one car versus two that are owned. According to Utilitarian Theory, welfare decisions must be made based on the maximization of utility for society. This view may be in favor of the engineer as he has much utility to benefit society as a healthy person rather than maybe a fry-cook at McDonald’s. An inguinal hernia is a potentially life-threatening condition. A utilitarian would argue whether or not he would be able to get another position as an engineer before retirement in order to justify the treatment.

Case B – A 5-year-old boy consistently falls victim to fevers and ear infections and has already ruptured his eardrum at one point. The closest charity hospital is 50 miles away and takes his mother several hours to get him there via bus, after already receiving a ride into the town. In this case, the child and mother are cursed by the social lottery as they do not have necessary funds to attend a private physician nearby and do not own a vehicle to increase accessibility to the charity hospital. In this scenario, is it justified to receive a car under health insurance to accommodate the situation? Some patients undergo treatments for years and cost insurance companies and hospitals thousands of dollars. Can these payments be translated towards a vehicle? While there is no way to measure the monetary benefits of the time saved from commuting to the hospital via car versus a ride into town and then a bus, it is a debate with many factors that should be considered. A communitarian might argue in favor of providing transportation to the mother as the car would not be a cost to those in the community, but it would potentially aid the 5-year-old with help to prevent drastic consequences to the frequent ear infections and fevers.

Case C – An old couple encounters a dilemma that threatens their marriage. The husband has been diagnosed with Alzheimer’s disease and must be put into a nursing home as the condition worsens. As Medicaid will not cover the payments, the wife must mortgage her house in order to come up with the funds. A lawyer suggests that all assets be moved into the wife’s name and then a divorce occur in order to make the husband eligible for Medicaid as an indigent. A libertarian would be appalled at the situation. All humans have the right to liberties, and that should include marriage. If society has driven this couple to assume the route of divorce in order to qualify for payments to be put into a nursing home due to such a saddening and hopeless disease as Alzheimer’s, then something must be backwards. If this will allow the husband to qualify for Medicaid, then it should be justified that the payments should be given to him anyways and spare the couple from divorce. Both individuals are scholars – the woman a librarian and the man a college professor – who benefit society and others, and the wife should be spared from undergoing the processes of red tape while her beloved is withered away.

Conclusion:

While these 3 cases show different angles at which people can be faced with obstacles to receiving health care, there is a common question that begs to be answered: under what circumstances should one be denied healthcare, or should everyone receive the healthcare? When one stretches as far in our society to say that a personal car should be justified as a form of healthcare, it is easy to say that we may fall into a slippery slope into providing funds for anything if it can be justly argued to link to healthcare. The problem is that not all the funds in the world are available to help every single person, so who is the judge to say that one circumstance is more deserving than another?

WORKS CITED

Beauchamp, Tom L., and James F. Childress. “Justice.” Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. 249-67. Print

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

Case 6.3 Tracy and Robert Latimer: “It Was Right to Kill My Daughter”

Background:

This case deals with two main discussions: 1) the decision Robert Latimer made to take his daughter, Tracy’s life and 2) the appropriate sentence for Robert Latimer’s crime.  Robert admitted to taking Tracy’s life by leaving her in the cab of his truck and closing in the exhaust fumes to let her pass from carbon-monoxide poisoning.  “Tracy had suffered from cerebral palsy and had been both physically and mentally disabled since the time of her birth.  At the time of her death [12 years old], she weighed no more than 38 pounds.  She had never been able to walk, sit up, talk, feed herself, or express her thoughts or wishes.  She had suffered a great deal of pain throughout her life and had undergone numerous surgeries to correct orthopaedic and musculoskeletal difficulties,” (Thomas, Waluchow, Gedge, 222).  Robert’s reason of committing the act was that to be phrased as “mercy killing.”  Robert was found guilty of second-degree murder and sentenced to life in prison with a possibility of parole after 10 years.  After a failed appeal, he appealed to the Supreme Court of Canada and resulted with a new trial on the grounds that the previous sentence was “cruel and unusual punishment.”  The new trial resulted with a sentence of one year in prison followed up by one year of house arrest.

Dilemma:

Was it appropriate for Robert Latimer to take responsibility of his daughter’s life under his hands (with respect to the principles of nonmaleficence and autonomy), ultimately with the decision to end it?  Also, is the heavily reduced sentence justified?/Was the original sentence too harsh?  What are the implications of the reduction in sentence?

Discussion:

The first discussion regards Robert’s decision to end Tracy’s life.  Obviously in almost every case, it would be fair to say that any man who would take his 12 year old daughter’s life is sinister, ill, a threat to society, unholy, overall a disaster of a human being.  However, in this case, all evidence has been shown – with acceptance by the Judge in the second trial – that Robert was not a threat to society, quoted by his family and Tracy’s doctors as being very loving, supportive father, and was very close to his daughter.  He was born and raised in the same town and is known throughout the community as being a responsible and hardworking farmer who never does anything unkind towards others.  The method of choice to end Tracy’s life was of the least harmful to Tracy and made the process easy and unnoticed.  Carbon monoxide poisoning causes no pain and is odorless.  Also, from the day Tracy was born, she had been feeling much pain her entire life.  She has had countless surgeries to cut her muscles in order to reduce pain, leaving her with limp limbs.  She only had control of her head and one arm.  Her body was so distorted she needed a steel rod down her spine to partially correct the shape.  She has never lived a normal day in her life, and was under total care.  Her quality of life was non-existent.  Every act of treatment was to reduce pain, not to treat the problem.  So was this an act of maleficence?  I don’t think so, after watching his daughter go through so much pain for so many years, knowing no amount of treatment would better her quality of life, it was possibly the responsible thing to do.  Regarding the principle of autonomy, she had never voiced her opinion in her entire life.  One of the great debates in this case was whether Robert and his wife should make the decision or should Tracy.  The decision of non-voluntary euthanasia made by Robert is justified because Tracy has never voiced her wishes or expressions at any point in her life.  Robert and his wife had always made decisions for Tracy in her best interest, not in her best wishes.  For all we know, Tracy could have rejected the idea of every having her countless surgeries, but we would never know.  At the time Robert felt it was necessary, he decided that, in her best interest, he should let her pass.  The Judge ruled this as an extremely rare case of compassionate homicide.  With the changing in the sentence, a question arises in a quote made by Aristotle: “once we disturb our disposition to fight death at all costs, it may become easier to sanction the actions of one who kills for compassionate reasons,” (227).  I read a comment on another post discussing the balance between morality and practicality and how they bump heads.  It is a difficult concept to wrap your head around, but with a case such as Robert and Tracy Latimers’, is our society changing its attitude and view about the withdrawal from life-support and euthanasia when it seems practical?  Is the balance between morality and practicality shifting?

References:

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.