In this course, we have primarily focused on the medical ethics for physician-patient relationship. I wonder if the principles that we discussed in the class can be applied to being other than humans and people. It would be a very interesting thought experiment to see if artificially intelligent/conscious robots can be given the same moral status as humans which would then open a plethora of dilemmas and questions.

The last few decades have seen a phenomenal rise in computer science and technology. We are accelerating at a pace that we could not have predicted just a hundred years ago. I think we are at a point where the ethical implications for a lot of our scientific achievements are not well understood. But, that has not stopped us from progressing ahead. One field of interest is the invention of artificial intelligent machines. While we already have machines that are intelligent such as smartphones and computers, but they are nowhere near close to the human intelligence. However, the machines are getting smarter and smarter with each iteration and there could be appoint where a computer can rival the intelligence of humans. This event is described as technological singularity. It could potentially trigger runaway technological growth resulting in drastic changes to our way of life.

At this point it is very important to distinguish between artificially intelligent machine and an artificially conscious machine. The former suggests a type of machine that can do a task better and faster than what humans can do. The later suggests a type of machine that has a conscious perception of it doing work.

According to Michael Graziano, a highly reputed neuroscientist from Princeton University, consciousness is generated by the interoperation of various parts of the bran, called the neural correlates of consciousness (NCC). Some computer scientists believe that it is possible to create machines that can emulate this NCC interoperation.

Hypothesizing that such artificial conscious (AC) machine is indeed created, should we then give the machine a moral status or not. I try to battle this using Beauchamp and Childress’s theories of moral status.

• A theory based on human properties: This theory wouldn’t give the machine a moral status. But, it is important to note that this theory also excludes the animals. We now know that many species of primates and cetaceans have significant self-awareness and not giving them moral status would be considered inhumane. AC machine would have the same issue as the animals. Therefore, we need to look at other theories to get a better picture.
• A theory based on cognitive properties: Beauchamp and Childress list 6 conditions under this theory that are necessary for a being to be considered worthy of moral status. I invite you to read those conditions and thing about how AC machine would fall under this theory. I think that a true AC would satisfy all the conditions.
• A theory based on moral agency: According to this theory, a being derives moral status from its capacity to act as a moral agent. A machine can be programmed to follow certain laws that are essential to being considered human. The machine can also consciously choose to follow this rules and tell if something is right from wrong.
• A theory based on sentience: Sentience is defined as a consciousness in the form of a feeling, this is the capacity to feel pain or pleasure. Admittedly, capacity to feel is limited to biological life and while an AC machine can emulate these feelings, it is impossible to know if it “feels” rather than it “thinks that it feels”.
• A theory based on relationships: This theory states that relationship between beings should be for moral status, rather than being directly. This would then follow that dynamic relationships between AC machines and people would be given a moral status.

Let me know what you guys think about this!

Buchanan’s attempt to justify the right to a minimum healthcare through libertarian approach is interesting in the sense that it goes the norm. While proponents for right to healthcare usually argue through the utilitarian grounds, libertarian approach is often employed by the opponents to argue against such right.

It is easy to see why Buchanan would attempt to do so as it provides a framework for libertarians who are opposed to it to look at it in an alternative way and potentially change their views. While his arguments make quite a convincing case, there are some issues with it that need to be addressed.

Buchanan takes a two-pronged approach to state his case. He uses arguments of special rights to healthcare, harm-prevention, and prudential arguments to justify a public health measure such as universal right to healthcare. He uses arguments to show how duty of beneficence would justify coercive policies that are needed to fund such a public health measure.

I will now try to critique his two-pronged approach and state my concerns for it.

• Arguments from Special Rights: The government owes certain groups of people special privileges for rectifying past or present institutional injustices, compensation to those who have suffered unjust harm by the act of private individuals or corporations, and for sacrificing their lives for the good of society. This argument on its own doesn’t help the case for universal right to healthcare as it pertains to special groups of people.

• Argument from the Prevention of Harm: The Harm Prevention Principle that is already used to justify traditional health services such as immunizations, sanitation, etc. can be elaborated to include the universal right to healthcare as it would also aim at improving the health of the population. Buchanan also brings in the equal protection clause from the constitution to further bolster his point. He argues that it would be unconstitutional to not have universal right to healthcare as it would mean that certain sections of the society would be unjustly put to harm.

This argument is probably his strongest argument as it makes a clear case and works in the contest. One issue with bringing in the equal protection clause is that it was originally aimed to prevent the government from unjustly infringing upon the right of selected individuals through making laws. It is analogous to the principle of non-maleficence in the sense that it prevents the government from doing something rather than telling it to do something. Using it to argue for universal right to healthcare therefore isn’t prudent use of the equal protection clause.

• Prudential Arguments: It emphasizes the benefits from an universal right to healthcare as it would improve the productivity of labor and fitness of the society. The argument is not enough to justify that individuals have moral right to healthcare.

Buchanan explains that the above-mentioned arguments taken together provide a convincing case for universal right to healthcare. I don’t necessarily see how it justifies universal right to healthcare because it fails to explain why individuals have the moral right to healthcare. It does however provide a very convincing case for why governments ought to provide universal healthcare to its citizens.

• Argument for Enforced Beneficence: Every person has a duty of beneficence to others. This duty expands to providing for others healthcare. But, if this duty is not enforced then it would be impossible for the whole system to work as people are short-sighted and often fail to see the long-term benefits. Enforcement would take place in the form of individual taxes and penalties.

This argument wouldn’t work through libertarian approach as it twists the duty of beneficence to some extent. Duty of beneficence is considered an imperfect duty as it is a matter of choice of the individuals to help others. It is also very important to note that it should be a choice of individuals who to help. This freedom of choice is very important in libertarianism. Any enforcement would be against the libertarian value of personal liberty. While you may argue that it the right thing to do, doing so through libertarian approach is troublesome. Let me know what you guys think.

In this case (Case 2.2) in “Well and Good” the issue concerning social determinants is reviewed. IT specifically looks at a woman named Martha, who has suspicion over a growth in her mouth she suspects is oral cancer. However, Martha and her partner are both unemployed and care for three children. So, when her doctors recommend a series of tests and regimens for her to follow she consciously declined treatment since she was not able to pay. This case brings about issues concerning public policy and healthcare.

One of the questions that arose for me: was the length at which universal healthcare should stretch to? In the case, it mentions how in Canada only 50% of low-income citizens. Many people believe that dental care is a luxury form of healthcare. Even in the US, many plans do not cover many dental procedures, as they are not deemed necessary. Under the Affordable Care Act, there is an extreme lack of dental coverage and to get any kind of dental one must get outside care/coverage. However, at what point to we deem medical care as necessary or superfluous. In the case of Martha, her symptoms were seen as a sign of a possible severe illness or it could have been simply a direct result of prior poor oral hygiene. But, with poor coverage for issues such as dental/oral concerns many people are subject to live in conditions that severely lower their quality of life. At what point do we quantify beneficence and try to establish a way to maximize profit from healthcare.  Although most people will agree that things like heart conditions and kidney failure are more important to treat for people, is it fair to subject people to live with tooth decay or serious oral issues.

The interesting thing, that ties into the idea of social determinants, is that poor people are the ones that fail to get coverage. It’s not like the coverage for these issues are not an option, they are just not a viable option. I know that universal healthcare programs cannot cover everything for everyone, but where do we draw the line for what is a ‘health privilege’ . How can we protect the underprivileged from being stripped from basic health needs? Since we are able to determine some health measure to be “extra,” what stops other basic needs to be put into that category. I feel that with determinants like this opens a slippery slope to removing more coverage from the poor while only supporting people that have the means to pay for the luxury of healthcare.

In Howard Brody and Eric Avery’s Medicine’s Duty to Treat Pandemic Illness: Solidarity and Vulnerability, they conclude physicians have a duty to treat pandemic illness because there is “no single ethical foundation for a duty to treat that would be commensurate with the needs posed by an emerging infectious disease pandemic” (Brody, 42). While I respect and understand the reasons behind their conclusion and appreciate their consideration to individual commitments and social values, I do think they fail to speak to some other ideas in question such as, what does it mean to be a physician?

The authors claim “by announcing to the community they are practitioners of medicine, physicians implicitly accept and undertake these duties,” (Brody, 40) but this raises the fundamental question of what it means to be a physician. As mentioned in the article, some physicians reacted to the assumption of their duty to treat with thoughts such as “Wait a minute—I never signed up for this” (Brody, 42). This got me wondering, why do people become physicians? Is it for the “awe of discovering the human body, the honor of being trusted to give advice, the gratitude for helping someone through a difficult illness”, for the prestige of the “Dr.” title, for the financial means it provides, or for another reason (Ofri)? Whatever the reason may be, these few listed options make me question whether all physicians go into medicine so that they may “help people” as many of my pre-med colleagues would say. There are many different professions and roles people can take on to help people, and perhaps, people take on the role of physician for the science rather than the people-aspect. If that is the case, we could argue that they indeed did not “sign up for this (referring to endangering oneself for the sake of the patient).” That being said, “the tradition of the American Medical Association, since its organization in 1847, is that: ‘what an epidemic prevails, a physician must continue his labors without regard to the risk to his own health” (Daniels, 37). So, in a way, physicians should know what is expected from them. However, I acknowledge reality is not so black and white. Some physician specialties to consider are: anesthesiologist, cardiologist, dermatologist, endocrinologist, family medicine, forensic pathologist, hematologist, infectious disease specialist, neurologist, oncologist, psychiatrist, radiologist, sleep disorder specialist, sports medicine specialist and more. There are so many different types of physicians and each specialty has different degrees of exposure to hazard. I wonder if the strict adherence to the duty to treat would deter people from entering certain specialties innately more prone to hazards involved with pandemics (ie. infectious diseases, etc). There are many frustrations that come with the role of a physician including the short amount of time allotted to visiting patients and the documentation and technical duties that come with patient visits.

To read more on the debate over duty to treat, I recommend the book, which comes to mind called Five Days at Memorial by Sheri Fink. It is a book about Hurricane Katrina wreaking havoc and sending hospitals such as Memorial into a state of crisis. While some healthcare professionals flee the storm and leave behind patients, others stay at the hospital and continue giving care, working till exhausting and continuing despite being understaffed and having limited resources. This parallels the treatment of pandemics in that health care professionals put themselves in harms way.

I also recommend checking out this article, “Duty to Treat and Right to Refuse”, by Normal Daniels: https://www.jstor.org/stable/3562338?seq=1#page_scan_tab_contents

While I hope physicians take on the duty to treat no matter what, I ultimately still see the role of treating during pandemic as supererogatory. I see these healthcare workers as humans first, then physicians. If they want to prioritize their own health, family, or something else, they should be able to do that.

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.

Brody, Howard, and Eric N. Avery. “Medicine’s Duty to Treat Pandemic Illness: Solidarity and Vulnerability.” Hastings Center Report. The Hastings Center, 15 Jan. 2009. Web. 16 Apr. 2017.

Fink, Sheri. Five Days at Memorial: Life and Death in a Storm-ravaged Hospital. New York: Broadway, 2016. Print.

“Medical Specialists – Types of Specialists.” WebMD. WebMD, n.d. Web.

Ofri, M.D. Danielle. “Why Would Anyone Choose to Become a Doctor?” The New York Times. The New York Times, 21 July 2011. Web. 17 Apr. 2017.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. Print.

Dr. Asadour is a physician in a vertical aid program to treat cholera in South Sudan where many refugees have come to escape war. A vertical aid program only targets one disease instead multiple and because of this, it is mandated to send away anyone who does not have that particular disease of interest. The refugees are poor, tired, and many are very sick with various diseases, not just cholera. Dr. Asadour is conflicted because the program only allows him to treat cholera patients but people with other diseases and illnesses come to his work station because the hospitals are beyond capacity or do not have enough or the right resources. He knows that most of the illnesses that the people have can be easily treated in his work station under the program, however he also realizes that this could cause further problems as cholera is communicable and could be passed to the people who do not have cholera in the first place or the people who do not have cholera but are treated at his workstation could tell other people in the community resulting in over capacity at the workstation. (Thomas, et. al., 267-268).

How Should Dr. Asadour Decide Which Patients to Treat?

On the same terms as his employer, I would say that Dr. Asadour should turn away the non-cholera patients as his only job for that program is to treat those with cholera. Furthermore, it would cause more problems than needed, especially if he mixes cholera patients with non-cholera patients or if his work station gets filled because then that would not be beneficial for anyone. On the other hand, in the ethical sense, Dr. Asadour should treat the patients that have easily treatable illnesses if he has the right resources to do so. As a physician his duty is to treat and turning away patients goes against this duty.

“Diagonal” Aid Program

Vertical aid programs are beneficial because they have the potential to eradicate a specific disease, they receive sufficient funding, and it is easy to measure the results (Thomas, et. al., 267). The case mentions that, “Dr, Asadour wonders whether vertical aid programs simply undermine efforts by local authorities to develop sustainable health responses for their own communities and for health broadly” (Thomas, et. al., 267). After some research I found an article that talks about the advantages and also the disadvantages of not only vertical aid programs but also horizontal aid programs. Horizontal aid programs have the goal of treating all of the “underlying issues of a population that cause various diseases and health problems” (Jimenez). Although this seems like the perfect fix to Dr. Asadour’s worries, there are still drawbacks to how cost-effective this type of program is and the long length of time it takes to see successful, measurable results (Jimenez). Because of these two independent programs that both have their ups and downs, the article proposes that they be combined to be “diagonal” where the new program “aims for disease-specific results but through improved health systems” (Jimenez). If this new type of program was implemented, Dr. Asadour would not have to be so conflicted about the right thing to do because he would be helping the community as whole instead of focusing on just one part of the community.

Works Cited:

Jimenez, Yilena B. “Vertical Vs. Horizontal Approach: The Drawbacks of Each and a Need For a Merging or “Diagonal” Approach.” ANTH 1310 S01 International Health Anthropological Perspectives. Brown University, 22 Oct. 2015. Web. Apr. 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.

The case in the W&G book on the Ethics and Humanitarian Aid draws on a lot of issues and nuances that are involved with providing, allocating, and rationing care to individuals in LDC’, such as the example in the book with South Sudan. There has been a lot of opposition and questioning surrounding the allocation of this care, and the criteria that one uses to make decisions on the care. The PBE mentions some categories, which include age, conditions, and money. One criteria, especially when one looks at Africa, which is where a lot of these vertical aid programs are located, should be history. The history of Africa should serve as a criteria as to the aid in which it receives, because the history of Africa has adversely affected the health and wealth of the populations that live there. Colonialism interrupted, pushed back, and severely reversed any form of progress, infrastructure, societal growth that was taking place and that could have been taking place in Africa. As a result, a lot of communities, even today, are still reaping the damages done by colonialism. In the Case discussion portion of the case study, the point of ‘geopolitical justice and injustice’ having a relevancy in the decision to allocate and ration out care is a valid point, because the history there has had a negative impact on the health.

Source:

PBE “Allocating, Setting Priorities, and Rationing” pp. 279-293

W&G Case 8.2 “Ethics and Humanitarian Aid: Vertical Aid
Programs.” pp. 267-268

Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs

Vertical aid programs are special programs that are created to “target a particular disease, sector or technical intervention” (PBE 267). These programs are implemented in times to sudden disaster, such as the Cholera outbreak in Dr. Armans Asadour’s case. Vertical aid programs are set out to eliminated or control the specific disease. Although this is the goal, the site in which the doctors work in often have medicine to treat illnesses. In case 8.2, “Ethics and Humanitarian Aid: Vertical Aid programs”, Dr. Asadour brings up the question of whether or not vertical aid programs should accept/help patients without Cholera, and whether or not vertical aid programs actually bring about beneficial change. I firmly believe that vertical aid programs are most beneficial if the program follows its goal. In the case of Dr. Asadour, I believe that the programs should not accept people that do not have Cholera or Cholera symptoms.

Looking from a policy standpoint, this is a tough decision both ethically as well as logistically. However, the pros out weigh the cons; the doctors should only help those that have Cholera. The doctors of the vertical aid program were sent out for a specific goal: stop the Cholera outbreak. Cholera is an infectious and often fatal bacterial disease, which is easily contracted from infected water supplies (CDC). Given the fact the outbreak occurred in a heavily dense population of refuges, the impact of such a deadly disease should be given precedent. By allowing others come for unrelated medical treatments will only waste resources when battling against time. It is more important to control the disease that can do the most harm to the most amounts of people than spreading the aid to others.

Looking from a doctor’s standpoint, I can see how this decision to turn away easily treatable injured people can be conflicting to their morals. These doctors however are not in control of the situation and must look at it from a utilitarian standpoint. The most lives can be saved by first preventing the outbreak of Cholera. That being said, the doctors working in the field are working for a NGO for a specific cause, and should respect the decision of the NGO when committing to the job.

This case specifically reminds me of the most recent Ebola outbreak. At the time a vertical aid program was establish, where people were sent into countries to contain the virus as well as money being spent to find a cure . Due to the rapid response and focused goal of preventing the spread of this disease, the transmission of Ebola in West Africa was controlled. The increase of funding to combat Ebola has given countries in the area the experience and tools to rapidly identify any additional cases and to limit transmission(CDC).

Over all, I believe that Dr. Asadour has good reasons to be wary of his and the other doctors actions; however, he is not looking at the impact of his actions in a larger picture. Before the outbreak, the population had the diseases that they are seeking help for. They were surviving and were not posing immediate harm onto others. At the time of the outbreak, people were being infected with Cholera, and the disease was spreading rapidly. It would be logically sound to control the damage of the Cholera before attempting to help everyone else. That being said, I believe only after the outbreak has been contained, should the doctors be able to help others  with non-Cholera related diseases.

Resources

Beauchamp, Tom L., and James F. Childress. Principals of Biomedical Ethics. New York: Oxford U.P., 1983. Print.

“Cholera – Vibrio cholerae infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 15 Apr. 2017.

“2014-2016 Ebola Outbreak in West Africa.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 22 June 2016. Web. 15 Apr. 2017.

Case 8.2 discusses the issue of vertical aid programs, programs that are intend to target a specific disease. Dr. Arman Asadour has been sent to a town in South Sudan to set up temporary work stations for the treatment of cholera. Dr. Asadour is under the strict jurisdiction of the non-governmental organization (NGO) to treat ONLY those patients who present symptoms of cholera and to direct all other cases to the local hospital. While the NGO possesses the medical supplies necessary to treat other cases, they fear that an integrated program will reduce the number of cholera patients who are able to benefit from the work station. How should Dr. Asadour decide which patients to treat (Thomas et al., 267-268)?

This case study reminded me of Friday’s class debate. In class, we were asked if individuals who have suffered from extreme alcohol abuse should have the same right to a liver transplant as non-alcoholics (note the phrasing is slightly different)? While I don’t think that a consensus was ever reached, I want to highlight several of the arguments made by each side. The pro side stated that liver transplants should be based on the potential success of the treatment and that alcoholics are likely to abuse the new liver as well. By contrast, the con side argued that alcoholism is highly affected by social and biological determinants such as genetics, location, peer pressure etc. with genetics accounting for 50% of the risk for alcohol use disorder (“Genetics of Alcohol Use Disorder”). Though the debate was not ultimately decided, Beachamp and Childress argue that although individuals with alcoholic use disorders who receive a liver transplant and continue to abstain from alcohol tend to do as well as other patients there is reason to exclude high risk patients altogether (Beauchamp et al.,275). For example, they argue that the alcoholic who fails to seek effective treatment for alcoholism prior to receiving a liver transplant should receive a lower priority for treatment (Beauchamp et al.,276).  Like the case debated in class, case 8.2 is also based on the allocation of limited resources.

Unlike the case presented above, case 8.2 discusses the decision to provide basic healthcare to patients unaffected by cholera. That being said, I believe that cases such as case 8.2 and the case debated in class should be decided on a case by case basis. While I understand that such a platform does not yield to both national and global health policy, I believe that all people have a right to a decent minimum of health care. According to one theory presented by Beauchamp and Childress, healthcare should be thought of as a two-tiered system with the first tier meeting needs by “providing universal access to basic services” while the secondary tier covers “better services” that can be acquired with voluntary private coverage (Beauchamp et al., 273). Under this mandate, patients seeking basic needs would be able to seek treatment at work stations.

Beauchamp, Tom L., and James F. Childress. Principals of Biomedical Ethics. New York: Oxford U.P., 1983. Print.

“Genetics of Alcohol Use Disorder.” National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 15 Apr. 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.

Summary:

Dr. Arman Asadour is a Canadian physician who got sent by the non-governmental organization to a town in South Sudan in order to participate in a global vertical aid anti-cholera program. The purpose of the program is designed to treat targeted cohort group with cholera disease. The dilemma raised because while the medical care staff from NGOs are only supposed to treat for one specific disease, refugees also demand other health care items from the stuff due to the scarcity of treatment locally. The physician would need to make a clear decision based on his legal and ethical obligation.

The legal obligation

To understand the issue concerning this topic, it is important to understand the definition of vertical programs. They are called so because they are “directed, supervised, and executed, either wholly or to a great extent, by a specialized service using dedicated health workers”. (Atun, Bennett, Duran) In this case, the physician is directed to work in South Sudan to reach the purpose of eradicating the cholera from the area. By the nature of the vertical aid program, its goal would be to achieve a concrete goal. It would be good for the funders to be aware that their funding would be bringing some changes to the problem. Also, because of the legal obligation bearing on the physician, the right thing to do would be to follow the project rules and obligation, making sure the resources are allocated to the targeted group.

Flaw of Vertical program

It could also argue that vertical program waste resource as it allows the inefficiency to happen within the system. Unable to utilizing the resource because of untargeted sickness is unfair and unjustifiable for the needed. Allocating health resource to one specific illness could reduce the health system effectiveness. Furthermore, the voices and priorities of the locals are also often overlooked rather than to achieve the main goal of the program.  (Thomas, Waluchow, and Gedge, 268) Although NGOs would have investigated the demand of people before entering for service, the need for health care could always change in time and vary in situation. While the health care service could be particularly rewarding to the certain targeted group, its policy would reject the treatment of people coming with various risks(such as HIV and cholera at the same time).

The ethical right thing

After all, the main purpose of the project is to aid the humanitarian purpose of the NGO. Leaving people in a worse-off condition without medical treatment would be against the mission. A physician’s duty would be to the patient he faces rather than the sponsor of the program even if the decisions are not legally correct. Balancing the legal obligation and the ethical right thing, Dr. Arman Asadour should follow his obligation first and then the obligation as the employee of the NGO.

Reference:

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

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

Atun, Rifat A., Sara Bennett, and Antonio Duran. When do vertical (stand-alone) programmes have a place in health systems? Geneva: World Health Organization, 2008.

Though vertical aids programs directly assist groups in dire need, such as individuals with Cholera as discussed in the case study, these programs don’t aid in global health as effectively as alternative programs. Instead of providing funding to provide better hospitals and better training of health care professionals in order to develop an overall more supportive health care system in these impoverished areas, organizations create programs to only address one issue or ailment. Vertical aid programs essentially make these needy areas continuously dependent on outside help, rather than establishing better systems to address as many needs of the community as possible.

The issue lies in supporters of vertical aid programs. Rather than sacrificing some of the praise they will receive for providing financial aid that directly aids in a global health issue, supporters would rather maintain their image and support vertical aid programs despite a great amount of evidence indicating that these programs are not as effective as other options. I would compare vertical aid programs to putting a Band-Aid on a deep wound, without properly stitching the injury. Instead of exploring the root problem of the situation, which often implies a vast socio-economic inequality, proponents of vertical aid programs would rather throw money and resources at an issue with a clear ‘solution’ so they can claim to eradicate some issue. In order for there to be real change in the world, financial supporters will need to swallow their pride and contribute aid in order to help improve global health, instead of contributing aid in order to make a name for oneself or claim to be an advocate for a disease.

Despite the fact that I think resources can be better allocated than in the use of vertical aid programs, vertical aid programs are a necessity of our world. Even though, ideally, people should contribute aid for the benefit of society, I fear this is not human nature and not the reality we live. The human race is a selfish one and because of this we strive to benefit ourselves before others, especially when the benefit is for a group that is vague and distant from our lives. If contributing financial aid doesn’t directly have a benefit that one can visualize, “the money might well dry up” (Levine). Like the infamous Nigerian prince email, I think the reasoning behind this is that people want to see their money put to use so they know its not being abused and wasted. Additionally, living in a first world country, its difficult to imagine living somewhere where basic health care isn’t accessible, and death is around the corner for most. As we live in our little bubble of a world, we need “advocates” to raise awareness of global health issues so that we can help—global health advocacy is “active[ly] support[ed by] organizations and individuals who are associated with particular health causes” (Levine). Without these vertical aid programs, our global health initiatives would not have nearly as much support, and might not even be in existence.

Works Cited

Elzinga, Gijs. “Vertical–Horizontal Synergy of the Health Workforce.” World Health Organization, Apr. 2005, www.who.int/bulletin/volumes/83/4/editorial10405/en/. Accessed 14 Apr. 2017.

Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center for Global Development, 5 Oct. 2007, www.cgdev.org/blog/should-all-vertical-programs-just-lie-down. Accessed 14 Apr. 2017.

Thomas, John, et al. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed., Broadview Press, 2014. “Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs.” 267-268