Image source: http://www.savethechildren.org/site/apps/nlnet/content2.aspx?c=8rKLIXMGIpI4E&b=8943305&ct=14066953&notoc=1

Humanitarian aid programs exist in two different structures: horizontal programs and vertical programs. Horizontal aid programs aim to strengthen health systems to treat multiple diseases, while vertical aid programs utilize outside agencies to target a specific disease. Much debate surrounds the two different approaches to humanitarian aid.

“Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs”  discusses a vertical approach to treating cholera in a refugee camp in South Sudan. However, due to the limited resources in the nearby hospital, individuals visit Dr. Asadour’s, physician with a Canadian NGO, temporary work station seeking out care for other illnesses and diseases. Thus, the case poses the following ethical dilemma: Should Dr. Asadour use his resources to treat all individuals despite their disease, or should Dr. Asadour follow the mandate and only treat individuals suffering from cholera?

Due to the nature of the situation, Dr. Asadour ought to continue the vertical approach to aid. Of all disease outbreaks in refugee camps, diarrheal diseases, such as cholera, generate the highest mortality rate (Connolly et al., 2004). In addition, the World Health Organization states, “Cholera is an acute diarrheal disease that can kill within hours if left untreated,” (World Health Organization, 2014). Furthermore, when not treated quickly, a cholera infection can lead to kidney failure, coma, shock from dehydration, and of course death (Mayo Clinic, 2014). Thus, cholera causes a great deal of suffering in a population, especially in refugee camps. Fortunately, however, simple treatment for symptoms of cholera exist. For example, oral rehydration salts successfully treat up to eighty percent of cases of cholera (World Health Organization, 2014). Therefore, Dr. Asadour possess the ability to reduce the suffering of eighty percent of the population who may end up dead from untreated cholera. Thus, on the basis of the principles of nonmaleficence and beneficence, Dr. Asadour ought to admit only patients infected with cholera.

Furthermore, the case explains that Dr. Asadour cannot always determine the cause of an individual’s suffering upon entrance into the medical tent. As a result, he may admit patients who have a different disease. At this point, an additional ethical dilemma arises. Dr. Asadour can either treat the individual or send him or her to the local hospital. Based on emotional state of the refugees, as articulated as frightened, Dr. Asadour ought to treat the patients whom he misdiagnoses during “intake” to minimize harm. For instance, since the refugees traveled unknown distances, admittance into a medical facility would provide the refugees with  hope. Therefore, by discharging patients without cholera, Dr. Asadour would be negatively impacting both their physical well-being and mental well-being. Thus, treating all admitted patients, with the initial screening process of cholera patients only, serves as the most ethical course of action.

Moreover, implementing a horizontal approach to aid could have potentially prevented the aforementioned ethical dilemmas. The sustainability of horizontal aid programs sets up the area for greater success and less suffering in the future instead of dependence from vertical aid. Nonetheless, since Dr. Asadour already traveled to South Sudan and set up his clinic, he ought to continue treating patients as previously outlined.

Connolly, M. A., Gayer, M., Ryan, M. J., Salama, P., Spiegel, P., & Heymann, D. L. (2004). Communicable diseases in complex emergencies: Impact and challenges. The Lancet, 364(9449), 1974-1983. doi: 10.1016/S0140-6736(04)17481-3

Mayo Clinic. (2014, April 5). Cholera. Retrieved from http://www.mayoclinic.org/diseases-conditions/cholera/basics/complications/con-20031469

World Health Organization. (2014, February). Cholera. Retrieved October, 2014, from http://www.who.int/mediacentre/factsheets/fs107/en/

Case

Lucy Mait, a 45-year-old woman, found out she has the BRCA1 gene mutation, which meant she has a high risk of developing breast cancer. Lucy was having a very hard time processing this information and was referred to post-test genetic counseling to make sure she was fully informed of the implications of these results. Lucy has a 29 year old daughter, who is planning a wedding, and an 18 year old nice. Her doctor, Dr. Braesecke, has encouraged her to share the information with her daughter and nice so they can be tested as well but she is very reluctant to tell them. She claims that she needs more time to process the situation herself and that she does not want to ruin the mood of the upcoming positive events. All three of these women have been lifetime patients of Dr. Braesecke and he is put in a very tough position because he knows that early diagnosis and preventative measures can save lives.

Dilemma

Dr. Braesecke is faced with the dilemma between sharing the information with Lucy’s family, which breaks confidentiality, and respecting Lucy’s wishes by not saying anything.

Analysis

Dr. Braesecke is aware that “confidentiality can sometimes be ethically broke if there is a direct, imminent, and avoidable threat to the life of a third party” (CITE 259), but he is not sure whether this case fits this description. I argue that Dr. Braesecke ought to act under the principal of beneficence and inform the daughter and nice of this information. One can argue that this decision will violate the trust that is in the physician-patient relationship, which is important for future ongoing care. Dr. Braesecke can act under the utilitarian principle of justice, which states we ought to “seek to produce the maximal balance of positive value over disvalue – or the least possible disvalue, if only undesirable results can be achieved” (Beauchamp and Childress 254). In this case the benefit of telling two patients they are at high risk of having this mutation can possibly lead to preventative actions being taken that can save their lives. The disvalue in this case is violating the wishes of Lucy, who is just one patient. In this simple reasoning, two patients will be benefitted and only one would be offended. One can also look at the risks of keeping this information confidential compared to the risks of telling. The benefit of saving lives outweighs the harm of violating one’s autonomous decision. It can also be argued that Lucy will tell her family in the future, it is only a matter of timing. In response to that, it is impossible for Dr. Braesecke to be certain that Lucy will tell her family. The fact that Lucy may want to tell her family in the future but is not entirely sure speaks to the validity of the autonomy in her choice. Lucy has just been told she is at risk high risk for cancer, which other women in her family have had. According to Beauchamp and Childress, illness can limit one’s understanding of the situation and therefore limit one’s autonomy. Lucy’s judgment may be clouded and she may not fully understand the consequences of not telling her family, which can be seen in how she states she needs more time to process the situation. As their doctor, Dr. Braesecke is obligated by the principle of beneficence to prevent evil or harm (Beauchamp and Childress 152). He is in a situation where he has the ability to prevent serious harm by catching breast cancer in its early stages. One can argue that if Dr. Braesecke told Lucy’s family this act would be an act of hard paternalism. This hard paternalism is justified because, as stated above, the prevention of harm outweighs the risks of the action taken (Beauchamp and Childress 222). In this case Lucy’s genetic information ought not to be seen as entirely confidential because it may have direct implications on the well-being of others.

Sources

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

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 9.3: Genetic Testing and Disclosure.” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. N.p.: n.p., n.d. 294-296. Print.

http://www.myriadtests.com/app/brac.htm

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

Case 8.1 introduces the case of Janet. Janet is a 44-year old woman on welfare who was separated from her husband and is the mother of two children. Janet Greene, was admitted into the intensive care unit being severely injured in car accident. She was treated for her fractures and abdominal injuries. She developed acute renal failure, but was treated with peritoneal dialysis.  After recovering, Janet was discharged only to suffer from a second bout of acute kidney failure after being home for 3 months. Her physician expressed that Janet was in urgent need of dialysis because tests revealed high levels of potassium.  However, when Janet’s physician tried to get Janet’s admitted to two, different tertiary hospitals in the area, the hospitals reported back that they did not have any space for Janet to be treated.  After asking if Janet could take the place of another patient with a poorer prognosis, the hospital expressed that they had “first come, first serve” policy

Reflection

Janet’s case is one that is morally difficult because it raises challenging questions about micro-allocation and quality-of-life decision-making.  For many people including the hospital policy-makers in this particular case, a “first-come, first-serve” or lottery type of system is the most equitable way of deciding who gets to use the resources.  While I can understand having this type of system does not have to involve having to make quality of life decisions, I do not agree with the hospital’s decision to completely decline exploring the physician’s request as a possible option. Unfortunately, in a world with few resources, but many needed services, a “first-come, first serve” is not necessarily always morally justifiable.  A “first-come, first serve” policy in this case seems to be a “short-cut” or easy route in order to avoid making difficult decisions.  In Beauchamp and Childress, they write that the “first-come, first-serve rule” can have the potential to lead to injustice (Beauchamp & Childress 290). How can a first-come, first policy justify refusing treatment to a patient who has a moderate to high chance of survival in order to continue treating another patient who only has very small to no chance of survival?  In this particular case, Janet is being denied treatment even though there is a chance that she may have a higher chance of survival than another patient.  The hospital argues that this approach is “fair”. Although an egalitarian may agree that their approach is fair, a utilitarian would most likely argue that it is not fair. I am arguing that for utilitarian approach in this case. The ethical course of action would have been for the hospital to assess who would have the highest chance of benefiting from treatment.  The hospital should have made a decision based on medical/scientific evidence. The utilitarian approach is the most ethical because it minimizes the most harm for the most people.

I do understand, however, that making quality of life decisions is difficult. For the utilitarian approach to be morally just in this case, it is important that the quality of life decisions that are being made by the physicians are not based on age, ethnicity, socioeconomic status, etc.  In this particular case, the physician expresses that the fact that Janet is a mother should also be taken into consideration which raises additional ethical questions. Should a mother’s life be considered more important or have a higher priority when allocating scarce resources? I would argue that it should be taken into consideration.  Janet is responsible for the well-being for two children. Thus, not giving Janet adequate treatment is not only causing her harm to her, but also the children that depend on her. Of course, this does present challenges when deciding to allocate between mothers or people who have numerous persons depending on them. However, in this case, the hospital simply refused to even consider “bumping” another patient, so it is not possible to know whether the other patients were in a similar position to Janet.   In order for there to be justice in this case, quality of life and the patient’s role as a mother must be taken into account.  Ultimately, the way one views this case and their approach is largely going to be reflective of their definition of justice.  While the hospital has a more egalitarian approach, I do not find that approach to be appropriate nor “just” in this case.

 Work Cited

Beauchamp, Tom L., and James F. Childress. “Beneficence” Principles of Biomedical Ethics. Seventh ed. New York: Oxford UP, 2013. 249-296. Print.

Thomas, John E.,and Wilfrid J. Waluchow. “Dialysis Machine Shortages: Who Shall Live? “Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Peterborough, Ont.: Broadview, 1998. 215-221. Print.

Background:

Janet is a middle-aged single mother of two children with a serious drinking problem. After being discharged from the hospital where she was treated for injuries incurred in a traffic accident just three months prior, Janet has been readmitted for high blood potassium levels indicative of impending renal failure. In order to live, Janet requires long term dialysis. However, both of the tertiary care hospitals offering long term dialysis do not have any open dialysis machines. Her physician argues Janet’s case, but is met by heavy opposition. Both hospitals refuse to consider Janet’s case because of their “first come, first served” policy.

Discussion:
The moral principles at play in this distributive justice case are non-maleficence and justice. If we fail to treat Janet’s high potassium levels, we greatly increase the risk that her heartbeat will stop. Since we are not informed of alternative options for lowering her potassium levels, refusing Janet dialysis is effectively sentencing her to death. Therefore, if the tertiary care hospital does deny her access to the dialysis machine, the principle of principle of non-maleficence is being violated. If we treat Janet at the expense of other patients already on dialysis, we are also violating the principle of non-maleficence. Since doing harm is unavoidable in this case, we must turn to the principle of justice to make the most moral decision. In order to reach the most fair decision in this situation I will first determine Janet’s eligibility and then her perceived societal worth. If these exceed other patients’ eligibility and worth I would argue that the most just thing to do would be to allow Janet to take one of those patient’s places at the tertiary care hospital.

In the third edition of Well and Good, it is suggested that eligibility for having access to a scarce medical resource should first be established according to the following factors: constituency (proximity to the resource), the progress of science (research interests of the hospital), and the prospect of success (amount of benefit) (Thomas and Waluchow). As stated in the dialysis machine shortages case, the two tertiary care hospitals that Janet’s physician was attempting to negotiate with were both “geographically accessible.” Since no research on dialysis patients was mentioned, we can assume that the progress of science was a negligible factor. Janet’s physician also seems pretty confident that his patient has great promise of long-term benefits. Therefore, we might also assume that her prospect of success was pretty high, perhaps even higher than some of the current patients in the two tertiary care hospitals.
Since there is not enough of the medical resource after applying the eligibility criterion listed above, Thomas and Waluchow advise that one must then select individuals based on their “worth.” In Well and Good, the authors suggest that this “worth” is determined by the individual’s family role and contributions to society (Thomas and Waluchow). Although I would argue that Janet’s role as a single mother of two should factor into the assessment of her worth, in order to protect members of society that are mentally or physically handicapped or socioeconomically disadvantaged (like Janet, who is on welfare), I believe that it is important to also consider an individual’s vulnerability when establishing worth. Basing worth solely off family role and contributions to society effectively excludes the aforementioned populations who may not have access to the same resources that able-bodied, able-minded, financially stable individuals do. Without these resources, individuals in these groups in many cases do not have as many or as great of opportunities to contribute to their communities.  Yet another factor that must be taken into consideration is whether or not a patient’s behavior may be exacerbating the illness. As was mentioned previously, Janet is a heavy drinker. According to the National Kidney Foundation, chronic drinking can decrease the kidney’s ability to filter blood, and can cause liver disease and high blood pressure which, both of which can lead to kidney disease (National Kidney Foundation). Although it is difficult to discern just how much of Janet’s kidney damage can be attributed to her drinking, considering she had previously experienced kidney failure after sustaining injuries from an automobile accident and had never quite fully recovered, if Janet continued to drink heavily after returning from her first hospital visit, she at the very least increased her risk.

In any case, I believe that the tertiary care centers’ decisions to provide patients with dialysis on a first-come, first-served basis is morally wrong when applying the moral principle of justice. Although it would be arguably more difficult to take away care from someone with a poorer diagnosis than to deny it from them in the first place, when medical resources are limited, I believe that those resources should be allocated to individuals who have the greatest prospects of success. If we assume that all individuals all have the same prospect of success however, I would argue that the tertiary care centers should grant access based first on the individual’s family role and then, if there are still not enough resources available, degree of responsibility for ailment. Applying this to Janet’s case, I would argue that the tertiary care center should bump an individual with a poorer prognosis than Janet and, if there are none, bump an individual who is not providing for a family. If, by some chance, there are no individuals who have poorer prognoses or who do not have children or other individuals that are dependent upon them, I would make Janet wait on the tertiary care dialysis list.

Sources:

“Alcohol and Your Kidneys.” – The National Kidney Foundation. N.p., n.d. Web. 16 Apr. 2015.

Beauchamp and Childress propose a two-tiered system of health care. The first tier covers basic and catastrophic health needs. The second tier, includes better services such as luxury hospital rooms and cosmetic surgeries at your own personal expense. They claim that this system “guarantees basic health care for all on a premise of equal access while allowing unequal additional purchases by individual initiative, thereby mixing private and public forms of distribution” (273). This system is too general. There are several ways to treat a medical issue and at times many diagnostic tests are needed to find out what the exact medical issue is and how to treat it. So what would be included under basic services? Also does not address the historical injustices and prejudices of the medical system. Minority populations have been targeted for unethical medical research and blocked from necessary medical care. A just health care system has to take into account these injustices and prevent them from happening again. The system must also attempt to right the wrong that occurred and repair the damages that were done. For example, the blood of Henrietta Lacks was studied in the lab. Her cancerous cells helped create lifesaving vaccines, but she was never given proper treatment for her illness. Some of her cells are still used today in research. Until recently, there was no compensation for the use of her cells. Immediate members of her family did not even have access to health care due to a lack of insurance, yet Lacks cells brought millions of dollars into the health care industry. Recently, the government gave her family full free health coverage to attempt to right the wrong that was committed. Using Lack’s cells without her permission violated her privacy and autonomy. The health care system has to account for the historical medical injustices that occurred. There are systems and ideologies that reinforce institutional racism, especially in the health care system. A fair system has to actively attempt to deconstruct these systems and ideologies. Therefore, the health care system cannot be general. We have to address very specific aspects of what is right and wrong. We also have to stop acting like we live in a perfect world and recognize the wrongs that have been done in our society and address them. A decent minimum must account for the barriers that people have to overcome in order to have health care. We also have to recognize that access to health care does not automatically translate to the use of the health care system. People, especially vulnerable and minority populations, are very skeptical of the medical system because of the historical injustices. Therefore, I believe that the health care system should give more benefits and help to vulnerable and minority populations because they are extremely disadvantaged. The only way to close the disparity gap and begin to build fairness is to disproportionately target vulnerable and minority populations for social and health benefits. This is very similar to the egalitarian view of justice.

References:

Principles of Biomedical Ethics: “The right to a Decent Minimum of Health Care”272-279.

Contrary to popular belief, the United States has had universal healthcare with automatic enrollment and a penalty for opting out for decades: Medicare. Upon the 65th birthday of any United States citizen or legal resident, the person in question is pulled into the Medicare system of health benefits, open enrollment plans, and medication payment initiatives. With this history of implementing broad, social standards for the betterment of society as a whole, it makes sense to try to extend this same system to the greater masses.

With respect to the justice of doing so, one must approach this from a public health standpoint. If the majority of people are gaining good quality, inexpensive, and accessible treatment for their general health concerns, the majority of people will then use this benefit and better the overall health of the country. This will consequently add to the work capacity of the nation, overall happiness, and quality of life of the general population.

The issue, however, arises in the United States in particular, when any policy seems to impede on social liberties normally tied to autonomy. With the implementation of a marketplace healthcare “shopping” system,  the choices available for coverage seem to be limited. However, I believe that it is a positive trade-off given that the quality and cost are being adjusted to better suit the consumer. There is still an aspect of choice involved with partaking in the marketplace system and the general population maintains or gains more benefits. If that is the main issue with the use of such a system, especially one that is already accepted as a social good for the elderly, I believe it is negligible and can be set aside to better public health policy.

Beauchamp and Childress summarize moral arguments for the need for the United States to adopt a national health care policy and recognize health care as a right. Proponents of national health care argue that a “decent minimum” should be provided to give individuals basic medical care they need to prevent and treat illnesses. The benefits of this would provide collective social protection for the country and give individuals a fair opportunity for health outcomes. A national health policy has yet to be adopted in the US, though, with opponents arguing that healthcare should be something people need to work for and purchase themselves instead of relying on the government to provide it for them. This is an example of a libertarian argument that emphasizes the need for individual choice and autonomy. In the case of developing a national health policy, it contrasts with the utilitarian approach that strives to offer the most benefit to the most people with the cost-sharing approach of a single-payer socialized medicine system. With such a system, people are not left out from receiving care because they cannot individually pay. These contrasting views make it very difficult for health policy in the US to change.

Possible middle ground to contrasting viewpoints could be to offer free medical care to children. It provides the two benefits of national health care that Beauchamp and Childress give: collective social protection and fair opportunity. Children’s health care majorly involves vaccination protection and treatment from illness. This provides collective social protection because it helps to eliminate communicable diseases from the population, a serious public health concern. It also benefits others by preventing them from catching children’s viral illnesses that may otherwise go untreated. Children are a vulnerable population that easily spread illnesses through their close contact with other children and staff members in schools. Investing in children’s health not only protects individual children, but also the rest of the population.

Free health care for children provides them with a fair opportunity in life. Unlike adults, children have no control of their life circumstances. Providing them with life-saving vaccines and minimum care as children allows them to face less disadvantages as an adult. Both of the benefits of free health care for children follow the moral principle of beneficence and nonmaleficence because it aims to help those in need and prevent harm from occurring. The same moral principles could be applied to free health care for all people, though, so this is not where the distinction of free care for children comes through.

Free health care for children is uniquely interesting because it has less of a violation of autonomy. Libertarians argue for the need for people to be responsible for themselves and make their own choices, but few would extend this argument to children. Children are unique in that they often have no choices and if they do they are under the constraint of their parents. They also have not made poor choices affecting their health outcomes such as smoking and excessive drinking. Some would argue that being unable to afford healthcare is a result of individuals’ poor decisions and that it is their individual responsibility to provide themselves with adequate care, not the government’s. No logical person would argue, however, that it is a child’s responsibility to provide his own medical care. Providing free medical care to children provides them with a fair opportunity at medical outcomes, irrespective of their parents’ decisions. An extreme libertarian approach could argue further that children should not be entitled to free care because they are individual parents’ responsibility, not the responsibility of the government. However, not providing children with free care has serious consequences to disease prevention and opportunity fairness. Government provided care for children fulfills moral obligations of beneficence and nonmaleficence with limited threat to individual autonomy.

I agree with the authors of this paper (Buchanan) that health care is a universal right that we have as humans. It’s more than just an act of beneficence to provide health care to those who need it but an issue of justice. It is hard to enforce an act of beneficence. I don’t believe you can force anybody to perform or provide financially an act of beneficence if they don’t want to, so it’s important to understand that life-sustaining health care is not simply an act of beneficence, but an issue of justice. As humans, there’s no question that we hold a certain moral status that should be respected by fellow humans. Therefore, I believe that we are morally obligated to take care of those in need by providing necessary, life-sustaining or life-saving health care. Besides it being the fair and morally correct thing to do in regards to justice, it is also what is best for not only the individual receiving the health care, but also society as a whole. By providing preventative health care such as immunizations, we are protecting whole communities from the spread of disease. Also, by keeping individuals healthy, we are keeping our communities healthy, which means its people will better be able to provide for the society’s needs.

The only issue I run across with saying that health care is a universal right is when people abuse this right. Whether we want to acknowledge it or not, there will be people who will take their right to health care for granted and not take care of their bodies like they should. There is definitely a limit to the health care resources we have, and if we are constantly providing health care to people who do the harm to their own bodies, then we are wasting it. There are other people who need support in obtaining health care who will never get it if we waste all of our resources on those who exploit the right. Therefore, I believe that even though health care is a universal right, there needs to be a system set up to ensure that the right isn’t being abused. However, I am a little stuck on what this should look like practically. It seems easy when you’re talking about people who smoke or abuse drugs or alcohol, but what about those people who put their health in jeopardy for their livelihood or to perform another beneficent service to humankind such as military or servicemen and women? Should their health care be restricted in the same fashion as drug addicts’ health care because they both knowingly put their health at risk? It hardly seems fair to put the two in the same boat, so this is when I struggle with saying that everyone has the same right to health care. However, you also don’t want to give special health care rights to certain individuals because then I don’t think it can really be considered a universal right if others receive more of the right or better quality of treatment. Therefore, I think we need to be careful making qualifications that certain people have more of a right to health care than others, but we also need to make sure the right to health care is not being abused, if we want to have enough resources to be able to provide to everyone.

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

Buchanan, Allen, “The Right to a Decent Minimum of Health Care” Philosophy and Public Affairs 13 (1): 68-78 (1984).

Martha is a mother, who was recently diagnosed with gum disease and was instructed to take certain medications and visit her dentist. Unfortunately, Martha is unemployed and cannot afford to see a dentist. This case is set in Canada, a country in which universal healthcare is provided to all their citizens. It seems, however, that dental care is not included and pharmaceuticals are difficult to acquire by the poor. Although this case is based off of the Canadian healthcare system, social determinants of health are virtually the same across the globe and access to health care should be a right no matter what country a person is living in. Because Martha is unemployed, this case raises the dilemma of whether health care should be available as a public good or whether Martha’s situation is a product of her own poor decision-making.

The case gives no reason to believe that Martha chose to be unemployed or was in some way making irresponsible choices. I think this case is representative of a number of other cases, specifically in the United States, when a person if faced with a drastic medical change or emergency and simply cannot afford care. These medical emergencies are never chosen and nor is their inability to pay for medical insurance. As Beauchamp and Childress argue, there are a number of other uncontrollable factors such as race, gender, and ethnicity that play into a personals health status (Beauchamp and Childress 264). Disparities such as these not only directly affect a person’s health, but they also influence whether or not they will have medical insurance if it is not universal.

In a number of other countries that are comparable to the United States in terms of economy and development, Great Britain, France, Germany, Taiwan, and Japan all provide healthcare for their citizens. While these countries may not face as vast of disparities in terms of race as the United States, they still have large inequalities based on socio-economic status. Depending on the country, they usually have higher taxes, but they are more efficient with the money in terms of health care spending. It is almost unheard of to go bankrupt over a medical bill, except for the United States where medical bills are one of the leading causes of bankruptcy. Although, longer life expectancy and overall better health cannot be pinpointed to better healthcare systems, it is definitely a large contributing factor.

Many other countries in the world are able to provide healthcare to every citizen without questioning whether or not health care service companies should be making a profit or whether providing coverage for everyone is infringing one’s rights to make decisions for themselves (Thomas, Waluchow, and Gedge 101). We would never say that someone could not have clean water because we want them to make a decision about whether they want to purchase Aquafina or Dasani and we would never say that their utility is maximized by making the decision about what type of water they want to purchase. Clean water is simply something that is expected to be provided because it is necessary for life. Likewise, a comprehensive health care package should be provided to Martha because it is necessary for her life.

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

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Social Determinants of Health”.” Well and Good. Toronto: Broadview, 2014. Print.