Background on Case

Henrietta Lacks’ case is one of the most famous cases involving non-consent and the argument over whose rights prevail. Henrietta died from cervical cancer at age 31, and a biopsy of her tumor was taken for the sake of research. Henrietta had not given permission for her cells (now known as HeLa cells) to be used for research, however this was standard in the 1950s. When researchers grew Henrietta’s cells in the lab, they divided every 24 hours and became the “most proliferated cells in history” (Skloot, p. 4). On account of this, HeLa cells were quickly passed along to other researchers and were soon being mass produced to test vaccines, such as for polio. However, the Lacks family was never compensated for Henrietta’s cells, and to this day they remain in poverty, and ironically enough, unable to afford to even see a doctor.

Argument Surrounding Protecting Patients’ Identities

While what happened in Henrietta’s case is unlikely to happen again due to the standards for providing consent, it is important to discuss the issues surrounding protecting patients’ identities. If we ignore the fact for now that Henrietta did not agree to her cells being used for research, did the researchers at least owe it to Henrietta’s family to keep her identity anonymous? While the researchers in this case nicknamed the cells HeLa and attempted to use fake names such as Helen Lane (Thomas et al., p. 255), it was not long before most of the world knew whom the HeLa cells had belonged to. Prior to the Lacks family even becoming informed that Henrietta’s cells were being widely used, they were being bombarded with publicity. If we are to respect anonymity and the right that a patient has to their own body, then the family should have been informed first of the use of HeLa cells prior to the public.

With the idea of justice, one of the primary components is respecting people’s choices. If we want to adhere to autonomy, and Henrietta was not able to give informed consent, then the most logical thing to do in the eye of justice would have been to ask the family. In order to respect autonomy, we now require informed consent. However, if Henrietta was not able to consent to her cells being used, it would have been most beneficent to inform her family and ask for their permission, and to keep Henrietta’s identity concealed. This practice has significantly improved with the mandate of HIPAA today.

Debate About Receiving Compensation for Research

Another line of argument comes from the idea of whether the Lacks family should have received compensation for Henrietta’s cells. It does seem unjust that the Lacks family neither a) gave consent for Henrietta’s cells to be used for research; b) were informed of their decision to use her cells for research and vaccination; c) not keep Henrietta’s identity anonymous; d) not provide any sort of compensation. If we look at this all together, the Lacks family was not treated through principles of nonmaleficience, as they were neglected in the decision making process and not treated fairly. Nowadays, individuals typically are compensated for participating in research. Money is often given to subjects as an incentive to get people to be in studies. Thus, it would seem logical that an individual who agrees for her cells to be used in research should receive compensation, and if she dies her family would receive the compensation on her behalf. It is difficult to set a price on the immense positive contribution HeLa cells gave to society, however the fact that the Lacks family is still so poor and received no compensation is completely unjust. So, there should have been some form of compensation or privilege given to this family that helped make science so much better.

One of the most important parts of justice to look into in this situation is the idea of decreasing vulnerability, exploitation and discrimination. The economically disadvantaged are often taken advantage of, and this is exactly what happened in Henrietta’s case (Beauchamp & Childress, p. 267). In order to be just and to eradicate any sort of exploitation of the vulnerable populations, a better method needs to be determined for there to be nonexploitative, fair payment for services.

Resources

Rebeca Skloot, The Immortal Life of Henrietta Lacks (New York: Corwn Publishing, 2010), 4.

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

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

There is no denying that we live in an unbalanced society, where the allocation of wealth and resources greatly varies across populations. And unfortunately, this comes into play in regards to healthcare as well. In “Access to Health Care,” Brody and Engelhard raise important points on how health care ought to be distributed versus how it is distributed. It is first and foremost important to note that a perfectly distributed society is not possible—at least in today’s society and government—and that different levels of wealth and resources will always exist. However, the debate of how those resources should translate to everyone’s necessary need of healthcare is a different story. Thus, as Brody states, “To what extent and at what cost ought a society attempt to provide equal health care for all?”

Brody presents us with three case studies. In Case A, the main issue is financial access to resources. Should Mr. A be denied surgery because he can’t pay for it, or should the physicians be upheld strictly to their duty to provide help and service to all who need it? For Case B, the main issue is physical access to resources. Mrs. B needs transportation to effectively make use of her right to healthcare, and so her access is very limited. Here, we have to evaluate if it is fair for Mrs B—and consequently her son—to be stripped of healthcare due to location and inaccessibility. Case C, in my opinion, tugs at the heart strings the most, as it entails making personal sacrifices to ensure the access to health of a loved one. Here, we must evaluate the justice in asking someone to divorce a spouse or lose access to Medicaid.

For Case A, financial resources have and always will be an inequality in healthcare. It is fair to require payment for healthcare when healthcare requires cost to perform, such as a surgery. However, Mr. A should not be denied all-together because of his current financial status. Should his condition worsen quickly and dramatically, the physicians could face a situation where they forewent treatment before and are now faced with a more severe situation, which I believe is not ethical. There should be alternative options here, such as a payment plan, contracts, and policies to help people in Mr. A’s situation receive healthcare. I do not think it is just and right for society to deny someone right to healthcare fully, as it is a necessity to life.

For Case B, the issue is physical access to healthcare. The question posed here is: Should one allow such inequalities in access to health care resources? In the case of Mrs. B, she could take action to relocate closer to health facilities if needed, should the son require persistent healthcare. Here, the ball is more in her court than society’s. If the demand is not there for a healthcare facility where she lives, then she must make the play. The cost/benefit for the community to place a healthcare facility in her home location is not feasible.

For Case C, different governments and policy makers might approach this situation with varying perspectives. However, based on the readings and class discussions on utilitarianism and libertarianism, it breaches all ethics to require one to let go of their right to marriage for their right to healthcare. Those two rights should be independent on one another. Society is not justified to interfere in that manner. Their job is to provide healthcare, which should be done independently of personal matters, particularly marriage.

In each case, different issues of justice and resource allocations arise. However, each case describes situations that occur all the time today. Our healthcare system is flawed and our justice system is varied, which provides loopholes for each scenario. However, society ought to make valid attempts to find ways to provide healthcare for all, in manners that don’t require one to compromise their other obligations and morals to do so.

Works Cited

Beauchamp, Tom L., and James F. Childress. “Justice.” Principles of Biomedical Ethics. 2001. 249-67. Print

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

In the article “Health Care and Equality of Opportunity”, author Gopel Sreenivasan posits that the argument that ones’ right to health suggests that they should have access to healthcare, is flawed; equal opportunity does not require universal access to healthcare. In one supporting argument he uses to defend his thesis, Sreenivasan argues that even if access to health care is held constant, socioeconomic status seems to strongly contribute to the distribution of health (Sreenivasan, 24). This suggests that universal healthcare may not be the solution to the problem of health, but rather, other social determinants may greatly influence health and we need to look deeper into these other issues and try to come up with other solutions to the problem of health. In the Whitehall study, mortality rates and cardiovascular prevalence were investigated in British men ranging from ages 20 to 64. All of the subjects were stably employed, lived in the same region of greater London, and had free access to health care provided by the NHS. The subjects were divided into 4 cohorts as defined by the British Civil Service: administrative, professional/executive, clerical, and “other” (Sreenivasan, 24). The interesting findings in this study showed that after nine years, clerical civil servants had significantly lower mortality rates than the “others”, and the mortality rate for professionals is more than a third lower than that for clericals. Following the trend, the mortality rate for administrators was in turn a third lower than that for professionals (Sreenivasan, 24). The results strongly support the idea that socioeconomic status makes a contribution to the distribution of health.

Energy should be devoted to improving the social determinants of health and not so much emphasis should be placed on universal healthcare. Yes, access to healthcare is very important, however, there are other factors including race, gender, and social status that prove to be problems of fair opportunity (Beauchamp, 264). The ethical principle of justice is the underlying issue in Sreenivisans’ article. Justice in this case is referring to the equitable allocation of health. Unfortunately, not everyone is treated the same. For example, minorities, women, and the poor, all have significantly compromised health in comparison to their counterparts. Social factors thus prove to have negative effects on health, and if justice were being served on the race, ethnicity, and social status levels, disparities in healthcare would cease to exist.

I believe it is important to understand why these health disparities even exist. Unequal access to quality health care  is one very important one. But there are other important factors, including education, and living and work environments. Race and income are also often correlated to important health risk factors, like smoking, being less active, and obesity. To me, equal opportunity looks like placing Whole Foods supermarkets in neighborhoods where there are food deserts, limiting the amount of alcohol stores in poorer neighborhoods, and having access to great public schools. I believe these will definitely help to diminish health disparities and they serve a greater purpose than simply providing equal access to healthcare.

Works Cited

Sreenivasan, Gopal. “Health Care and Equality of Opportunity.” Hastings Center Report 37.2 (2007): 21-31. Web.

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

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

Inequalities in health care access are apparent. They warrant a response from the community. We all run the risk of becoming ill during the course of our lives. Brody suggests that how able we are to address these crises is just chance of a social lottery. Beauchamp and Childress state that based on the principle of need that essentially social resources including healthcare should be distributed according to need. This is in line with distributive justice earlier described by them: that is fair distribution of burdens and burdens determined by norms that structure the terms of social cooperation. This is done in line with the principle of non-maleficence: if the person will be harmed without it they should be distributed to said individual. I would like to challenge this notion. There are instances in which this is not applicable. For instance if a person seeking transplant if found to be non compliant they can be removed from a transplant list regardless of need. With regards to the principle of non-maleficence, implanting into a non-compliant individual does more harm.

Cases like B and C are easier to agree upon with regards to material principles of justice. They are issues of financial resources. If we can agree that healthcare should be accessible to all, the question lies to what extent do we mean accessible? With cases like Ms. B this question is exemplified. In her case transportation was a factor as to why healthcare couldn’t be accessed. It is important to note that it is her five-year-old son is the one suffering in the situation. A child this age lacks the ability to make autonomous decisions and care for himself. It is his parent’s job to provide this care, and in some cases the state’s responsibility as well through social services. The case suggests that her issues with providing healthcare to her son could be mitigated if she had a car. So does the public then have a moral obligation to provide a vehicle to her?

The fair opportunity rule in essence states that social benefits of life should be distributed equally. People should not receive social benefits based on undeserved features. The fair opportunity rule can be used to minimalize the effects of life’s lotteries through the rule of redress. Justice can only be achieved by this measure when life’s lotteries stop being the basis for distribution of recourses. Increasing accessibility to social benefits such as education and health care could increase autonomy of individuals who live lotteries have not been in favor of.   On the other hand this becomes problematic because some social benefits are scarce and a flooded market can be problematic. It could be argued that Mrs. B has been systematically socially disadvantaged from birth. Sharecroppers often live in rural areas, which are economically and socially isolated. She probably lacks both the recourses and time involved with taking her child to the hospital via the bus. With regards to the principle of justice and to minimalize harm, she should then be given a car. However, I think it is impossible to provide a service like this to every individual. Further I do not believe that society has a moral material obligation to provide vehicles to people. This frame point of material principle is very tricky. Where is the cut off? Do we make special cases for special people and populations? Is that just? As Brody mentions, it is sometime hard to balance social goals with individual rights. Maybe this it would be good to look at how countries with higher-ranking healthcare systems address problems of access of rural populations.

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

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

Some regard paternalism to always be a negative presence because it’s nature of being something that takes away autonomy. However, paternalism is not a morally wrong because it takes away autonomy away; some situations, as shown by Thaler and Sunstein benefit the individual thus making the presence of paternalism morally defensible. Thaler and Sunstein propose a different kind of paternalism, which they call libertarian paternalism that encompasses a libertarian approach to paternalism. In order to showcase why libertarian paternalism works, there must be some discussion of autonomy.

As Beauchamp and Childress have stated, autonomy is about someone being able to govern their own actions free of impediments like illness, coercion, or misinformation (101). A key phrasing in the definition is that autonomy is ones “own actions”, meaning they do not come from elsewhere, even if the intentions are good. With that stated, not every violation of autonomy is a bad thing, and can garner positive results. In libertarian paternalism it signifies having paternalistic interventions that even the most fervent libertarian would accept (Thaler 386). Thaler and Sunstein laid out their reasoning and examples of why this paternalism is acceptable. For this discussion I want to focus on the aspect of autonomy being taken from a person and how that is not always immoral.

People may argue that autonomy being a very basal common morality that any violation of it is automatically harmful. This assumption is not true when regarding autonomy. For instance, if an employment agency forces their employees to get yearly check-ups in order to keep their jobs that is an exercise of paternalism. However, if as a result of this check up employees were seen to be healthier on average, the paternalistic approach had positive result and would be justifiable. Another example, given by Thaler and Sunstein is when employees are “forcibly enrolled in 401K programs, something that is beneficial a majority of the time (388). Although autonomy is violated it was violated with the employees benefit in mind and does favor them in the end.

I agree heavily with the notion that people are not always making choices in their best interest. One would assumed that someone who is of sound mind and body would theoretically always be making the choice that benefits them; but as Thaler and Sunstein point out this is not the case (387). Now this is not to say that people purposefully make the wrong choice and therefore they cannot be trusted to make their own decisions ever. Sometimes someone may make a choice that they anticipated to be best for them at the moment and it turned out it really set them back. The aforementioned individuals decision was certainly autonomous but it ended up being harmful to them. If a libertarian paternal decision had been made for the individual in their choices stead that had a positive impact is that not morally acceptable? If a paternalistic decision is made with the goal of avoidance of harm or bringing of benefit to the individual there is not wrong being done. Both those distinctions go along with principles of non- maleficence and beneficence. It is the default for everyone autonomous wants to be respected, but sometimes that should be disregarded. The reason being, that people are not always making the best choices.

There is room for a slippery slope rebuttal, in that in justifying libertarian paternalism, we may end up having all of our autonomous choice taken from us. With that fear, Liberian paternalism is not a pass for all free choice to gone from the individual; it merely is an indication that autonomy can be violated with non-malicious intentions that supply a better result than autonomous choice. That stated, libertarian paternalism should never be carried out with coercion or malicious intention.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New

York: Oxford UP, 2009. Print.

Thaler, Richard H., and Cass R. Sunstein. “BEHAVIORAL ECONOMICS, PUBLIC POLICY,

AND PATERNALISM: LIBERTARIAN PATERNALISM.” Arguing about Bioethics. New York: Routeledge, 2012. 386-391. Web.

Webster’s dictionary is defines Paternalism as the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates’ supposed best interest. As we can assume such characterization leaves a negative association with such acts, as it eliminates individuals right to self-sufficiency also known as autonomy. As discussed there are a variety of types of paternalism. The author’s highlight one, which seems to have the individual’s best interest in mind, libertarian paternalism. The basic idea is that private and public institutions might nudge people in directions that will make their lives go better, without eliminating freedom of choice. The paternalism consists in the nudge, which can wrongly be considered coercion but it is not; and the libertarianism consists in the perseverance on freedom, and on imposing little or no cost on those who seek to go their own way, which is based in autonomy.

One core example of libertarian paternalism provided by Thaler’s and Sunstein, is one by which workers can sign up to devote some of their future wage increases to savings. Another example is the automatic enrollment plan, in which workers are automatically enrolled in a savings plan, but can opt out with no trouble and at no expense if they choose to do so (Thaler, 385). One of the essential arguments is that because default rules and starting points often matter, institutions can’t avoid pushing people, which is the “paternalism” factor. If 0% of take-home pay goes to savings, it isn’t because nature so intended it.

The authors go on to argue that people are not always making choices in their best interest. Thaler and Sunstein show us that making decisions, which provide the best benefits to an individual, is not always the outcome. For example Sunstein and Thaler might agree that anyone who does not see the benefits of saving for retirement is not thinking rationally, and would not be making the best decision for their benefit. If a libertarian paternal decision had been made for the individual in their choices, we can guarantee that it had a positive impact even if it is that not morally acceptable. Libertarian paternalism is similar to asymmetric paternalism, which refers to policies designed to help people who behave irrationally and so are not advancing their own interests, while interfering only minimally with people who behave rationally (Colin Camerer, 1220). Such policies are also asymmetric in the sense that they should be acceptable both to those who believe that people behave rationally and to those who believe that people often behave irrationally.

What libertarian paternalists add is that the opposition between “individual choice” and “institution” is confusing and unhelpful when institution is unavoidably establishing unseen rules that govern outcomes if choices haven’t been specifically made, and that influence people’s choices in any situation. Its is important to note that both private and public institutions can’t possibly avoid a form of paternalism, so long as they establish rules and starting points. The question is how to make those starting points as good as possible, while also preserving free choice. So, restraints on ourselves may not be so much external restraints by others who do not like the way one lives and chooses, but restraints that I choose for myself in a moment of deliberate rationality, aware that another I, far from the best self, may make bad choices if I am not restrained by the laws.

Works Cited

Colin Camerer, Samuel Issacharoff, George Loewenstein, Ted O’Donoghue & Matthew Rabin. 2003. “Regulation for Conservatives: Behavioral Economics and the Case for “Asymmetric Paternalism”. 151 University of Pennsylvania Law Review 101: 1211–1254.Web.

Thaler, Richard H., and Cass R. Sunstein. “BEHAVIORAL ECONOMICS, PUBLIC POLICY, AND PATERNALISM: LIBERTARIAN PATERNALISM.” Arguing about Bioethics. New York: Routeledge, 2012. 386-391. Web.

The Ethical Principle of Justice:

The concept of justice in bioethics encompasses fairness in treating patients of different population groups; impartiality in providing both healthcare benefits and burdens to people in different communities or social organizations; and the equitable allocation of healthcare financial resources (Feinsod and Wagner). There are many questions that need to be answered in order to clarify the concept of real justice, also referred to as real distributive justice, in the healthcare system. Some of the questions that should be asked are: How can we apply fairness in deciding the kinds of treatment that would be administered?  Should decisions be based on the a) need of treatment, b) age of the patients, c) diagnosis of the diseases, d) financial capabilities of individuals? Are these factors sufficient to determine distributive justice in the healthcare system or should there be more topics to consider? The following case will answer the question of whether age must be a basis for allocating healthcare services and administering treatment.

The Case:

An orthopedic surgeon, Dr. Rossi, is a voting member of FutuRx Health Maintenance Organization’s (HMO) committees that underline the services that should be covered or excluded for the various FutuRx HMO plans (Morreim et al.).. In one of the committee meetings there was a discussion about the exclusionary age criteria for arthroplasty replacement. They proposed the age of 90 as a cutoff age for the surgery taking into consideration the median lifespan of the average adult American and the idea that most people will not live long enough after the age of ninety to justify the expenses of the surgery. The cost saving expenses of such surgeries will be reallocated toward lowering the premiums of various health plans and providing more comprehensive coverages for other younger members (Morreim et al.).  During this meeting, Dr. Rossi was hesitant to vote for or against this proposal as all what he was thinking of was, Mr. Turner his 91 years old patient.

Mr. Turner, a previous Olympic marathon runner, is in excellent health except for his right knee, which is burdened by severe osteoarthritis preventing him from enjoying and doing the things he love. One year ago, despite his right knee pain, he completed the full marathon in 4 hours and 45 minutes (Morreim et al.). However, currently, he can’t run at all. Mr. Turner is in acute pain that prevent him from enjoying his life. He told Dr. Rossi that running means everything to him and this activity is the source of his enjoyment and content. Dr. Rossi knows that there is no age risk for recommending a knee replacement surgery for him. Dr. Rossi also knows that Mr. Turner will not be affected with these changes as he is not a member of FutuRx HMO plans. All what Dr. Rossi was thinking of was that he doesn’t want to prevent others within the age group of Mr. Turner from doing such surgeries if they were healthy and members of FutuRx HMO plans. However, Dr. Rossi feels great about the re-allocation of the cost saving expenses of such surgeries in lowering the premium and offering more comprehensive coverage for others (Morreim et al.).

Dilemma: 

If doctor Rossi votes for the exclusionary age of 90 for such surgeries then his act will conflict with the rule of Beneficence that claims from the doctor to do what is medically righteous and helpful for the patient. His act will also conflict with justice bioethics rule as many patients within the age group of Turner and who are as healthy as Turner do not meet criteria for such procedures if they were members of Futu Health Maintenance Organization (HMO) plans. According to Beauchamp and Childress, “To deny benefits to some when others in the same class receive benefits are unjust, but it is also unjust to deny access to equally needy persons outside the delineated class, such as workers with no health insurance” (251). This made him think of that if he votes in favor of such a plan then he will be helping many other patients who are younger and in need of lowering their premiums and having better comprehensive coverages that promotes better services for their wellbeing and welfare. The question here is, “What alternative provides distributive justice, equality and fairness?” Or should the question be, “What alternative will provide more distributive justice than the other?” We say more distributive justice because both of these alternatives encompass injustice to many patients.

Discussion:

The principle of justice should imply that all the population, without limitation of age, gender, race, financial status, disease treatment and many more must have equal accessibility to healthcare services. “Everyone should be able to live a normal life without dying prematurely or forced to live at a lower quality making the life not worth living” Beauchamp and Childress (259). The above principle of justice together with the principles of beneficence and non-maleficence compel the doctor to do the surgery for Mr. Turner regardless of age, financial status and even if he was a member of Futu HMO plan. However, I also have learned that the allocation of the scarce financial resources must be taken into consideration especially when a surgery on Mr. Turner that improves his quality of life,  might deprive another younger patient from a lifesaving procedure. “Distributive justice refers to fair, equitable, and appropriate distribution of benefits and burdens determined by norms that structure the terms of social cooperation” (250).

We cannot deny the fact that in healthcare we have limited financial resources that prevent us from providing many healthcare interventions with credible benefits to everyone regardless of limitations. In economics, we have scarcity of resources (natural resources) that fall short to meet all humans’ needs and force those in charge to decide what to produce and how these resources should be allocated. If in economics, the scarcity of resources will limit the production of what are considered extras to the people’s primary needs, healthcare scarce financial resources will bring about medical restrictions that will affect patients’ life, quality of life, and wellbeing. The questions that should be asked is, “how can we add more money into healthcare system”? President Obama has founded the Affordable Care Act in order to bring about affordable health care costs that will expand health coverage to encompass a larger portion of the population and improve the quality of healthcare services. Under this Act, no one is denied access to medical insurance regardless of age, health, and status (“Patient Protection and Affordable Care Act”). Money is not a limited resource as natural resources and the studies should concentrate on the ways to increase financial resources in the healthcare system, rather than limiting some medical interventions that might be beneficial to those who are denied such an opportunity. Huge budgets and enormous financial resources are allocated for weapons productions and wars, while fewer financial resources and smaller budgets are allocated for healthcare that saves the lives of people.

I can’t deny the fact that age sometimes has to be one of the factors in deciding the allocation of healthcare financial resources considering people have a natural lifespan. However, life expectancy varies not only by different racial groups and gender, but also by different economic and social standards, besides the basic health conditions of different individuals (Morreim et al.). Since everyone is different and since there are many exceptions to any sort of categorization of people, any medical restrictions of age, gender, race, economic standard, even disease diagnoses, will not do justice to all patients in the healthcare system. Hence, the question that should be answered above is, “What alternative will provide more distributive justice than the other?” Though I do believe that everyone must have equal accessibility to healthcare services but, with all the shame, I agree that age restriction alternative will provide more distributive justice but will not provide real justice in the healthcare system.

After being exposed to the current rules of medical practice, I found myself shocked with the reality of medicine nowadays. I previously thought that doctors should only be medical care providers and reservoirs of hope, but I was confronted with the bitter reality that they can participate in life-ending measures by even starving a patient to death in the name of respecting the patient’s autonomy, as in the case of Margret Bentley. I realized that many people justify the legalization of physician assisted suicide (PAS), which visibly conflicts with the Hippocratic Oath, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect” (“Hippocratic Oath”). I came to realize that the sanctity of human life doesn’t exist because the value of life decreases with disability, illness, age and even financial capability that deprive one from certain medical interventions just because he/she can’t afford it. I understood that doctors are not free to do what they learned to do but rather they should be obliged to listen to the patients’ autonomous decisions and respect their choices even if it conflicts with the rule of beneficence and non-maleficence as Jehovah’s Witness cases and Alzheimer cases. I also was stunned to find myself among very few who do not believe in mercy killing options because according to me no one has the right to take the life of another person. However, this is life and this is the reality of current medicine.

Works Cited

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

Feinsod, Fred M., and Cathy Wagner. “The Ethical Principle of Justice: The Purveyor of Equality.” Annals of Long Term Care. HMP Communications, 5 Sept. 2008. Web. 03 Apr. 2015.

“Hippocratic Oath.” MedicineNet. N.p., n.d. Web. 03 Apr. 2015.

Morreim, Haavi, Ryan M. Antiel, David G. Zacharias, and Daniel E. Hall. “AMA Journal of Ethics.” Should Age Be a Basis for Rationing Health Care? American Medical Association, May 2014. Web. 03 Apr. 2015.

“Patient Protection and Affordable Care Act.” Wikipedia. Wikimedia Foundation, n.d. Web. 04 Apr. 2015. <http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act>.

In discussing access to health care, Brody and Engelhard question, “To what extent and at what cost ought a society attempt to provide equal health care for all?” (296). “Does the pursuit of such a goal violate rights to property and free association?” (Brody & Engelhard, 297). There are various cases, in addition to the scenarios Brody and Engelhard mention, that illustrate the inequality of health care and bring notions of justice into question. These cases exemplify the challenges in providing affordable and accessible health care to all citizens. In considering the accessibility, affordability, and quality of medical services, my Medical Sociology class discussed how health care falls short of fulfilling all three dimensions simultaneously. There is often a give and take in structuring health care to provide “the greatest good for the greatest number”, but this does not morally justify the disparity facing individuals. Equitably providing accessible, affordable, and quality medical services promotes nonmaleficence and beneficence. However, autonomy can be viewed in conflict with health policy. Health care is viewed as a privilege in the eyes of many, but in regards to morality, adequate health care should be viewed as a right without infringing upon personal liberties.

Beauchamp and Childress discuss how the principle of justice is engaged in the distribution of health policy. The principle of justice is more closely linked with legality and freedom than the other principles we have discussed in class. Beauchamp and Childress define distributive justice as referring to “fair, equitable, and appropriate distribution of benefits and burdens determined by norms that structure the terms of social cooperation” (Beauchamp & Childress, 250). This definition is somewhat ambiguous because it does not clearly articulate the issue of how justice ought to be fairly and appropriately distributed. Beauchamp and Childress further their discussion of justice by distinguishing between traditional and recent theories of justice. In analyzing these theories and how they apply to the cases posed by Brody and Engelhard, I noticed strengths and weakness in each theory. I will focus my attention towards analyzing the traditional theories of justice.

Utilitarian theories maximize welfare and assert that, “justice is the name for the paramount and most stringent forms of obligation set by the principle of utility” (Beauchamp & Childress, 254). The theory further articulates that, “human rights and principles of obligation have no other basis than utility maximization” and rights have a “tenuous foundation when they rest on the overall utility maximization” (Beauchamp & Childress, 254). I argue that by focusing on society as a whole, this theory neglects to address the individuality and uniqueness of autonomous humans; human beings are not cogs in a machine. Libertarian theories claim that, “any distribution of goods, including public health measures and health care, is just and justified if and only if individuals in the relevant community freely choose it” so long as they do not violate the rights of others (Beauchamp & Childress, 256). This theory does not view health care as a right, which in turn deprives some individuals of receiving adequate medical attention. Egalitarian theories advocate that, “the allocation of health care resources…should be structured to ensure justice through fair equality of opportunity” (Beauchamp and Childress, 257). This theory stresses the notion that, “each member of society, irrespective of wealth or position, would have equal access to an adequate, although not maximal, level of health care” (Beauchamp and Childress, 257). Is it better to provide adequate health care to all citizens or maximal health care to a select few? The provision of accessible, adequate health care for all citizens promotes the principle of nonmaleficence, however, individuals should have the opportunity to exercise liberty in obtaining a maximum level of care. Beauchamp and Childress address the communitarian policy of organ removal when discussing the communitarian theory. I do not think that individuals have an obligation to donate organs for the good of society even if the removal of cadaveric organs comes at no cost to the patient. An absence of an objection does not elicit or justify action. Organ donation promotes the principle of beneficence, but it does not necessitate the routine removal of organs since informed consent was not obtained. An action that promotes a good in society is not always best for the individual; the common good does not always justify erosion of individual rights.

Works Cited

Beauchamp, T. L., and James F. Childress. Principles of Biomedical Ethics. New York:

Oxford UP, 2009. Print.

Background:

In “Access to Health Care,” Brody and Engelhard analyze several different models of healthcare that exist in the world such as the British National Health Service. Even in a developed country like the United States, people are not always able to receive the medical care that they require. For example, the CDC estimates that, in 2013, 5.9% of people in the United States did not receive the care that they needed as a result of high costs.

Dilemma:

At the end of their discussion, Brody and Engelhard present several cases that involve people struggling to obtain medical care. In Case A, Brody and Engelhard describe a patient, Mr. A, who has been diagnosed with an inguinal hernia. Since Mr. A has been disqualified from receiving surgery at the county hospital due to his income, he and his wife cannot afford the procedure. The dilemma in this scenario includes the doctor suggesting that Mr. A wait for a better job or save up money as opposed to operating on Mr. A despite the financial issues.

Discussion:

One aspect of this situation to consider is whether the doctor is violating the principle of nonmaleficence by suggesting that Mr. A postpone the surgery. Nonmaleficence revolves around not inflicting harm or evil (Beauchamp and Childress, 151). As per the Mayo Clinic, without treatment, the hernia will most likely cause the patient pain, and it may also lead to intestinal damage. Therefore, by not performing the surgery, the physician is directly inflicting harm since Mr. A will suffer until he is operated on.  Ultimately, the physician is violating the nonmaleficence principle by refusing to do the surgery, so he should operate on Mr. A despite the financial complications.

Another point to discuss is that the symptoms from the hernia may also lower Mr. A’s chances of receiving a better job or saving up more money as the physician had recommended.  If that turns out to be true, then Mr. A will never be able to afford the procedure, and the hernia may only get worse. This suffering that Mr. A will have to endure only due to financial reasons relates to justice. Beauchamp and Childress present the definition of distributive justice: “The term distributive justice refers to fair, equitable, and appropriate distribution of benefits and burdens determined by norms that structure the terms of social cooperation” (250). If one assesses the situation from the justice perspective, then the doctor should make the decision to perform the procedure.

It is important to clarify that I certainly do not believe that Mr. A should be operated on for free by the surgeon. Resources are clearly used in order to treat Mr. A, and he should be held responsible for paying for the procedure. However, a payment plan could be designed to ensure that Mr. A instead pays over a longer period of time. For instance, the case mentioned that the family had two cars, so one car could be sold to finance the payment plan. There can be multiple approaches towards creating a payment plan that Mr. A and his wife would be comfortable with. Furthermore, after the procedure, Mr. A’s health is likely to improve, so he may also be able to obtain a better job more effectively. Ultimately, the doctor should operate on Mr. A despite the financial issues, which can be resolved over a longer period of time after the procedure.

References:

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

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

CDC. “Access to Health Care.” Centers for Disease Control and Prevention. N.p., 20 Jan. 2015. Web. 03 Apr. 2015. http://www.cdc.gov/nchs/fastats/access-to-health-care.htm

Mayo Clinic Staff. “Inguinal Hernia.” N.p., n.d. Web. 03 Apr. 2015. <http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/basics/complications/con-20021456>.

Source for image: http://www.wohlsenconstruction.com/assets/uploads/projects/Phoneixville_Hospital_-_Operating_Room.jpg