Providing Healthcare: Should it Truly be Equal

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     Norman Daniels provides a different outlook on healthcare that questions the equality of health care and if it is distributed fairly.

One question that I asked myself while reading Daniels piece was whether certain social issues or conflicts (adventitious needs) warranted health care provision just as course of life needs are provided for. Should a nose augmentation be done if its purpose is not to enhance the ability to breathe, but to enhance self-esteem? Does not psychosocial or psychological issues warrant health care as well?

It is my opinion that certain procedures are more important than others and individuals who are in need of these procedures should receive the health care that is necessary to complete the procedure. If the disease or illness negatively affects normal opportunity range, then it is necessary to receive health care. I believe, however, that it is these differences and variances between individuals (effective opportunity) that constitute and allow that health care be just a little different amongst people. This does not mean that there should be a large variance in health care which will lead to unfair mistreatment and neglect of some patients over another, but it will make it so that all patients receive the healthcare that will most benefit their needs while giving all the opportunity to return to their normal opportunity range.

When comparing the lungs of a smoker and the lungs of an individual who is not a smoker, but has developed some type of lung disease, it is possible to see that these individuals are both in need of the same kind of health care. However, who should receive the better kind of care? Who should receive more attention? Who should be addressed first? Though many may say that the smoker placed these health issues on themselves and caused their disease or illness, it is only moral to provide healthcare to both these individuals. However, because no one is the same, the health care that is provided to both patients can vary in many ways. For example, the smoker may have been born with other health issues that make it more difficult to treat the lung problems the patient may suffer from. The other patient who developed the lung disease may also be an athlete and thus it is required that the kind of health care provided must also consider this health factor. Regardless of the extraneous issues that the patients may face, it is only moral and fair that these patients both receive health care that can allow the patients to return to their normal opportunity range.

Daniels also discusses there are some born with an advantage and a very lucky “natural lottery” (Daniels 465). Daniels indicates that health care addresses things that are not equally distributed; one person may never get sick, and another person must live their live on medication. I believe that this issue is one that undoubtedly must be cared for with health care, but the amount of health care that is provided depends on the severity of each case. Someone with constant allergies may need more care than someone who is allergic to animals. Alternatively, if someone is deathly allergic to cats, and another individual is allergic to multiple things but is not morbidly ill, the person with the possibly fatal allergy must be given more attention and health care in the case of a reaction.

Individual health care needs vary due to genes, location, family, and personal strengths, and many other factors. These factors do have a strong hand in deciding what kind of health care is most beneficial to a patient. I believe that it is moral to provide varying levels of health care if it means that all patients will be able to return to their normal opportunity range as Daniels describes.

Daniels, Norman. “Health-care needs and distributive justice.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 457-471.

13 thoughts on “Providing Healthcare: Should it Truly be Equal”

  1. “Regardless of the extraneous issues that the patients may face, it is only moral and fair that these patients both receive health care that can allow the patients to return to their normal opportunity range.”
    While I agree with the general premise of your argument in this post, but I disagree with the statement above in regards to the smoking case. I think that if there are two cases which are almost identitical except that one person has brought the disease onto themselves in some easily avoidable way* and the other hasn’t, it is fair, if a decision has to be made, to give preference to the second person. This is potentially easier to see in the case of organ donations because it is easy to see how you would have to make a choice between people whereas with lung cancer you can usually treat both people. I have long been in the opinion that in the US you should have to opt out of being an organ donor rather than opt in because I think we would get many more donors that way. A few years ago I was doing some research on organ donation and came across that fact that in some countries (eg Israel) if two people need the same organ, and one of them is an organ donor and the other is not, preference goes to the organ donor. I think this is completely reasonable and justified. While we should strive for equity in our healthcare systems, when a decision has to be made between two patients I believe it is only fair to look at if they have brought this upon themselves in some way and their choices (eg organ donor or not) to decide who should get the better treatment.

    *with lung cancer, I would see this as smoking volutarily, but not working in a mine, as that could easily have been their only or best job option

  2. I agree slightly more with Samantha’s argument. I think in some cases there should be varying levels of care – most easily seen through elective surgeries but it depends on the cause of the problem. All people should have the option of accessing basic health care but I do believe that priority goes to the individual severely ill because of a non-avoidable cause. This could lead to the argument that diabetes or really any CVD or diabetes related disease is not as important as that of a healthy child or an accident patient, but should some blame be placed on the patient for their own health? To me the only reasonable way to truly deal with this situation is putting the pressure on preventative care. Avoiding diseases that can be easily changed through behavioral choices at a younger age.

  3. I agree with you about needing to treat the smoker and non-smoker equally in order to provide moral healthcare and about needing to provided everyone with healthcare to restore them to their normal opportunity range. Additionally, I agree with you about treating the fatal allergies before the non-fatal but constant allergies. That is the system of triage which is used by current medicine today because it makes logical sense.

    However I was wondering is a patient’s personal life should play a factor in a situation where two patients were of equal deteriorating health. Should the fact that one patient is a single mother and their children are relying on their mom for support give added reason for that patient to receive more immediate care over another patient who is equally as sick but does not have a family? I wanted to say yes, but I feel like there is something morally wrong about providing better treatment to a person just because they have a family. This is similar to the trolley cart problem and it is a conundrum that I have questioned previously and still do not know my personal answer to.

  4. The smoker case that you have presented can be viewed from multiple angles. Perhaps, the smoker was influenced by faulty advertising and peer pressure as a teen (which means during a time when his or her brain was still developing the reasoning centers). He or she has tried to quit on several occasions when they were old enough to understand the injurious effects of smoking but unfortunately was not provided excellent resources that would prevent a relapse in smoking. Should the smoker be penalized for a dumb decision that they might have made in their teens due to their unfortunate circumstances? On the other hand, what if the non-smoker worked in a factory that contained asbestos. Should he or she be penalized for their occupation even if it is the only job they could afford to hold in a rough economy? Hence, your argument that it would be moral to treat both equally seems the most logical because ultimately it is impossible to understand how each individual patient arrived at their diagnosis.

  5. At the end of your argument, you bring genetics into the discussion of healthcare insurance. As genetic testing becomes cheaper and more accessible, I think insurance companies will try to push genetic testing upon their clients as means of charging certain individuals more than others for their coverage. I find this to be practical in theory but not in reality. Let’s say an insurance agency wants to test their new clients for Huntington’s Disease. Clients can choose to have their results disclosed or not to themselves. Learning such news could be extremely devastating to the individual especially at a young age. If they decide to not disclose their results but then are charged a large amount for their insurance policy, they indirectly receive the bad news. Either outcome of genetic testing still reveals the news and cannot be applied to insurance policies in practice.

  6. I agree with your stances on the example of the smoker vs. the non-smoker. Also, there are instances in which you have to consider the individuals history, and what they cause upon themselves. However, that should not be a factor in the level of treatment that a person deserves. When deciding who deserves the better treatment, it should really focus on level of urgency. Who could it effect faster? So, the method is to prevent death, in order to execute these you then give care to the person that needs it the quickest.

    You state that there are certain factors that come into play when deciding what kind of health care is most beneficial to a patient. I believe that it is difficult to provide the ideal health care, but through paying attention to the points that you made then you can provide optimal care. Should providing health care be equal? Yes, and there are ways to make it equal, because there are certainly cases that deserve more attention than others.

  7. This conversation about healthcare distribution to individuals of different circumstances reminds me of the pivotal history of dialysis machines. Initially, dialysis machines were large cumbersome machines, and there were very few in the country. Thus, this limited life-saving resource had to be allocated to patients, and those who decided who received dialysis were called “God Squads.” These God Squads were charged with a burdensome duty to “decide who shall live and who shall die.” Ultimately, personal information became pertinent in decision making, but I agree with Simone–should a patient’s personal life really play into treatment? While in theory, I believe personal life should be irrelevant from decisions about healthcare, but in reality, when choices need to be made personal information will be an influential factor. As in the case of dialysis, care often went towards individuals who were termed “good citizens” while criminals died. I find this extremely unethical, but what should have been done under these circumstances when a choice HAD to be made? We need to put in place a system that address what ought to be done in there circumstances because medicine is a place of limited resources and unlimited patients. The dialysis God Squads misused personal information to make life-changing decisions, but for the case of smokers, personal information can often be hearsay. Furthermore, our healthcare system functions off a level of urgency and I think this is ethical justified. As Kandis mentioned, you can give the care to the one that needs it the fastest or evaluate who is likely to recover from such treatment.

    Source: http://www.nytimes.com/2006/08/29/health/29essa.html

  8. From the argument that you made, it seems like you are saying that in these different circumstances, people are not being treated equally since one person is receiving more care than the other person. From where I am from, there is a common saying, “if it ain’t broke, don’t fix it.” I believe that the same could be said about a person’s health. If a person is not sick, then why are they trying to get medical care? However, I agree with your argument concerning which person should be treated first. Often, doctors do not need to decide which person to save. The doctor simply will see the sicker person first. The type of care will be different because the two cases are different, but that is not saying that the actual care is unequal.

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