The Sreenivasan article discusses how health should not be a determining factor for ‘fairness’, rather, ‘fairness’ should be determined by equal opportunity to life options. Sreenivasan states that ‘equal opportunity rationale is simple and appealing. Unfortunately, it is also invalid’. I agree with him that rationing out healthcare to everyone is unrealistic because some people have more health problems than others, and by rationing the help, these people are unable to actually get the healthcare that they need because they have already used up their ’ration’ of healthcare. However, Sreenivasan continues on to discuss what he believes reality should look like. He believes that ‘each person’s share of opportunity ought to be (more or less) the same as everyone else’s share’. I believe that his argument is invalid because it is more Utopian than realistic. Because of the society that we live in, certain people will have more of an advantage than others. This advantage does not just involve financial resources, but also cognitive abilities. Sreenivasan’s argument makes it sound like society should allow certain people who have more opportunities in life to have worse health than everyone else in order to level the playing field. This is immoral because this is saying that one person’s health is more important than another person’s health. For example, if we had a society like what Sreenivasan imagines, then we could say that the president of America should receive the same ‘ration’ of healthcare as say the vagrant who is living on the streets. In Sreenivasan’s society, the vagrant should receive more healthcare than the president in order to level the opportunities available. This is immoral because the president needs to be able to make wise decisions for the sake of all citizens, and being in poor health would not give him that ability. I am not saying that the health of the vagrant is not important—it is, but in our society, there needs to be a gradient in order to protect the health of everyone.
I agree more with Buchanan in that everyone has a right to a decent minimum healthcare, rather, everyone has a right to the access of healthcare. I believe that in a perfect world, everyone would have perfect health/healthcare. However, in our society, this is unrealistic because, like Buchanan stated, everyone would expect the same level of healthcare, even when determining factors change, causing this healthcare system to be more of a burden than a useful resource to society. Another burden to the healthcare system would be individuals who have severe, lifelong health problems. Is it up to society to provide care for this individual their entire life, or is it up to the individual and his or her family? In a way, this can be seen to be a moral issue. Should society provide care for this individual for life, help him achieve the same level of self-help as everyone else. Or, should society let him suffer for life, struggling to pay bills and keep a job in order to pay more bills. There is no clear right answer for this issue as of yet.

It has long been questioned whether preventative medicine should be required. Some limitations to preventive medicine include lack of funds and lack of individual compliance. In reference to the lack of funds, many countries lack the finances to provide adequate prevention for any number of diseases and often have to decide between providing prevention and treating diseases. Often, these countries decide to provide the best care for the most people. The lack of compliance issue is usually more of a problem in developed countries where parents don’t want to subject their young children to things such as vaccinations that can cause severe health issues. This is immoral because these parents are presenting their children to a disease that is more likely to cause harm to their children than the possible side effects of the vaccine. I believe that everyone should be vaccinated for diseases that have been eradicated from the US or that are close to being eradicated.

A recent example for why routine vaccinations should be required can be seen in the recent measles outbreak in New York. Within the last month or two, there has been a measles outbreak in New York City. There have been at least 19 confirmed cases of measles. In 2000, measles was considered to be eliminated from the US. Between 2000 and 2013, an estimated 63 cases were found each year, mostly from those traveling abroad. Since 2013, the number of cases have tripled due to the number of people being vaccinated having dropped to only about 90 percent.

There are severe complications accompanied with measles, so most individuals are vaccinated. However there are some who refuse to vaccinate their children due to the rare risks associated with the vaccine. The public health question now is should everyone be required to be vaccinated for measles in order to protect the health of the population? I believe that, for the good of the population, everyone should be vaccinated and up to date on all their vaccinations to protect those around them. By requiring this, almost every individual will be vaccinated and will provide herd immunity to the select few who are not. I believe that there is a huge difference between those who do not want to be vaccinated and those who cannot be vaccinated due to other health related issues.

For those who have not been vaccinated, the reason usually stems from the desire to not be subjected to the potential risks associated with the vaccine. These people are called “free riders”. In my opinion, the decision to not vaccinate is immoral as these individuals put the rest of the public in harms way. Some may argue that vaccinations cost too much for certain classes of people in the US. However, the price of vaccination versus the cost of treatment shows that by not vaccinating, people are actually going to end up spending a great deal more for treating the disease. As Brody and Engelhard stated in their essay, ‘preventative medicine and public health measures have traditionally been a part of medicine.’ This statement is very real and true. We, as an individual and as a nation, have a responsibility to protect those around us from disease due to the lack of vaccination.

http://www.cdc.gov/measles/outbreaks.html

http://www.slate.com/articles/health_and_science/explainer/2014/03/measles_outbreak_in_new_york_should_people_get_revaccinated.html

Brody and Engelhard. “Preventative Medicine,” Bioethics: Readings and Cases

People, in general, only want to be communicated with and to know the risks associated with any procedure—be it medical or not. Personally, I believe that doctors should communicate normal risks found with procedures. If there are rare, but life threatening risks, the doctor should mention them out of courtesy, but it should not be required of the doctors. However, I also believe that it is unrealistic for doctors to communicate all of the rare risks associated with said procedures. Patients should research the procedure or medication prior to consenting to it, this way the patient will be able to ask well thought out questions. Because this should be happening, it means that patients need to be aware of what the doctor suggests with plenty of time to research and become used to the idea. Lidz points out that often patients are not fully aware of the procedure and risks until the night before. Perhaps having a group of professionals at a hospital or health care center to fully explain risks and benefits to patients is what is needed. Instead of placing full responsibility on the doctor or nurses, maybe explanations need to be delegated to a special staff trained in communicating with patients.

Patients also need to understand that any medical procedure is unnatural and all procedures carry risks, some more serious than others. It is also important to keep in mind the possible benefits of medical procedures and to weigh the risks and benefits. Because this takes some experience, doctors should clearly explain and give their personal recommendation. Because patients generally do not understand medical terms, it is important for doctors to communicate in simple, everyday terms. This is a barrier that Lidz hints at, but never fully comes out and states. This barrier is one between the knowledge of doctors and the knowledge of patients.

In a way, failing to adequately inform patients of risks is comparable to the food industry failing to inform consumers about the genetically modified food which has been shown to cause health problems. I use this example because, similar to informed consent, it is a topic that is often overlooked. In general, people only want to be aware of risks associated with anything that goes into their body. It is when they unknowingly take medications with severe, common risks that they become reasonably upset.

An interesting blog, written by Dr. Bernstein, brings up the issue of informed consent of “the level of resident participation.” Most patients consent to having a resident on the team during surgery, but often are unaware of how involved the resident is. According to the statistics found in the blog, “consent rates decreased from 94.0% to 18.2% as the level of resident participation increased.” Again, communication between doctors and patients is key to a well working environment to benefit everyone the most.

In conclusion, informed consent has evolved a great deal in the last century. However, there is still room for improvement.

M. Bernstein. (2013, September 16). Patient Informed Consent for the Teaching Hospital “Trainee” Care: Informing Realistic Scenarios. Retrieved from: http://bioethicsdiscussion.blogspot.com/2013/09/patient-informed-consent-for-teaching.html

Lidz, C. W., Meisel, A., Osterweis, M., Holden, J. L., Marx, J. H., Munetz, M. R. Barriers To Informed Consent. In S. Holland, Arguing about Bioethics (299-307). New York: Routledge.