In his report entitled “Health Care and Equality of Opportunity”, Sreenivasan argues that equality of opportunity may not be a sufficient rationale for universal healthcare. First, this idea implies that a fair share of opportunity leads to a fair share of health. Second, the equality of opportunity argument assumes that a fair share of health leads to a fair share of health care. Sreenivasan primarily focuses on the second argument, by analyzing the extent to which health care contributes to health. In his analysis, Sreenivasan points out other social determinants that may have an equal or even larger impact on health than health insurance. He states, “suppose that instead of introducing a national health insurance scheme, we had spent the same amount of money on equalizing the distribution of social status – then our society’s gradient in health would have been significantly reduced.”

This idea was very intriguing to me, as equalizing the distribution of social status would not only benefit individuals in terms of their physical health, but also help their mental and social wellbeing. However, one idea that Sreenivasan doesn’t really touch upon is what the idea of universal healthcare means to the individual and to a democratic society. From an economical standpoint, it is easy to understand why many would be against pumping a ton of money into a system that may not have substantial effects on overall human health. However, from a more sociological perspective, the idea of universal health insurance is an integral piece missing from the puzzle that is democracy.

The term itself has developed great meaning far beyond the policy implications that are fervently debated. Upon typing “what health cares means to me” into youtube, thousands of results pop up. Among the results, I watched several accounts of American citizens who recorded videos of their responses. For some, universal health care means being able to take their sick child a doctor without spending a week’s salary. For others, it is a security blanket – a back up plan to rely on if life takes a turn for the worst. And for others, it is a right that they deserve for living in a country as esteemed and developed as the United States. Many of the individuals in these videos don’t have the luxury of thinking about health care in political terms. In one of the youtube videos, a woman talked about her epilepsy that is fortunately controlled by a medication. However, this medication is extremely expensive and without it she would be unable to breathe. Without health insurance, this woman would not have access to the medication and would likely lose her life. It is of utmost importance that policymakers consider these voices that are often muted by political debate and contemplate not just what health care means to them, but to you and to me.

Sources

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

https://www.youtube.com/watch?v=UsV48GKrEBk

https://www.youtube.com/watch?v=0-36kdS7FqY#aid=P-9Ym54MmvM

https://www.youtube.com/watch?v=DH0LFrSfl0k

Preventive medicine is a branch of preemptive healthcare that focuses on the protection, prevention, and maintenance of well being in order to prevent disease, disability, and death. The way in which individuals think about health has changed drastically over the years, as research leads individuals to believe that they have a great deal of control over their health-related future. Preventive medicine has been given more attention in recent years, in an effort to combine new medical knowledge and advanced technology to decrease the incidence of disease and mortality. While preventive care can be extremely beneficial in reducing such high rates of disease and death, such intervention is often expensive and particularly controversial. In their work Preventive Medicine, Brody and Engelhard illustrate several cases that show the controversial nature of preventive care. Two specific cases addressed highlight preventive care conflicting with expenses and personal choice.

Case A: The central question in this case is how often pap smears should be given to women. While literature suggests that every 3 years is sufficient, clearly, a yearly test would be even more proactive in preventative care for women.  The clinic must decide if it is worth the 50,000-dollar difference to give yearly pap smears, as opposed to one every three years.

Case B: This case deals with preventive care in the form of a vaccination. A mother does not want her baby to get DPT vaccinations because of the potential side effects, such as mortality due to whopping cough. The mother is relying on the idea of herd immunity, however, this concept won’t hold true if more and more mothers become “free riders”.

Both of these cases address sacrifices that must be made in public health. In Case A, money can be sacrificed for greater prevention, whereas in Case B, personal values and autonomy can be sacrificed for a public good. While there is no “clear” right answer to either of the above scenarios, these types of decisions are made on a daily basis in the realm of public health.

In her op-ed article “My Medical Choice”, Angelina Jolie details her reasoning for getting a preventive double mastectomy this past year. Genetic testing showed that Jolie had the BRCA gene, a gene that increases a woman’s chance of developing breast and ovarian cancer. Jolie was told that she had an 87% risk of breast cancer, and a 50% risk of ovarian cancer. Fortunate enough to have the knowledge and the financial means necessary to undergo surgery, Jolie had the preventive surgery and her chances of developing cancer have decreased drastically.  Jolie states, “It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live.”

Preventive care is a crucial component of modern day health care as it expands individuals’ options. However, there are significant financial and moral costs involved in this type of care. For example, in reference to case A, giving pap smears more frequently may result in higher prevention of cancer, and in turn, less incidence of disease and mortality. However, giving pap smears more frequently may also result in a greater likelihood of misreading test results, causing patients needless worry and operations. Thus, it is important for patients to be fully informed in order to make their own decisions regarding medical treatment. While preventive care should be available to all, the facts and the risks associated with such care must be clearly understood in order for individuals to confidently make medical decisions.

Works Cited

Brody, Baruch and Englehardt, Tristam. “Preventative Medicine.” Bioethics: Readings and Cases. Upper Saddle River: Prentice-Hall, 1987. 298-301. Print.

Jolie, Angelina. “My Medical Choice .” New York Times 14 May 2013: n. pag. My Medical Choice by Angelina Jolie-NYTimes.com. Web. 14 Mar. 2014.

Informed consent is a legal agreement between a health care provider and a patient, in which patients are supposedly given an active role in decision-making processes regarding their course of medical treatment. One element of this doctrine is that patients make their decisions voluntarily, without coercion. What many patients don’t realize, however, is that they are often left in the dark when given information about their course of treatment.

Is true informed consent an oxymoron? If patients were really informed about all the risks of a medication or procedure, how many would consent? Take, for example, this ad for Seroquel XR, an antidepressant. Two thirds of the commercial details side effects. Do patients really pay attention to all of this information?

In Barriers to Informed Consent, Lidz et al. describe the reasons why patients want to be informed of some aspects of their medical situation. Some patients assume that their physicians will do what is best for them and just seek information so they can understand their role in treatment. Others wish to be informed to feel connected to the process or to veto a specific aspect of a physician’s recommendation. There are also some patients who want to play an active role in their treatment process and request information in order to participate in decision-making. These patients are the most discerning health care consumers. Lidz et al. also examine physicians’ attitudes regarding informed consent. Physicians’ knowledge, expertise, research, experience, and the opinions of colleagues go into the medical decision making process. When a physician makes a decision regarding another person’s health, it is assumed that they made the best possible decision for this individual. Therefore, when patients don’t consent to their decisions, they often view this lack of consent as a sacrifice to the patient’s health.

What is not explicitly stated is how physician’s values and religious and political beliefs come into play when discussing informed consent. As mentioned earlier, one facet of the informed consent doctrine requires patients to make their own, independent decisions. However, it is nearly impossible for physicians to give patients a totally unbiased perspective when presenting their options for treatment. Some procedures are extremely controversial, in which case physicians may have strong grounds to dissuade a patient from choosing a specific course of action. Abortion and male circumcision are examples of procedures in which informed consent could become a problem. A physician who is firmly against these procedures is likely to emphasize the health risks and potential for complications. The way that information is expressed to a patient prior to treatment has a significant impact on their decisions. As mentioned earlier, there are varying degrees to which patients want to be involved in their medical situation. When patients are not thoroughly invested, wanting information merely to veto or as a courtesy, they are more likely to be swayed by the physician’s beliefs. Therefore, the informed consent doctrine fails to prevent physician bias from clouding patient’s decision-making ability.

Physician bias also comes into play when physicians favor certain drugs and medical devices due to gifts or other benefits they receive from companies. In an effort to prevent drug companies from wrongly influencing the minds of physicians, the Sunshine Act was recently passed. This act mandates manufacturers of drugs and medical devices in national health care programs to report both monetary and non-monetary items of value that are given to physicians. This information is then posted on a publicly accessible website.

While efforts like the Sunshine Act may help shed light on some factors that influence physicians’ attitudes, the inherent bias due to more personal, fixed beliefs still remains. While certainly useful, the informed consent doctrine fails to take into account the complexities associated with medical decision-making, disregarding the human quality expressed in both physician and patient attitudes that complicate the process.

 Works Cited

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

American Medical Association. “Toolkit for Physician Financial Transparency Reports (Sunshine Act). “ ama-assn.org. Web. 9 Feb. 2014. <http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page>