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Medical Ethics Essay, Research Paper

Case Study:

Mary Wilson is a thirty-five year old woman who lives in Tennessee. She was diagnosed with a malignant cancer about a year and half ago. She has been treated many times with a mastectomy, chemotherapy, and radiation. The treatments have not prevented the spread of her cancer. Her health is deteriorating as the days pass. She gets a second opinion on her health status, but the other doctor does not have any medical solutions to better her health. Her does learn from her first doctor that she does have a possibility of survival if she participates in an experimental operation. This operation involves a bone marrow transplant. This operation only gives her the possibility of survival. They never tell her that she is going to be completely cured of the cancer. Her HMO refuses to pay for her operation because the operation is experimental. She decides to appeal to an internal review board. Her request was denied. After the rejection, she decides to take her case to court to force the health maintenance organization (HMO) to pay for the operation because she does not have enough money to pay for the operation. HMO is an example of managed care wherein a fixed annual fee is paid to an organized group of physicians and hospitals, which then supplies the individual with most kinds of needed medical services at no additional charge. The case takes a couple of months to deliberate and decide on an outcome. By the time the court decided to rule in favor for her, she had already passed away due to her cancer. This whole ordeal probable would have never happened if our health care system were better met for the whole public. Everyone should have the right to have equal health care. Would this have occurred if Mary had the same health care as everybody else?

The Issues:

1. Is there a right to health care?

2. How do we provide health care to everyone?

3. Why is there a need for change of the current system?

The Analysis:

Everyone in the United States should have the right to health care. The United States is currently faced with a health care crisis. The main element of this crisis is the lack of any program to provide health care for everyone in the society. When we speak of health care, we speak of enough care to achieve sufficient welfare, opportunity and a reasonably full and satisfying life. That there are people forced to do without needed health care for primarily financial reasons is morally intolerable. Society has an obligation to provide health care. The government has the ultimate responsibility to see that this obligation is met and if not, then it is sanctioning a situation that is morally and politically wrong.

Since all human beings are vulnerable to disease and all die, health care has a special interpersonal significance: it expresses and nurtures bonds of empathy and compassion (832). Health care has a special meaning because of its role in the beginning and the end of a human s life. Society s commitment to health care reflects some of the basic attitudes to be apart of the human community.

We need to begin by asking what is a right? A right is a principle that specifies something, which an individual should be free or have to do. Also it is entitlement, something you possess free and clear, and something you can exercise without asking anyone else s permission. There are two kinds of rights that need to be discussed to understand the rights to health care. Moral rights is one that is stated in or derived from the principles of a moral theory (Munson 828). According to Ross Theory, people have a duty to treat other people benevolently. The law does not recognize this duty so I guess you could treat someone harshly and not violate any laws. Once again, Ross theory says we have a prima facie duty not to injure or kill anyone. This duty along with the right is reflected in the body of the statutory law and common law that deals with bodily harm done to others. In our society, we need to rely on ethical theories, such as Ross , as a basis for evaluating our laws. If we were to violate any rights derived from ethical theories, then we would have a bad law. A moral theory could be the basis for reform of old laws. Essentially there isn t a clear line that separates the moral and the legal.

Political rights means that it is required by our political commitments or principles (Munson 828). Our society is committed to individual autonomy and equality, among other values. It is understood that everyone in our society is free to seek health care and when properly arranged, to receive the care. Also at the same time, physicians and hospitals are required to provide health care because seeking care does not imply that care should be provided. Only if a contract is signed between the patient and the doctor, then the doctor is required by law to give that patient medical attention. If we are going to make claims that health care is a right: everyone should be entitled to health care regardless of financial status , then we need to be able to support our claim. Kant s principle that every person is of inherent and equal worth might be used to support the claim that every person has an equal right to medical care, simply by virtue of being a person (Munson 829). Justification can also be in term of the commitment of society. A society that embodies justice and equality must be prepared to offer health care to all, if they offer it to others. Basically, politics has much to do with the health care issue. To answer the question Is there a right to health care? Yes, I believe that health care should be offered to everyone, but that would require some kind of tax increase. The reason I think this issue is so heated is because society is not willing to pay for this kind of service. There are many other goods that people seek for instance, education and transportation, but we cannot offer these goods to everybody without some kind of agreement that society as a whole is willing to pay for the service for everybody. According to moral rights, Mary should have received health care because she is equal to everybody else. Politically, she should not have received care because she did not have the finances and society was not willing to pay for her care.

The next issue that needs to be discussed is how to provide health care to everybody. There are two kinds of obligations: societal and governmental. Society has a moral obligation to ensure that everyone has access to adequate care without being subject to excessive burdens. Providing access to health care is societal rather than individual responsibility for several reasons. First, health care requires skills of many people, so it cannot be accomplished by one individual s efforts. Second, health care is unevenly distributed among people and securing care could be expensive. Very few people could secure care for themselves without some kind of share of costs by society. Third, illnesses are most likely not in the individual s control; therefore a difference in health care needs are largely undeserved. Obligation is societal, but there is someone ultimately responsible for these obligations are met.

The government has the ultimate responsibility for ensuring that society s obligations are met. The Commission states that it is not that the Federal government ought to provide it, but see that there is equitable access to health care. The concept of equitable access has twp main concepts: the level of care that ought to be available to all and the extent to which burdens can be imposed on those who obtain these services. Equitable access could be interpreted in a number of ways: equality of access, access to whatever an individual needs or would benefit from, or access to an adequate level of care. Several considerations support the stance that the government sees that the societal obligations are met. The obligation in question is society-wide, not limited to particular states or localities. The government responsibility at the national level is needed to secure reliable resources. Only the Federal government can ensure that the burdens of providing resources are distributed fairly. Society s obligation to provide equitable access requires an overview of efforts.

The relationship between moral obligation and moral right is complicated. A person has moral right to something is saying that he or she is morally entitled to it. All moral rights imply corresponding obligations. To say that society has a moral obligation to do something is to say that it ought morally to do that thing and that failure to do it makes society liable to serious moral criticism (836). The government s responsibility for seeing that the obligations are met is independent of a corresponding moral right to health care. An example of this is that a person might have a moral obligation to help someone in need, even though the needy cannot demand that person s aid as something they are due. The Commission has decided to concentrate on a more important question: what is the nature of the societal obligation, which exists whether or not people can claim a corresponding right to health care, and how should this societal obligation be fulfilled (836)?

Another issue that needs to be discussed is the need for change in the current health care system. There is a need for this change because apparently there are problems with the current health care. Two major factors in American health care system put it a state of crisis. One is the increasing cost to society of health care and the other is the failure to deliver at least a decent minimum of health care to everyone who needs it. In 1950, the U.S. spent about the same on health care as the national defense and about half of that was spent on education. Now in the year 2000, defense and education are equal and health care is equivalent to both of them added together. These are outrageous numbers. The national gross domestic product has even more amazing numbers. In 1960, the U.S. health care costs were at 5.3% and now they have tripled to 15% in this millennium. Why have these costs increased? One of the main reasons is that the population of aging adults has increased. We ve all heard of the baby boom generation of the 1940 s. Well, these babies that were born 60 years ago are now older and in turn this generation is seeking more health care. Medical technology has advanced along with the growing need for health care. This technology has helped doctors provide services to more patients in less time. This success of medicine has in turn created the need for more new medicine. For example, knee and cataract operations used to extensive surgeries where the patient had to stay at the hospital for weeks. Now the operations are being performed on an outpatient basis which means that they can leave the same day that they had the operation.

Another problem with the health care system is the failure to deliver care to everybody who needs it. There are several reasons for the failure for delivery. First, there are stricter regulations of eligibility for Medicaid and Medicare. This has led to a decline of poor people receiving health care. Second, forty-four million people have been found to be without medical care. This number is up from twenty-nine million in 1979. Sadly, half of the uninsured people are children or families with children. The children alone consist of about twenty-five percent of the uninsured people. Some of these children are eligible even though the parents are not. Welfare laws limit the time an adult can be eligible for Medicaid. These limits do not apply to their children. Another fact is some states set the level of income to receive health care so low that it is below the federal poverty line. Essentially what they are saying is that we know that you are poor, but you are not poor enough. The poor are often seeking medical care and by the time they receive care; it is too late because they are already dead.

To elaborate on the lack of care and delayed care, a study showed that ten percent of the population received absolutely no care at all and more than four million people actually in need of care are forced to do without. Some believe that the U.S. has moved to a two- tier medical system. Essentially the poor are provided with second-class care, while people who can pay for insurance receive the best care available. There has been evidence that people without insurance are discharged earlier and receive fewer diagnostics than people who do pay for insurance. It never seems that people have problems buying new cars or clothes, but when it comes to health care there is a serious price to pay if you cannot afford it.

Recommended Solution:

The intense debate over health care has produced a number of proposed solutions to the problem. Each solution differs in ways of controlling cost and how and to what extent access might be provided. The single-payer plan could be one solution to the problem. This plan would automatically enroll all citizens and residents in a health insurance plan. Everybody would be provided with the basic minimum of medical care and entitled to choose their physician. Private insurers would offer policies for benefits that are not covered in the basic package. The advantages of this plan would be universal coverage, portability of insurance, accessibility, and comprehensiveness. It cuts down overhead expenses and preserves people s freedom to choose physicians. The single-payer system is simple and the most direct way of providing for universal coverage. Although appealing, the plan is too radical for the U.S. because it involves the government too intensely in health care. There have been similar successful systems in Canada and Hawaii.

The Canadian health care system, which is similar to the single-payer plan, eliminates most forms of private medical insurance. This plan is paid by federal and provincial taxes. The system principles are not much different from U.S. Social security or Medicare. There are several principles of the plan: universality, portability, accessibility, comprehensiveness, and public administration. Under this system, every citizen is covered and they can move to another province, change jobs, or be unemployed and retain their coverage. Everyone has access to physicians and hospitals. Medically necessary treatment must be covered and also the system is publicly operated and publicly accountable. Public administration has created much controversy because it is suggested that this principle be adopted in the U.S. Canada does not spend as much as the U.S., but everybody is covered in the Canadian policy. The Canadian system has a couple of weaknesses. One problem is that they spend too much on high- cost medical technology. Technology is not par to the U.S. Another weakness is there are restrictions to specialized care, equipment, and procedures. The U.S. would not be able to adopt the Canadian system because similar to the single-payer plan, it is too radical. It would probably cost the U.S. too much money to provide the kind of plan that everybody would prefer.

The Hawaiian system requires all employers to provide health insurance for their full-time workers. Part-time workers, that work less than twenty hours a week, are not required to be included in the coverage. As a result of the system, ninety-six percent of the 1.2 million Hawaiians have health coverage. In 1975, seventeen percent of Hawaiians had no insurance. The Centers for Disease Control put Hawaii either at or near the top of the list of states in lowering infant mortality, increasing longevity, and lowering rates of premature death from cancer, lung disease, and heart disease (825). A positive of the system is the cost-saving aspect. The pooled workers that are covered by a given insurance plan are drawn from the entire population. Spreading the risk in a large pool provided lower costs per person. The factors that help the Hawaiian system s success are small population, healthful climate, and large number of workers in the union. Hawaii also has a low number of unemployment.

Basically, the U.S. is not going to be able to adopt any system because that would be too drastic. They can utilize different aspect of the other plans. I believe that everybody should have the right to have health care, but because of costs the U.S. will not be able to do this very quickly. There could be some changes in the near future because of all the debating. If the U.S could employ some of the high percentages of coverage and low costs of Canada, then the population of the U.S. would be content. At the same time, any beneficial change in the U.S. health care system would please the population.

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