Access to Health Care Ethical Issues
Introduction
As the American health care delivery system reels under the weight of fickle coverage, uncertain quality, and inefficiency, proposals on how to reform it have increased. While some of these proposals have focused principally on ameliorating quality, others have concerned themselves with reducing costs. All of these indirectly or directly address the question of access to health care. The principal goals of a first-rate health care are to cure disease, relieve symptoms, improving the quality of life, and prolonging life. Healthcare access has been an unending challenge to health care providers in the United States (McLean, 2013, p. 62). Health care managers must take into consideration important factors such as efficiency, effectiveness, and equity in designing systems that meet the goals of quality health care. The inherent philosophy may view health as being an essential human right, a political demand, an investment, expenditure, or a commodity for commerce. The design, policies, as well as operational arrangements will typically the philosophies that support the health care system, and therefore, access. The methods of funding, which include cost-recovery, cost sharing (insurance, be it government sponsored or private), fee-for-service, or free-of-fee (payments usually made via health levies or taxes), all present certain ethical difficulties that can compromise the ethical practices of healthcare namely justice, beneficence, autonomy, and non-mischief.
Justice and the Access to Healthcare
The question regarding access to health care fall principally under the principle of justice, which deals with concepts such as fairness, the right to and fair distribution of resources (McLean, 2013, p. 63). The issues concerning justice in health care into two broad but related dimensions, which include access and allocation. Access describes whether individuals who, or at least should be, entitled health care services are getting them. Some important points in discussing access comprise the right to health care, what comprises entitled health care services, as well as the impediments to these services. Conversely, allocation is the process used in determining how resources are disseminated for health care purposes for individuals and within populations. The question of allocation exists in three tiers (McLean, 2013, 63). The first tier, which is the social level, concerns itself with the amount of resources allocated by the government for use in the provision of health care. The second level relates to the decisions regarding the health care fraction of the federal budget, as well as where, how, and for whom the funds are spent. Finally, the third level relates to the individual patient.
Ethical Issues
The standard practice in health care comprises established guidelines and boundaries, with inclusive training, as well as competency evaluations. The primary commitment of any health care provider is to participate in the improvement of health, safety, and the well-being of patients. This demands a high degree of alertness and the institution of appropriate action with respect to any incidences of incompetency, illicit, inappropriate, or unethical practice by members of the team providing health care (Limentani, 1999, p. 397). No simple formulae exist for enforcing ethical values. While some treatments may meet the values in a significant way and, thus, should be incorporated as part of comprehensive health care, in other instances, it will suffice if the therapy meets a couple of ethical values in an ample way. Even though it may not be obligatory to meet all of the values, on certain occasions, the failure to provide one value may prevent the addition of the therapy in the adequate healthcare plan. For instance, if the effectiveness of the therapy has not been revealed, considerable benefit not demonstrated, or substitute therapy is accessible with similar benefits but at a lesser cost, then therapy should not be considered.
Cost
Cost only cannot be a cause to exclude or include a therapy, even though the cost compared to the benefit or efficacy is very important. It may be straightforward to implement cost consideration. If a certain therapy provides similar benefits as another but at significantly lower costs, then it is obviously preferable. Conversely, therapies that are less expensive and less successful, and those that are more expensive but with higher efficacies may also be acceptable. The cost of health care is dependent on the benefit accrued or lost from expenses or cost savings (Liegeois & Van, 2005, p. 453). Traditionally, the question of cost in the provision of health care has been viewed as an area of complex clinical choices, including the decision to withdraw or hold back treatment. This conceptual formulation disregards the dominant organizational dynamics that connect the delivery of health care with biomedical science.
Autonomy
The aspect of autonomy compels the health care provider to allow others the freedom of action in the access to health care. This gives the patients the right to partake in their individual treatments, as well as make important choices with respect to their plans of treatment. Informed assent rests upon autonomous principles (Liegeois & Van, 2005, p. 453). Those providing health care services must accord the patients the freedom to decline surgery, therapies, or any other medical processes. It is unlawful and unethical to coerce or use deceitful means in prompting a patient to undo his or her decision.
Veracity
The component of veracity in the access to quality health care is intimately connected to autonomy. This code binds the patient, as well as the physicians to be candid with each other and share all the relevant and important information. The principle also obliges the health care provider to carry out thorough and precise representations in the patient’s medical records.
Compassionate Deception
The dilemma with respect to compassionate deception usually arises from holding back information for the “good” of the patient. In most instances, the health care provider may mean well and may intend to protect the patient from psychological anxiety. Nonetheless, besides suicide deterrence and in cases of pediatric patients, medical practitioners should always disclose important information with those seeking treatment.
Non-Mischief
The principle of non-mischief compels the medical professional to desist from, or prevent harm to the patient. It may occasionally become difficult to conform to this standard because of the accidental undesirable reactions of patients to certain categories of drugs, which may also be beneficial to them. The advantages and drawbacks must be balanced in deciding upon the most excellent treatment method in all circumstances. In most instances, if there is no malice, and the most effective treatment is offered to the patient, the undesirable consequences are considered as unintended and spontaneous.
Beneficence or Benevolence
This aspect of health care access concerns itself with quality of health care and compels the health care managers to vigorously foster and participate in ensuring the patient’s health and welfare. A number of issues relating to quality of life come about in considering this principle. Contemporary medicine provides the means to extend an individual’s life beyond the possibility of any significant recovery. The quality of life of a patient in the course of and after an infirmity constitutes a vital consideration in such circumstances (Fulda & Lykens, 2006, p. 145). This offers a quandary regarding whether it is desirable to extend life irrespective of other conditions, or if providing comfort interventions only without the delay of death is the best course of action.
An advance directive refers to a document permitting an individual to decide on issues that pertain to their medical care such as the freedom to decline or accept medical treatments or surgical procedures. It permits the individual to give express directives to the hospital and the physician about their healthcare in the event that they are unable to convey their wishes.
A living will is an example of an advance directive and constitutes an important document for individuals who want to decide on what treatment they should get prior to incapacitation. It provides orders that apply to the medical treatment of an individual if he or she is terminally ill or in a condition of permanent comatose (Larkin, 2000, p. 97). This document should be as comprehensive and precise as possible to ensure that the desires of the patient about future care are granted. Complications with living wills come about because of the impracticality in forecasting the circumstances that may develop in the course of health care provision. The document may offer directions on a number of issues such as how and when to discontinue life support, the precise therapeutic interventions, as well as the alternatives for long-term care. In this regard, the living will often calls for further interpretation even in instances where its contents are explicit. The 1990 Patient Self-Determination Act expects all health care organization getting Medicare reimbursement to offer information on advance directives to grown persons.
Written advance directives are recognized as legally valid, although each state has different language, the range of decision-making, as well as the limitations. For this reason, it is wise for an individual to consult informed sources, such as legal practitioners, in matters concerning specific laws before carrying out an advance directive. If an individual becomes incapacitated without issuing an advance directive, surrogates, who are usually members of his or her family, may be assigned to make the decisions regarding their care. However, some states do not have such provisions and the doctors or health care institutions must depend on close family members to make such decisions. Difficulties may be experienced when family members are divided regarding these decisions. In such circumstances, the patient may be at the risk of receiving treatment interventions that are against their wishes. In the absence of an explicit guidance direction in such directives, the patient’s kin may have to endure the distressing experience of making hard life or death decisions.
Confidentiality
The confidentiality code is based on the Hippocratic Oath and compels health care practitioners to desist from disclosing private information about patients, even upon death. However, there are a number of exceptions to this principle. These include when the physician is required under the law to disclose information and when it is of assistance to the patient.
Access as an Ethical Issue: A policy Perspective
Health insurance coverage is among the most crucial determinant of health care access in America. This means that individuals who do not have coverage are not able to gain access to adequate medical care. Poverty appears to be the most prominent factor that contributes to the dearth of insurance coverage. A number of legislations have been passed in an attempt to ensure access to quality health care. These include Medicaid, Medicare, the Children’s Health Insurance Program and the ACA (Affordable Care Act), which significantly influence access. Medicaid is a form of social program meant to provide health care to individuals and households with low income while Medicare is a nationwide social insurance program whose goal is to ensure the access to health care through insurance for American citizens of the age of sixty-five and over, as well as young individuals with disabilities. Such policies have been implemented by the government over time and have been aimed at enhancing access to health care.
Conclusion
The American system of health care delivery has been plagued with problems of coverage, as well as inefficiency and uncertain quality. Most of the policies that have been implemented by the government have addressed the issue of cost at the expense of quality. Some of such policies include Medicaid, Medicare, and Affordable are Act. However, it is important to note that there is no objective way of prioritizing between cost and quality (McLean, 2013, p. 64). The principal objective of proper health care is to cure disease, ameliorate symptoms, improve the quality of life, and extend life. The United States has experienced incessant problems in the provision of quality health care.
References
Fulda, K. G., & Lykens, K. (2006). Ethical Issues in Predictive Genetic Testing: A Public Health Perspective. Journal of Medical Ethics, 32, 3, 143-147.
Larkin, G. L. (2000). Advance Directives. Advanced Course on Ethics in Oncology, 97-98.
Liegeois, A., & Van, A. C. (2005). Ethical Dilemmas in Community Mental Health Care. Journal of Medical Ethics, 31, 8, 452-456.
Limentani, A. E. (1999). The Role of Ethical Principles in Health Care and the Implications for Ethical Codes. Journal of Medical Ethics, 25, 5, 394-398.
McLean, M. R. (2013). Allocating Resources–A Wicked Problem. Health Progress, 94, 6, 60- 67.
