Ethics of Nursing Argue a Case for These Policies of Restrictions on Access Access to Health - Coursework Example

Your name:   Course name:         Professors’ name: Date: Access to health service sometimes can be restricted or conditional, and the types of health services access provided may not be appropriated for some social groups (Andrews, 2012, p. 18). Johnstone (2009) argues that, “access to healthcare is a controversial and a complex, and sensitive moral issue” (p.136). Johnstone (2009) goes further to state that, “there are some barriers- such as loss of weight for obese patient before surgery and stopping smoking for patients before surgery- to access of healthcare services that are put in place intentionally by healthcare services such as the governments and organizations in order to increase health access (Kelly, Yang, Chen and Bray, 2012, p.12). This paper will argue a case for these policies of restriction on access to health services on ethical grounds. Appropriate ethical principles will be used to support to support the argument. Obese or overweight patients are more likely to suffer from many illnesses, which is more likely to lead to admission to hospital ward and may required specialist tools or equipment for safe treatment and management (Chiolero and Paccaud, 2012, p.14). However, healthcare facilities may be ill equipped to provide treatment or care for obese or overweight patients. Obese patients have become clinical risk because most hospitals in Australia are ill-equipped to treat obese patients and this may lead to obese patients receiving suboptimal treatment (Kelly, Yang, Chen et al, 2012, p.16). Obese or overweight patients have been noted to take-up extra bed space in health facility, require additional nurses or physicians when undergoing treatment (Chiolero and Paccaud, 2012, p.25). In addition, obese patient will need an array of super-strength equipments to withstand their size and weight as part of their growing burden on the hospital treating them (Kuriyama, 2009, p.26). In most cases, other patients miss out treatment because obese patients may require two physicians for their session (Chiolero and Paccaud, 2012, p.26), while fewer beds have been placed into some wards because overweight or obese patients require bigger beds (Must, Spadino, Coakley and Donnelly, 2013, p.18). In addition, obese patients use more hospital resources because they stay longer in wards, though this can be attributed to delays experienced while obtaining specialist equipment to help obese patients cope when they have been discharged (Adler and Newman, 2010, p.15). In addition, obese patients may receive suboptimal treatment and medical personnel attending to the patient may sustain injury when attempting to mobilize obese or overweight patients. A paper from the Australia published in 2012 highlighted patient safety incidents that are associated with overweight or obesity (Kuriyama, 2009, p.26). Beneficence is an underlying principle in all healthcare, medicine and research (Kelly, Yang, Chen et al, 2012, p.18). Both nurses and doctors in Australia are guided by the Hippocratic Oath, which states: ‘ any medical practitioner is required to use treatment to help a patient according to his/her judgment and ability, but never with an intention for wrongdoing and causing injury to the patient (Must, Spadino and Coakley et al , 2013, p.24). At same time, nurses are required to adhere to the Code of Professional Conduct which states that nurses must act in a manner that promote and safeguard the well-being of patient (Kelly, Yang, Chen et al, 2012, p.19). Both nurses and physicians are required to do their best while providing medical care to a patient? If we continue down the road that every hospital in Australia must accommodate the medical needs of every obese or overweight patient then it means every healthcare facility in the country will be required to purchase MRI scanners and CT scanners to accommodate patients of all weights . In addition to these requirements, all hospitals will be required to maintain additional set of beds, bathroom fixtures, commodes, blood pressure cuffs, and a plethora of other utilities or equipments that will be solely used to treat overweight or obese patients. This will be expensive to hospitals across Australia in term of workforce and resources that has been allocated in those hospitals (Andrews 2012, p.25). For example, a healthcare facility can transfer a bariatric patient if they don’t have a bariatric surgeon. Shouldn’t they also be able to transfer trauma patients if they don’t have trauma specialist. Rising costs of caring for obese patients results in increased costs for everybody (Allender and Rayner, 2009, p.32). Even the most basic medical management can be made difficult by overweigh by obesity. Obese or overweight patients have been found to be at increased risk for numerous medical problems, and this can affect surgical outcome (Kuriyama, 2009, p.34). Therefore, hospitals across Australia are right to ask every obese patient to lose weight before they can be listed for surgery. There is “strong clinical evidence” that obese or overweight surgical patients have a higher risk of complications. These include infections, breathing problems and longer recovery times (Dietz, 2009, p.15). For example, for an obese patient planning to have a knee replacement surgery, the patient will be doing himself or herself a big favor by losing weight two months before the surgery is performed because by so doing they will reduce the risk of post surgery complications that are associated with obesity . A report published in the Journal of Bone and Joint Surgery (Oct. 2012) states that overweight or obese patients are found to be at higher risk of complication following total knee replacement procedure such as infections ((Kuriyama, 2009, p.35). With the Non-maleficence principle, physicians or nurses are required to refrain from providing ineffective medical treatment. This principle cannot be applied in the treatment of obese or overweight patient since many beneficial health services in obese patient have serious risks. But the pertinent ethical issue when dealing with an obese patient is whether the benefits will outweigh the burdens (Kuriyama, 2009, p.34). The Journal of Bone and Joint Surgery (Oct. 2012) further state that surgeons should be prepared to recommend to their overweight or obese patients, one month before surgery, professionals who can assist their patients with losing weight (Kuriyama, 2009, p.34). There are risks when a normal patient is given an anaesthetic injection but there is a strong clinical evidence that proves that the same risk is three times higher when it involves an obese or overweight patient (Patkar, Vergare and Kit, 2012, p.35). An obese patient is more likely to get infections, suffer serious breathing problems, and have heart, kidney and lung complications. In addition to these complications, obese patients also take long to recover and have a higher risk of dying while under the anesthetic. So for these health complications, obese or overweight patients should not be allowed to surgery until they have recommended weight or have lost weight (Dietz, 2009, p.23). Patients who smoke especially the obese ones should be told to quit, at least temporarily for one month, before they face anesthesia and surgery. Smoking has often been a source of much anxiety for many patients who are addicted to cigarette (Kaminsky and Gadaleta, 2010, p.24). The Australia government has strengthened its smoking policy where surgery patients are being asked if they smoke, and smokers are given referrals to help them stop smoking before their surgery (Ho and Tyndale, 2009, p.13). These guidelines have offered smokers best chances to avoid life threatening complications (Ranny, Melvin and Andrews, 2013, p.32). According to study conducted in Australian, people who smoke are at greater risk of numerous complications as compared to non-smokers, these complications include heart attacks, pneumonia and wound infections (Dietz, 2009, p.24). Non-maleficence reminds remind physicians and nurses that their main concern when treating smokers is to do no harm (Ranny and Melvin et al, 2013, p.32). In the course of treating a smoker, there are some situations-for example choosing between carrying out surgery to a patient who smoke and referring the patient to come after two week when he has stopped smoking- in which harm seems inevitable, and physicians are morally bound to choose a lesser of the two evils, although the lesser evil may be determined by the situation (Glassman, Dimar and Bope, 2010, p.14). Therefore patients who are smokers should be forced to temporarily quit smoking for the simple reasons that nicotine the major element found in cigarette increases the patient’s blood pressure and heart rate, making the patient heart to work harder so that it needs more oxygen (Glassman and Dimar et al, 2010, p.15). Therefore, smoking has been seen to increase the risk for serious complications for smokers who have undergone a major surgery. In the current study, smokers have high risk for heart attack, pneumonia, blood clots and even death post-surgery as compared to non-smokers and those patients who have stopped smoking (Glassman and Dimar et al, 2010, p.16). There are many benefit for a patient to quit smoking at least one month before a major surgery. For example, within 24-36 hours of stopping smoking, there will be a decrease in the effects of carbon monoxide (CO) in the patient body and nicotine in the patient’s blood would be reduced. This will increase and improve patient’s oxygen level supply and reduce the oxygen requirement of the patient (Glassman and Dimar et al, 2010, p.25). This is seen as good from the cardiovascular standpoint. In addition, cigarette smoking is seen to increase the risk factors for postoperative complication across a spectrum of surgical specialties as compared to non-smokers (Ho and Tyndale, 2009, p.26). Patients who smoke and have been operated are at high risk of readmission, have longer hospital stays, have an increased risk of in-hospital mortality and more likely to be admitted to an intensive care unit. In Australia, most doctors require smokers to stop smoking at least three to six weeks before a surgery. There is a sound reason for denying patients surgery before they abandon their habit (Glassman and Dimar et al, 2010, p.35). Studies have shown that smokers don’t do as well as non-smokers on the surgery table. These kinds of patients are prone to risky complications, such as blood clots and lung infections, resulting in stroke or heart attack. In addition, smokers also consume valuable health-care resources (Dietz, 2009, p.34). Non-maleficence requires physicians and nurses to follow that method of treatment that will benefit the patient and prevent the patient from any harm (Ranny and Melvin et al, 2013, p.15). It is only ethical for a physician to perform surgery to a patient who has quit smoking at least 2 to 3 weeks where his chances of surviving are higher than to perform surgery to a patient who has not quit smoking, his chances of surviving are low and who is prone to risky complication during surgery such as blood clots and post-surgery complications such as lung infections, or heart attack (Ranny and Melvin et al, 2013, p.16). Therefore, “if society is going to spend thousands of dollars to treat them, it only fair for doctors to ask their patients to quit their risky habit because it will contribute to their chances of survival if they went through surgery” (Ranny and Melvin et al, 2013, p.16). There is a worrying trend on bad outcomes on the performance of a physician, which have been aggravated by smoking. This could tarnish a physician’s performance, with “report cards” separating separating the profession's stars from its screw-ups (Glassman and Dimar et al, 2010, p.35). For example, if a surgeon reputation is on the line, there no way he can be able to do surgery to a patient who has not stop smoking. According to a report by National Health Service, smokers have been found to take more time to recover from their surgery, blocking beds and ultimately costing more to treat. It should be a norm for all smoking patients to quit the habit prior to their treatment (Glassman and Dimar et al, 2010, p.36). If patients abandon their smoking habit prior to their planned operation it will improve their recovery. It would reduce lung and heart complications and wounds would heal faster. The purpose of these restrictive policies is not to deny patient access to surgery but to see if the outcomes can be improved. The action of a physician should support the principle of nonmaleficence. For example, there is a high chance of a patient who smokes to die in the operating table. If a surgeon fails to advice his or her patient before surgery to stop smoking at least 2 to 3 weeks, he or she is placing the patient in a dangerous situation (Glassman and Dimar et al, 2010, p.34). While there is no specific intent to harm, reasonable care was not taken to avoid harm. Breach of the obligation to cause no harm in the absence of a specific intent to harm is called "negligence" and may be treated as such under the law (Ranny and Melvin et al, 2013, p.35). In conclusion, obese and smoking patients should be denied health treatment (Ranny and Melvin et al, 2013, p.37). In exception, if the patient would be found to not have enough time to not have time to quit smoking or lose weight prior to their operation due to risk of life, then surgery procedure should be given. Hopefully restrictive policies would encourage those who smoke and those who are obese to change their lifestyles, without forcing them with the predicament of death. Penalizing risky behavior on patients who are overweight or are smokers would benefit the healthcare industry by discouraging such behaviors, significantly saving lives and decreasing health services costs. References Adler, N.E & Newman, K. (2010). Socioeconomic disparities in health: pathways and policies. Health Aff (Project Hope), 21(2),10-76. Andrews, R.A. (2012). Surgical management of severe obesity. New England Journal of Medicine, 50,14-65. Allender, S & Rayner, M. (2009). The burden of overweight and obesity-related ill health in the UK. Obes Rev, 8:4–53. Chiolero, A, & Paccaud, M.S. (2012). Viewpoint: An obesity epidemic booga booga? Eur J Public Health, 19,5-65 Dietz, W. H. (2009). Overweight in childhood and adolescence. New England Journal of Medicine, 350:8-85. Glassman, S.D., Dimar, J.R. & Bope, E. T. (2010). The efficacy of rhBMP-2 for posterolateral lumbar fusion in smokers. Spine, 32, 16-69. Ho, M.K. & Tyndale, R.F. (2009). Overview of the pharmacogenomics of cigarette smoking. The Pharmacogenomics Journal, 7: 2-98. Kaminsky, J & Gadaleta, D. (2010). A study of discrimination within the medical community as viewed by obese patients. Obes Surg, 12, 4–88. Kelly, T., Yang W., Chen, C.S & Bray, G.A. (2012). Global burden of obesity in 2005 and projections to 2030. Int J Obes, 32,1-57. Kuriyama, S. (2009). Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan. J Epidemiol, 16, 13–44. Must, A, Spadino, J, Coakley, E.H & Donnelly, J. E. (2013). The disease burden associated with overweight and obesity. JAMA, 28, 15–29. Ogden, C.L., Carroll, M.D., Kit B.K, & Flegal, K.M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. Journal of the American Medical Association , 30(5),4-490. Patkar, A.A., Vergare, M.J & Kit, B.K. (2012). Tobacco smoking: Current concepts in etiology and treatment. Psychiatry, 66, 18-199. Ranny, L., Melvin, C & Andrews R.A. (2013).  Systematic review: Smoking cessation interventions strategies for adults and adults in special populations. Annals of Internal Medicine, 14, 845-856. Thomsen, T., Villebro, N & Møller, A.M. (2010). Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews, 66, 13-49. Read More

In addition, obese patients use more hospital resources because they stay longer in wards, though this can be attributed to delays experienced while obtaining specialist equipment to help obese patients cope when they have been discharged (Adler and Newman, 2010, p.15). In addition, obese patients may receive suboptimal treatment and medical personnel attending to the patient may sustain injury when attempting to mobilize obese or overweight patients. A paper from the Australia published in 2012 highlighted patient safety incidents that are associated with overweight or obesity (Kuriyama, 2009, p.26). Beneficence is an underlying principle in all healthcare, medicine and research (Kelly, Yang, Chen et al, 2012, p.18). Both nurses and doctors in Australia are guided by the Hippocratic Oath, which states: ‘ any medical practitioner is required to use treatment to help a patient according to his/her judgment and ability, but never with an intention for wrongdoing and causing injury to the patient (Must, Spadino and Coakley et al , 2013, p.24). At same time, nurses are required to adhere to the Code of Professional Conduct which states that nurses must act in a manner that promote and safeguard the well-being of patient (Kelly, Yang, Chen et al, 2012, p.19). Both nurses and physicians are required to do their best while providing medical care to a patient?

If we continue down the road that every hospital in Australia must accommodate the medical needs of every obese or overweight patient then it means every healthcare facility in the country will be required to purchase MRI scanners and CT scanners to accommodate patients of all weights . In addition to these requirements, all hospitals will be required to maintain additional set of beds, bathroom fixtures, commodes, blood pressure cuffs, and a plethora of other utilities or equipments that will be solely used to treat overweight or obese patients.

This will be expensive to hospitals across Australia in term of workforce and resources that has been allocated in those hospitals (Andrews 2012, p.25). For example, a healthcare facility can transfer a bariatric patient if they don’t have a bariatric surgeon. Shouldn’t they also be able to transfer trauma patients if they don’t have trauma specialist. Rising costs of caring for obese patients results in increased costs for everybody (Allender and Rayner, 2009, p.32). Even the most basic medical management can be made difficult by overweigh by obesity.

Obese or overweight patients have been found to be at increased risk for numerous medical problems, and this can affect surgical outcome (Kuriyama, 2009, p.34). Therefore, hospitals across Australia are right to ask every obese patient to lose weight before they can be listed for surgery. There is “strong clinical evidence” that obese or overweight surgical patients have a higher risk of complications. These include infections, breathing problems and longer recovery times (Dietz, 2009, p.15). For example, for an obese patient planning to have a knee replacement surgery, the patient will be doing himself or herself a big favor by losing weight two months before the surgery is performed because by so doing they will reduce the risk of post surgery complications that are associated with obesity .

A report published in the Journal of Bone and Joint Surgery (Oct. 2012) states that overweight or obese patients are found to be at higher risk of complication following total knee replacement procedure such as infections ((Kuriyama, 2009, p.35). With the Non-maleficence principle, physicians or nurses are required to refrain from providing ineffective medical treatment. This principle cannot be applied in the treatment of obese or overweight patient since many beneficial health services in obese patient have serious risks.

But the pertinent ethical issue when dealing with an obese patient is whether the benefits will outweigh the burdens (Kuriyama, 2009, p.34). The Journal of Bone and Joint Surgery (Oct.

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