Scarcity of Healthcare Resources - Essay Example

Scar of Healthcare Resources Introduction: Scar of healthcare resources is an issue that is not limited to any part of the world and is a matter of concern universally. Access to healthcare and availability of healthcare to the large number of people that inhabit this planet is an issue that still dominates the concern of governments, communities and health aid agencies. The availability of healthcare has been found to be inversely proportionate to the population that inhabits that geographical area. Biomedical ethical issues have further aggravated the scarcity of healthcare services. The philosophical biomedical ethical issues have developed in complexity as they are influenced by a number of factors including religion, law, anthropology and sociology. Each of the influencing factors is complex by themselves and this tends to make the biomedical ethical issues even more confusing for the healthcare service providers, especially as they are in the forefront in the use of the massive technological developments that have been in the recent past. History of Biomedical Ethics: The origins of the practical normative ethics of biomedical ethics goes back to the school of thought normally associated with Hippocrates and the famous Hippocratic oath. This oath sums up the school of thought on the ethical principles of curing and healing. The emphasis in the early days of medical history was on healing and not on curing, as the means of curing diseases was limited. Helping people to cope with diseases that had inflicted them had more relevance. The mode of intervention was left to the judgment of the physician. Thus the first principles of biomedical ethics of beneficence and nonmaleficence were laid. Even today there are many who believe that the goals of medicine remain in these complimentary factors of curing and healing. The subsequent history of bio-ethics is limited to interpretations of Galen in the second century and the opposing views expressed by Vesalius thirteen centuries later. However the next significant step in the development of biomedical ethics was seen in 1803, through the expressions of Thomas Percival, in his work Medical Ethics. Percival expanded the prevalent biomedical ethics of beneficence and nonmaleficence to incorporate the idea of the professional responsibility of physicians and their responsibility to society. Thus introducing the third principle in development of biomedical ethics in the form of justice. Further development in the principles of bioethics was seen in the 1960s and 1970s. Concern on the medical treatment procedures without proper information being given to the patient or taking of their views was one part of this development. The second factor that contributed to this was the forced experiments conducted on humans by the Nazis as became evident from the Nuremberg Trials in 1947 and the incidents of medical research experiments on subjects without giving them proper advice on the risks involved. From this arose the need for the fourth principle of autonomy in biomedical ethics, which led to the doctrine of informed consent. The development of costly equipment to provide for medical intervention especially in life threatening situations and the scarcity of this intervention because of the cost of equipment led to the development of the fourth principle of justice in biomedical ethics that looks at the aspect of fair distribution of scant medical resources. These four principles of autonomy, beneficence, nonmaleficence and justice are central to biomedical ethics as per Beauchamp and Childress in their respected work Principles of BioMedical Ethics, which is widely accepted. (Glannon, W. (2002). INTRODUCTION TO THE HISTORY, TGHEORIES AND METHODS OF BIOMEDICAL ETHICS. Pp 1-8). Ramifications of the Principles of Biomedical Ethics: The principals of biomedical ethics are four in number namely, autonomy, beneficence, nonmaleficence and justice. These four principles need not be compatible. The case of the nurse in Zaire during the final days of the fight against the Ebola epidemic is an example of this incompatibility. One of the nurses involved in this action fell ill during the final days of the Ebola epidemic. Action by the Zairian physicians by transfusing whole blood of the nurse with one of the survivors may have been the factor that saved the life of this nurse. The foreign doctors objected to this mode of medical intervention, as they feared that the donor blood may be contaminated by other infecting organisms and thus could lead to infections like HIV/AIDS. There was also the possibility that the infection could be a less lethal infection like typhoid and medical intervention could take place at a later stage after confirmation. The Zairian doctors were not willing for this lack of action as they believed that this inaction could be fatal to the nurse in case it was an Ebola infection and more so since the nurse was willing for their intervention. The nurse recovered. (Rachels, J. (2002). Ethical Theory and bioethics. Pp 18-19). From the point of view of the principles of biomedical ethics both sets of doctors were right. The foreign doctors went by the reasoning that they were not sure that their action would be beneficial to the patient and the action being contemplated by the Zairian doctors could be harmful to her. This inaction by the foreign doctors was in keeping with the beneficence and nonmaleficence elements of the principals of biomedical ethics, as they were concerned in the welfare of the patient and thus supported by those who believe in the supremacy of these principles. The Zairian doctors were also concerned about the welfare of the patient but gave greater emphasis on the justice and autonomy aspects of the principles by making medical intervention available to the patient after getting the consent of the patient and thus acceptable to the supporters of the need to emphasize the principles of autonomy and justice in the biomedical practice. Both sets of doctors were right and both sets of doctors were wrong depending on which viewpoint is taken and this brings us to the aspect of conflicting views of the supremacy of the elements within the principles of biomedical ethics. The controversy arises from the approach that needs to be taken by the biomedical practitioners. Beneficence and nonmaleficence are steeped in the consequences of actions taken and hence may be considered as the consequential elements in the principals of biomedical ethics. Autonomy and justice are more concerned about the action that needs to be taken in keeping with the duty of the biomedical practitioners to their patients. Autonomy and justice elements of the principles of biomedical ethics pay scant heed to the consequences of their actions. These elements are called deontological elements in the principals of biomedical ethics. The consequential elements were the initial elements of the principals of biomedical ethics and there are many who claim that the newer elements of autonomy and justice are of more relevance with the changing world in keeping with the developments of humankind. The reasoning of what is good and what is bad could be impacted severely by religious and cultural backgrounds and thus could lead to inaction denying the patient the sort of medical intervention that the patient believes is required and thereby adding to the problem of scant healthcare resources. The rape victim who falls pregnant and is denied abortion on the basis of religious beliefs of the healthcare practitioner is being denied medical assistance even though she would like to have it. The consequences of this inaction by the medical practitioner on the patient are life long and are based upon the judgment of the medical practitioner that the conceived life is more valuable than the consequences on the rape victim and that the consequences of the taking of life is more important. This is an example of the conflict between the two sets of elements of the principals of biomedical ethics to the detriment of patients. These decisions may have to do with religious beliefs and so it would be useful to see the impact of religion and culture on the principles of biomedical ethics. Relevance of Religion and Culture: The impact of religion and culture in the field of biomedical practice has grown in significance due to globalization and the migration of people from a region of one religion and civilization to a region of another religion and civilization. This becomes marked when the contrast in the religion and culture are high. The example for this is the movement of people from Islamic religion moving to Christian areas like Europe. This clash of culture of religion and culture can be seen in Germany between the Muslims of Turkish origin and German healthcare practitioners. These conflicts are seen even in simple day-to-day healthcare practice. The simple examination procedure required by a healthcare practitioner in assessing the healthcare needs of the patient can become a violation of the physical integrity of the patient. Let us take the case of a female patient of Turkish Muslim origin having a need for healthcare service. The attending healthcare practitioner may be a male and many a time is so. In a culture that requires females to have the minimal interaction with males other than those of her immediate family, any attempt for physical examination would be a violation of her physical integrity. The patient may choose to do without attention to the healthcare need and the healthcare practitioner would have to let her go in keeping with principles of autonomy. In this case scarce healthcare resources are further aggravated by the impact of religion. The nursing care in a hospital is female dominated and let us look at the case of a male Turk requiring healthcare attention that has led to a surgical procedure such that he needs nursing care for all his daily routines. Such assistance may come form a female nursing attendant and the male Turk feels offended that his physical integrity has been violated. Diet is another issue with the Muslim patients in a healthcare facility. Alcohol and pork is taboo for them, whereas it is a regular item in the German menu. In case they feel that the food offered to them is contaminated by either alcohol or pork, they would choose not to eat and thus upset their diet regime. Ramadan is the month of fasting for the Muslims and though even the Koran exempts the sick from fasting it is quite common to see the sick not keep to the dosage of their medicines in keeping with the fasting requirements and putting themselves further in peril. Even the terminally ill are found to fast during the month of Ramadan, as they believe it is better to face death than to break the fasting requirements of Ramadan. These examples make it quite clear that religious and cultural requirements may cause people to avoid healthcare services or not to heed the healthcare intervention advice and the principle of autonomy would be broken if healthcare services were forced in such circumstances. (Ilkhilic, I. (2002). BIOETHICAL CONFLICTS BETWEEN MUSLIM PATIENTS AND GERMAN PHYSICIANS AND THE PRINCIPLES OF BIOMEDICAL ETHICS. The Experiences of Islamic Minorities in non-Islamic States). In addition to abortion one of the areas in which the Christian religion is at odds with the developments in the filed of healthcare is in the field of biotechnology and the direction that the application of these emerging technologies are likely to take healthcare to. The Christian religion with its roots in Divine intervention strongly opposes genetic engineering and stem cell research. This is because there is that strong impression that humankind is playing the role of God through genetic engineering. The rationale behind genetic engineering and stem cell research is the attempt to find a cure for diseases that have no cure so far and if no cure is possible a means to at least provide relief to the patients suffering with these chronic diseases. In short all the principles of biomedical ethics are satisfied by the rationale of genetic engineering in its search for cures. Beneficence, nonmaleficience, autonomy and justice are covered and it is only when the healthcare practitioners misuse the benefits of genetic engineering for pecuniary or other gains that the issue of genetic engineering not being in compliance with the biomedical ethical principles comes into play. The Christian religion will continue to oppose it as it is against the basic concepts of faith in the religion. (Reichhardt, T. (2004). Studies of Faith.) The future in genetic engineering may give cause for worry as far as the issue of autonomy of the healthcare seeker is concerned and the principals of beneficence and nonmalficience is concerned. This case provides enlightenment on that. Using genetic engineering to ensure a child without disease itself poses a dilemma to the healthcare provider, but when deaf parents request the means to ensure that their child is also deaf is an ethical dilemma for the healthcare practitioner of severe depth and dimension. A deaf couple did seek to have a deaf child and verified the genetic engineering possibilities of ensuring this. The genetic tests showed that this was not possible and the couple was so devastated that it took two years from them to overcome it and make the attempts to conceive a normal child. This a problem that is likely to develop in the future as and when advances in genetic engineering make such a possibility a reality and by then the principles of biomedical ethics would also evolve, as it has done and cover that eventuality providing a means to approach the ethical dilemma that such situations can create for healthcare practitioners. (Dennis, C. (2004). Deaf by design). The Issue of the Scarcity of Healthcare Resources: The scarcity of healthcare resources is impacted largely by the element of justice in the principles of biomedical ethics. The cost of making healthcare services in adequate measure to every citizen is a huge burden on any country. In the United States of America the healthcare resources made available costs the nation fourteen percent of its GDP. The amount of the nations resources that can be diverted to healthcare resources is always limited by the other demands on the resources and so it is necessary that the healthcare resources be utilized in the best manner possible. The principle of justice provides an ethical solution to this dilemma for health service practitioners in the rationing of the scarce healthcare resources. In the distribution of these resources it is necessary that those segments of society that be in a worse health condition receive more of these resources as their requirement is greater. So fair rationing of these resources in no way suggests equitable distribution of these resources. The sick are in greater need of the resources and the element of justice demands that they get a greater share of these resources in keeping with their needs. There is the requirement, however, to distinguish between the two kinds of sick people that are in greater need of these resources and identify them. The first is those who are in an acute condition and those that are chronically ill. Both these are in greater need of health services than the healthy. The acutely ill need to have their urgent healthcare needs provided for and done in a manner such that equal chances of receiving this healthcare is available to all the acutely ill. In the case of the chronically sick segment the health package created must be such that the health benefits that they receive as a result makes sure that they have the same chances of achieving and enjoying a health level similar to those who are healthy. The poor and the uninsured in the United States of America provide examples of a large part of the population in need of a health package that can help them hope to remain healthy. (Gannon, W. (2002). ALLOCATION OF SCARCE MEDICAL RESOURCES. Pp 401-402). The Elderly and Scarcity of Healthcare Resources: Increased life expectancy has seen a large increase in the elderly segment of population and increasing the demands on the already scant healthcare resources. The demands for healthcare services are in both the acute as well as chronic segments from the elderly. This comes from the aging process and its effects on the health condition of the elderly. This puts them in the segments with greater need for healthcare resources. Yet, there are some who suggest that the healthcare packages available to the elderly should be so tailored that the package tapers off after the achievement of a desired upper age limit. This amounts to telling the elderly that they are lucky to have lived so long and that they have been looked after for a long enough period and now they can no longer be allowed to put a strain on the health resources available. This suggestion is itself surprising and more so in a nation that spends more than $300 billion annually on national defense, $25 billion on tobacco products and even permits the spending of $500,000 on a Super Bowl commercial. The claims that the savings made on the healthcare provided to the elderly can be used better on the healthcare needs of the growing children, while noble in thought, is hardly a justification for reducing the healthcare resources available to the elderly. There are also no guarantees that these savings will be really spent on providing increased healthcare services to the young. The elderly need to be provided with adequate healthcare packages in keeping with their requirement of the healthcare services and not discriminated against. All the principles of biomedical ethics disfavor any discrimination of the elderly and in fact support enhanced healthcare facilities for them. (Callahan, D. (2002). Allocating Resources to the Elderly). Conclusion: The principles of biomedical ethics provide the healthcare service providers with a clear path through the minefields of moral dilemmas. The principle of justice in particular provides the beacon of light to prevent floundering in the growing difficulties faced in the distribution of scant resources. Healthcare practitioners need to implement these principles in their approach to providing healthcare services. Literary References Callahan, D. (2002). Allocating Resources to the Elderly. In CONTEMPORARY READINGS IN BIOMEDICAL ETHICS. Pp 405-411. Harcourt College Publishers. USA. Dennis, C. (2004). Deaf by design. nature. Volume 431. Issue no. 7011. pp 894-895. Glannon, W. (2002). ALLOCATION OF SCARCE MEDICAL RESOURCES. In CONTEMPORARY READINGS IN BIOMEDICAL ETHICS. Pp 401-402. Harcourt College Publishers. USA. Glannon, W. (2002). INTRODUCTION TO THE HISTORY, THEORIES AND METHODS OF BIOMEDICAL ETHICS. In CONTEMPORARY READINGS IN BIOMEDICAL ETHICS. Pp 2-6. Harcourt College Publishers. USA. Ilkhilic, I. (2002). BIOETHICAL CONFLICTS BETWEEN MUSLIM PATIENTS AND GERMAN PHYSICIANS AND THE PRINCIPLES OF BIOMEDICAL ETHICS. The Experiences of Islamic Minorities in non-Islamic States. Retrieved November 24, 2005, from, Medicine and Law, World Association for Medical Law, Vol. 21, Nr. 2, 2002, pp. 243-256. Web site: http://www.ruhr-uni-bochum.de/zme/healthliteracy/bioethicalconflicts.pdf. Rachels, J.. (002). Ethical Theory and bioethics. In Kuhse, H. and Singer, P. (Ed.), A COMPANION TO BIOETHICS. (pp. 18-19). Blackwell Publishing Ltd. U.K. Reichhardt, T. (2004). Studies of Faith. nature. Volume 432. Issue no. 7018. pp 666-667. Read More