As my healthcare ethics course comes to an end, I can only be reminded of the day to day situations in which I either read or hear about health related ethical dilemmas. The knowledge I have gained throughout this course has significantly increased my awareness of ethical situations in healthcare. I am grateful for the opportunity to expand my understanding of the healthcare field in regard to ethics and will undoubtedly use the information learned in this course throughout my career as a future healthcare manager. I would especially like to thank Dr. Dawn Oetjen, my healthcare ethics professor, for making me aware and appreciative of the many different ethical situations in this challenging yet rewarding field.
My final blog of the semester focuses on an article that I found on msnbc.com, titled “China restricts organ transplants for foreigners.” From just perusing the website’s health page and briefly looking at the various article titles, I knew immediately that this particular article would have a number of ethical issues! The article reports that China is restricting organ transplants for foreigners (i.e., patients from Hong Kong, South Korea and Japan), giving precedence to China’s patients (The Associated Press, 2007). The decision to restrict organ transplants for foreigners was a result of China’s attempt to perform the majority of its transplants for foreigners, who comprised nearly 30 to 40 percent of China’s patients (The Associated Press, 2007). According to the article, “China faces a severe shortage of human organs, estimating that out of 1.5 million people who need transplants in China each year, only about 10,000 operations are carried out.” This troubling statistic is fueled by its country’s belief of not removing one’s organs before burial. The article also reported that many of the country’s organ donors may be executed prisoners who did not give permission for donating their organs.
The ethical implications behind this story are endless. For starters, the fact that China was denying its own citizens organ transplants in an effort to make more money from foreigners is clearly unethical and most disturbing. Second, now that China is implementing guidelines that will now give priority to its citizens [for organ transplants] and ignore foreigners is unethical as well. The country is ultimately just substituting one problem for another. China may now be better able to treat more of its patient population, but is withholding treatment from the country’s foreigners. Should not patients from Hong Kong, Japan and South Korea be eligible for care? Do they not deserve medical care, too? Does being a foreigner automatically disqualify patients from receiving much needed treatment? Could one imagine America making such a claim? Turning away patients for medical operations because they are visitors and/or foreigners from other countries? Of course not! Such a practice would be deemed as extremely unethical in this country. Why should this type of unethical behavior be allowed in other countries? Perhaps they do not have the same ethical principles as America does. However, the importance of human life and the right to receive medical care should be the same “across the board,” regardless of which country one resides in or how much money he or she has.
Furthermore, the fact that China’s citizens do not believe in donating their organs before burial only perpetuates the problem associated with the country’s shortage of human organs. It would certainly be unethical for China to demand that its citizens donate their organs before death as this would interfere with one’s belief system and would be considered forceful by nature. However, if China can limit the number and sex of their children, is it out of the realm of possibility to think the country could create a better solution to their problem? I am sure that some of China’s citizens donate their bodies to science or what about the idea of scientists cloning and/or growing organs? Although it could be argued that the latter would prove to have ethical ramifications as well. In any event, with such a high number of individuals needing organ transplants and not receiving such treatment, the Chinese government must consider alternative options. It is also unethical to harvest the organs of executed prisoners in China without their consent to do so. Even though these individuals are in fact prisoners, it does not necessarily give China the right to take their organs. Informed consent should be considered in this case if not mandated.
Lastly, the above story is a good example of how healthcare ethics differ from country to country. What ethical obligations and principles are practiced in one country may be viewed completely different in another country. However, as stated beforehand, whether the practice of medicine exists in America or India for that matter, it is still the practice of taking care of human lives. There should not be conditions set on human life or on the medical care that individuals receive. In a perfect world, every human would have full access and coverage to healthcare and treatment. Healthcare should not in anyway be a luxury for the rich or privileged, but a fundamental right for all humans around the world.
References:
The Associated Press (2007, July 3). China restricts organ transplants for foreigners: New guidelines will regulate procedure, give priority to Chinese patients. Retrieved on July 4, 2007, from http://www.msnbc.msn.com/id/19584937/
Wednesday, July 4, 2007
Blog 7: My Take on the Great Debate!
Currently, my course on healthcare ethics is challenging students through the use of ethical debates. Different groups of students (i.e., affirmative) are paired up with another group (i.e., negative) to argue either for or against a particular topic in healthcare ethics. I have found this process of debating one another quite enjoyable and throughout the debate I have realized the intent of such an activity. Although each side may argue their topic until they are blue in the face, ultimately each side comes to the conclusion that their topic can be viewed both affirmatively and negatively. Moreover, a great healthcare manager should posses the ability to see “both sides of the spectrum” when making an ethical decision in the field of healthcare. It is my opinion that a healthcare manager cannot just view ethical dilemmas in medicine as black or white, but look at situations with a “gray” set of eyes. Due to the “gray” nature of ethics anyway, one must be capable of seeing and understanding both sides of an ethical argument.
In an effort to not produce “spoilers” for my group’s debate topic and conclusion, I have chosen to post my thoughts on another group’s issue, “Health care organizations should accommodate patient’s requests for gender or culturally sensitive special treatments.” If given the choice to argue this debate, I would have chosen the affirmative side. However, I could easily argue the negative position for this particular topic as well. With today’s ever changing environment and society, it is only natural for our healthcare system’s environment to change as well. During the past few years, our country has continued to see an influx of individuals moving to America. These people come from different parts of the world where they not only speak a different language, but practice different beliefs and values. Their culture is not like that of America and what might be culturally sensitive in one country may not be the case in another country. Individuals moving to America may have different norms, taboos, customs and ideas. Therefore, as a nation that embraces new cultures and supports the right to express oneself, it would only be fitting that our country’s industries do the same.
In the field of healthcare, there exists a multitude of patients from a variety of different countries, backgrounds, religions and so on. Today’s healthcare environment is not only diverse, but is also very competitive. In order for a healthcare facility to successfully compete, it is essential to accommodate the needs and desires of its patients. This might include anything from employing healthcare personnel who speak different languages and are knowledgeable about culturally sensitive medical issues to performing procedures for patients who wish to change their sexual identity (i.e., transgendered patients). Delivering the types of services and care a patient requests and producing high levels of patient satisfaction are two keys to operating and maintaining a successful practice. After all, it is the patients who contribute to making the healthcare industry a successful one. Without the patients, there would be no need for providers or facilities.
Lastly, it would be in some way unethical to deny patients their preferences to gender or culturally sensitive treatments. One could argue that by not treating the patient in the manner that he or she requests, such an act could be considered discriminatory in nature and as a result, reflect very poorly on a healthcare organization. As a future healthcare manager, I would not like for my hospital to take on a discriminatory reputation and be viewed as not making an effort to accommodate our patients’ requests. Furthermore, the practice of medicine includes making the patient as comfortable as possible. Healthcare is an industry that deals with human life, and to not treat patients as a result of their gender related or culturally sensitive requests for treatment would be a violation of ethical conduct and care. Again, in today’s culturally sensitive environment, one must take extra care to ensure a culture of acceptance and respect in a healthcare organization. Denying and rejecting the medical needs of patients is not only unethical but is inconsistent with the very practice of medicine.
In an effort to not produce “spoilers” for my group’s debate topic and conclusion, I have chosen to post my thoughts on another group’s issue, “Health care organizations should accommodate patient’s requests for gender or culturally sensitive special treatments.” If given the choice to argue this debate, I would have chosen the affirmative side. However, I could easily argue the negative position for this particular topic as well. With today’s ever changing environment and society, it is only natural for our healthcare system’s environment to change as well. During the past few years, our country has continued to see an influx of individuals moving to America. These people come from different parts of the world where they not only speak a different language, but practice different beliefs and values. Their culture is not like that of America and what might be culturally sensitive in one country may not be the case in another country. Individuals moving to America may have different norms, taboos, customs and ideas. Therefore, as a nation that embraces new cultures and supports the right to express oneself, it would only be fitting that our country’s industries do the same.
In the field of healthcare, there exists a multitude of patients from a variety of different countries, backgrounds, religions and so on. Today’s healthcare environment is not only diverse, but is also very competitive. In order for a healthcare facility to successfully compete, it is essential to accommodate the needs and desires of its patients. This might include anything from employing healthcare personnel who speak different languages and are knowledgeable about culturally sensitive medical issues to performing procedures for patients who wish to change their sexual identity (i.e., transgendered patients). Delivering the types of services and care a patient requests and producing high levels of patient satisfaction are two keys to operating and maintaining a successful practice. After all, it is the patients who contribute to making the healthcare industry a successful one. Without the patients, there would be no need for providers or facilities.
Lastly, it would be in some way unethical to deny patients their preferences to gender or culturally sensitive treatments. One could argue that by not treating the patient in the manner that he or she requests, such an act could be considered discriminatory in nature and as a result, reflect very poorly on a healthcare organization. As a future healthcare manager, I would not like for my hospital to take on a discriminatory reputation and be viewed as not making an effort to accommodate our patients’ requests. Furthermore, the practice of medicine includes making the patient as comfortable as possible. Healthcare is an industry that deals with human life, and to not treat patients as a result of their gender related or culturally sensitive requests for treatment would be a violation of ethical conduct and care. Again, in today’s culturally sensitive environment, one must take extra care to ensure a culture of acceptance and respect in a healthcare organization. Denying and rejecting the medical needs of patients is not only unethical but is inconsistent with the very practice of medicine.
Sunday, July 1, 2007
Blog 6: Pulling the Plug...an End of Life Decision
An article on ABCnews.com stirs up another controversial discussion on end of life decisions. According to the report, a man by the name Jesse Ramirez suffered severe injuries to the brain due to a car accident. As a result, Ramirez was in a coma for over a week. The doctors told his wife that her husband may not recover and that she would need to make an end of life decision for him. After only one week, the wife decided to have her husband’s feeding tubes removed. However, Ramirez’s family members appealed the decision and won. Within weeks, Ramirez regained consciousness and was able to interact with loved ones (Childs, 2007).
One expert in the field suggests that it takes many weeks to make an end of life decision for a loved one. Ramirez’s wife made the decision in just nine days. Experts also believe that spouses are better suited for making end of life decisions than family members because they know more about the loved one (Childs, 2007). On one hand, this fact may be true for some individuals. Spouses often spend more time with one another than with family members and one could argue that a spouse truly knows the wants, needs and desires of his/her significant other. However, does this idea still hold true in times of a spouse’s medical needs? What if a couple never discusses his/her medical wishes with their spouse in relation to end of life decisions and medical care? After all, such a topic is not one that couples often discuss over date night or in passing conversation. Think about it, have you and your significant other ever discussed the possibility of having to end one another’s life during a medical crisis? The answer is probably not.
So, is it safe to assume that all spouses discuss end of life decisions with one another? What is the result if the answer to the above question is no? Such consequences can be seen in such cases as the story above and Terri Schiavo. The decision to end a loved one’s life is anything but easy. How does one know when to “pull the plug” so to speak? Should a family member or spouse base their decision on what the provider recommends? What if the provider suggests that a loved one end the life of the patient but the loved one chooses not to and as a result, the patient wakes up and/or recovers from his/her condition? Could the provider (i.e., doctor) ultimately be charged with malpractice in that he/she recommended an end of life decision when such a decision was not appropriate? In the case of the above story, should Ramirez’s wife be charged with a crime due to the fact that she wanted to end her husband’s life when not necessary? Who should be responsible for making such a difficult and personal decision? Clearly, the above story demonstrates the ethical challenges involved when dealing with end of life decisions.
According to Hofmann & Nelson (2001), “a medical error can be defined as either a mistake in execution or a problem of planning (the intended action itself was not correct).” Based on the definition of a medical error, could it be feasible for a provider to be charged with malpractice who recommends prematurely ending the life of a patient and then his/her patient recovers? In this case, the intended action of ending a patient’s life was not correct. What (if any) implications would there be for this situation? Could the family of the recovered patient sue the hospital, medical provider or the spouse who wanted to make such a decision? Do ethical guidelines exist for assisting a spouse and/or family member with making an end of life decision if the patient does not have a “living will?” Should it be the decision of someone other than the patient to make such a decision? Should family members and/or loved ones even have the “right” to end someone’s life? What if a patient has a living will but the family and/or loved ones take the situation to court and try to have the will amended? If a spouse and the patient’s family are both fighting over a decision, who wins and why? How can one decipher between such legal and ethical decisions? Are they even the same?
The preceding paragraphs should at least cause an individual to begin thinking about end of life decisions. Do you have a living will? Would your friends and/or family know what your medical desires and/or wishes would be if you were injured and in a coma? Have you and your significant other and/or spouse discussed such issues? Do you even know what you would want for yourself if one day faced with a brain injury and rendered unconscious? Confronting these issues may not be easy; generally human beings do not like to think about their own mortality and end of life decisions. However, it is so very important to talk about one’s medical wishes if ever faced with an end of life decision in an effort to avoid legal and ethical complications with loved ones.
References
Childs, D. (2007, June). Pulling the Plug: Ethicists Debate Ramirez Case. ABC News Medical
Unit. Retrieved on June 28, 2007, from http://abcnews.go.com/Health/story?id=3325418&page=1
Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago: Health
Administration Press.
One expert in the field suggests that it takes many weeks to make an end of life decision for a loved one. Ramirez’s wife made the decision in just nine days. Experts also believe that spouses are better suited for making end of life decisions than family members because they know more about the loved one (Childs, 2007). On one hand, this fact may be true for some individuals. Spouses often spend more time with one another than with family members and one could argue that a spouse truly knows the wants, needs and desires of his/her significant other. However, does this idea still hold true in times of a spouse’s medical needs? What if a couple never discusses his/her medical wishes with their spouse in relation to end of life decisions and medical care? After all, such a topic is not one that couples often discuss over date night or in passing conversation. Think about it, have you and your significant other ever discussed the possibility of having to end one another’s life during a medical crisis? The answer is probably not.
So, is it safe to assume that all spouses discuss end of life decisions with one another? What is the result if the answer to the above question is no? Such consequences can be seen in such cases as the story above and Terri Schiavo. The decision to end a loved one’s life is anything but easy. How does one know when to “pull the plug” so to speak? Should a family member or spouse base their decision on what the provider recommends? What if the provider suggests that a loved one end the life of the patient but the loved one chooses not to and as a result, the patient wakes up and/or recovers from his/her condition? Could the provider (i.e., doctor) ultimately be charged with malpractice in that he/she recommended an end of life decision when such a decision was not appropriate? In the case of the above story, should Ramirez’s wife be charged with a crime due to the fact that she wanted to end her husband’s life when not necessary? Who should be responsible for making such a difficult and personal decision? Clearly, the above story demonstrates the ethical challenges involved when dealing with end of life decisions.
According to Hofmann & Nelson (2001), “a medical error can be defined as either a mistake in execution or a problem of planning (the intended action itself was not correct).” Based on the definition of a medical error, could it be feasible for a provider to be charged with malpractice who recommends prematurely ending the life of a patient and then his/her patient recovers? In this case, the intended action of ending a patient’s life was not correct. What (if any) implications would there be for this situation? Could the family of the recovered patient sue the hospital, medical provider or the spouse who wanted to make such a decision? Do ethical guidelines exist for assisting a spouse and/or family member with making an end of life decision if the patient does not have a “living will?” Should it be the decision of someone other than the patient to make such a decision? Should family members and/or loved ones even have the “right” to end someone’s life? What if a patient has a living will but the family and/or loved ones take the situation to court and try to have the will amended? If a spouse and the patient’s family are both fighting over a decision, who wins and why? How can one decipher between such legal and ethical decisions? Are they even the same?
The preceding paragraphs should at least cause an individual to begin thinking about end of life decisions. Do you have a living will? Would your friends and/or family know what your medical desires and/or wishes would be if you were injured and in a coma? Have you and your significant other and/or spouse discussed such issues? Do you even know what you would want for yourself if one day faced with a brain injury and rendered unconscious? Confronting these issues may not be easy; generally human beings do not like to think about their own mortality and end of life decisions. However, it is so very important to talk about one’s medical wishes if ever faced with an end of life decision in an effort to avoid legal and ethical complications with loved ones.
References
Childs, D. (2007, June). Pulling the Plug: Ethicists Debate Ramirez Case. ABC News Medical
Unit. Retrieved on June 28, 2007, from http://abcnews.go.com/Health/story?id=3325418&page=1
Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago: Health
Administration Press.
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