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.
Thursday, June 14, 2007
Blog 5: Waiting to Death in the ER
The other day I was listening to Good Morning America while getting ready for work and heard of a story that made me cringe. The report involved a woman who actually died on the floor of an emergency room while waiting for care in Los Angeles, CA. Edith Rodriguez, mother of three, arrived at the ER feeling sick and vomiting blood. For over 45 minutes, Rodriguez lay on the ER floor while staff members ignored her. From surveillance videos, one can even see a janitor sweeping the floor around Rodriguez. The woman’s boyfriend called 911 from within the inner-city hospital and was told by the dispatcher that he (and paramedics) could do nothing for him due to the fact that the man’s girlfriend was already in a hospital. A bystander also called 911 for help and was told by another 911 dispatcher that there was nothing he could do for her. In fact, the dispatcher stated “I cannot do anything for you for the quality of the hospital. It is not an emergency. It is not an emergency ma'am” (The Associated Press, 2007). The man actually argued with the caller over whether or not Rodriguez’s situation was an emergency. Toward the end of the conversation, the caller told the dispatcher that God should strike him dead as a result of his actions. The dispatcher replied, “No, negative ma'am, you're the one” (The Associated Press, 2007). Shortly after the call, Edith Rodriguez died on the floor of an ER from a perforated bowel that could have been easily treated. To view this article in more detail, please go to http://abcnews.go.com/US/WireStory?id=3273647&page=1
How could this happen to a patient who sought care from a hospital in her time of need? Clearly, the patient was in severe pain and hospital staff could visibly see her vomiting blood. Who is to blame in this situation? Ironically, the Chief Medical Officer of the hospital has been absent from work since this story was reported to the public. Is the hospital staff to blame for Ms. Rodriguez’s death in that they did nothing to help her and simply ignored her? Perhaps the 911 dispatchers are to blame for not taking the calls seriously and choosing not to send an ambulance for the sick woman so that she could be transported to another facility. In this type of scenario, who would receive the appropriate disciplinary action? How does one go about deciding who is to blame in this case? Does the hospital have an Ethics committee to decide such cases? Will the Chief Medical Officer be held accountable or will it be the staff members on duty that day? What reasons will be provided for not giving Rodriguez the appropriate care? How does the hospital “prioritize” patients when they first enter the ER? Is there a particular system in place for seeing ER patients based on their condition? If so, what are the requirements?
According to the story this is not the first time such an incident has happened at the hospital. Apparently, the hospital has encountered similar problems in the past in regard to not treating patients appropriately. In my opinion, allowing this hospital to continue operating would be unethical, not to mention dangerous for the patients who choose to go there for care. After reading this story, I immediately thought to myself, “should someone in this case be charged for the murder of Edith Rodriguez’s death?” If so, how would this affect the hospital’s staff, the deceased patient’s boyfriend and family, the organization’s stakeholders and the community? If staff members could be charged with murder in this case, would it change how hospitals operated their ERs? Would it change how healthcare workers treated their patients? Would situations like the one above be less likely to occur if such laws and/or actions were put into place for healthcare organizations? Unfortunately, for Edith Rodriguez, such laws and/or disciplinary actions will be of no help. Perhaps some type of compensation will be awarded to her family for the lack of treatment she received. As future healthcare managers, what can we do in order to prevent such tragic occurrences and unethical behavior from happening? What can be done to reduce wait times within our nation's ER department? How can we better train our employees to react appropriately to patients when pressed for time and/or space?
References
The Associated Press (2007, June 13). 911 Dispatchers Denied Dying Woman Help. Retrieved June 13, 2007, from http://abcnews.go.com/US/WireStory?id=3273647&page=1
How could this happen to a patient who sought care from a hospital in her time of need? Clearly, the patient was in severe pain and hospital staff could visibly see her vomiting blood. Who is to blame in this situation? Ironically, the Chief Medical Officer of the hospital has been absent from work since this story was reported to the public. Is the hospital staff to blame for Ms. Rodriguez’s death in that they did nothing to help her and simply ignored her? Perhaps the 911 dispatchers are to blame for not taking the calls seriously and choosing not to send an ambulance for the sick woman so that she could be transported to another facility. In this type of scenario, who would receive the appropriate disciplinary action? How does one go about deciding who is to blame in this case? Does the hospital have an Ethics committee to decide such cases? Will the Chief Medical Officer be held accountable or will it be the staff members on duty that day? What reasons will be provided for not giving Rodriguez the appropriate care? How does the hospital “prioritize” patients when they first enter the ER? Is there a particular system in place for seeing ER patients based on their condition? If so, what are the requirements?
According to the story this is not the first time such an incident has happened at the hospital. Apparently, the hospital has encountered similar problems in the past in regard to not treating patients appropriately. In my opinion, allowing this hospital to continue operating would be unethical, not to mention dangerous for the patients who choose to go there for care. After reading this story, I immediately thought to myself, “should someone in this case be charged for the murder of Edith Rodriguez’s death?” If so, how would this affect the hospital’s staff, the deceased patient’s boyfriend and family, the organization’s stakeholders and the community? If staff members could be charged with murder in this case, would it change how hospitals operated their ERs? Would it change how healthcare workers treated their patients? Would situations like the one above be less likely to occur if such laws and/or actions were put into place for healthcare organizations? Unfortunately, for Edith Rodriguez, such laws and/or disciplinary actions will be of no help. Perhaps some type of compensation will be awarded to her family for the lack of treatment she received. As future healthcare managers, what can we do in order to prevent such tragic occurrences and unethical behavior from happening? What can be done to reduce wait times within our nation's ER department? How can we better train our employees to react appropriately to patients when pressed for time and/or space?
References
The Associated Press (2007, June 13). 911 Dispatchers Denied Dying Woman Help. Retrieved June 13, 2007, from http://abcnews.go.com/US/WireStory?id=3273647&page=1
Thursday, June 7, 2007
Blog 4: Will America be Sick over Michael Moore’s Sicko?
In response to David Moses’s recent blog concerning Michael Moore’s new documentary, “Sicko”, I too felt compelled to write about this politically charged movie. The premise of the documentary involves taking a close look at the many flaws found within America’s healthcare system. More specifically, Moore investigates the inner-workings of our healthcare system and brings to light an array of problematic issues such as access to care, unaffordable healthcare coverage and powerful managed care organizations. He also gives insight into the world of healthcare through other peoples’ eyes and experiences such as political entities, healthcare workers, and of course the patients. In one interview with a mother, Moore discovers that her infant died because she could not receive medical care (Grover, 2007). Similar heartbreaking stories can be found throughout the documentary from a number of patients that were interviewed.
For many of us working in healthcare, Moore’s documentary may come as a breath of fresh air. As healthcare workers (and students studying health services administration), we are exposed to the inner-workings of a healthcare organization each and every day. We are able to see the political battles that take place over finances and patients, the unethical practices that occur between healthcare personnel and patients, medical errors, the controlling nature of managed care companies and the coverage gaps found within health insurance. Most importantly, we are able to see the effects that these elements have on the patient. Many of us in the field hope to see universal healthcare coverage and complete access within the next few years. Many political figures have tried for such coverage and access in the past but have failed miserably. Perhaps next year’s elections (along with “Sicko”) will bring fresh ideas to the table on improving America’s fragmented healthcare system.
According to Hofmann and Nelson (2001), “In the midst of the politics, it is too easy to forget that healthcare is a good and service prerequisite for the well-being of all human beings.” As one of the most powerful and so-called wealthy nations in the world, why is it so difficult to provide reasonable medical care at an affordable price for our nation’s citizens? Why does America still not consider it a basic right for all of its citizens to have equal access to healthcare (Hofmann & Nelson, 2001)? Perhaps just too many “hands are in the pot.” Managed care organizations want their cut, hospitals want to see the bottom line increase, stakeholders want fuller pockets, doctors and nurses want bigger and better salaries/incentive programs and the list goes on and on. There must be a way to reduce the cost of medical care and improve access for everyone. It should be the right of each American to have affordable coverage and convenient access to a system that was originally created to help take care of people and save lives; not fill the pockets of greedy stakeholders and politicians.
Hopefully Michael Moore will shed some much-needed light on the state of today’s healthcare system. Political entities, health authorities, managed care companies, and healthcare organizations in general should brace for the possible large-scale impact this documentary may have on America. Look at the ramifications and outcomes associated with Morgan Spurlocks’s documentary on the fast food industry, “Super Size Me.” This eye-opening movie not only pushed schools to incorporate healthier meal options during lunch (in addition to increasing physical education time) but ultimately caused McDonalds as well as other fast food restaurants to now post nutritional information and ingredients on food packaging. McDonald’s also created the “Adult Happy Meal” and offered healthier alternatives in their happy meals for children. “Super Size Me” created enough awareness within the fast food community for action to actually take place. With any luck, Michael Moore’s documentary “Sicko” will do the same. Our country’s healthcare system desperately needs attention. If Michael Moore can draw enough awareness to this issue and turn up the heat on today’s political figures, than perhaps our nation’s fragmented healthcare system can begin to repair its fragile state.
References
Grover, R. (2007, June 4). Michael Moore Wants to Reform Healthcare. Retrieved on
June 7, 2007, from http://news.yahoo.com/s/bw/20070604/bs_bw/jun2007db20070604109406;_ylt=AgeaZ2tQjvqxrVXrAq1i9fzq188F
Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago: Health Administration Press.
For many of us working in healthcare, Moore’s documentary may come as a breath of fresh air. As healthcare workers (and students studying health services administration), we are exposed to the inner-workings of a healthcare organization each and every day. We are able to see the political battles that take place over finances and patients, the unethical practices that occur between healthcare personnel and patients, medical errors, the controlling nature of managed care companies and the coverage gaps found within health insurance. Most importantly, we are able to see the effects that these elements have on the patient. Many of us in the field hope to see universal healthcare coverage and complete access within the next few years. Many political figures have tried for such coverage and access in the past but have failed miserably. Perhaps next year’s elections (along with “Sicko”) will bring fresh ideas to the table on improving America’s fragmented healthcare system.
According to Hofmann and Nelson (2001), “In the midst of the politics, it is too easy to forget that healthcare is a good and service prerequisite for the well-being of all human beings.” As one of the most powerful and so-called wealthy nations in the world, why is it so difficult to provide reasonable medical care at an affordable price for our nation’s citizens? Why does America still not consider it a basic right for all of its citizens to have equal access to healthcare (Hofmann & Nelson, 2001)? Perhaps just too many “hands are in the pot.” Managed care organizations want their cut, hospitals want to see the bottom line increase, stakeholders want fuller pockets, doctors and nurses want bigger and better salaries/incentive programs and the list goes on and on. There must be a way to reduce the cost of medical care and improve access for everyone. It should be the right of each American to have affordable coverage and convenient access to a system that was originally created to help take care of people and save lives; not fill the pockets of greedy stakeholders and politicians.
Hopefully Michael Moore will shed some much-needed light on the state of today’s healthcare system. Political entities, health authorities, managed care companies, and healthcare organizations in general should brace for the possible large-scale impact this documentary may have on America. Look at the ramifications and outcomes associated with Morgan Spurlocks’s documentary on the fast food industry, “Super Size Me.” This eye-opening movie not only pushed schools to incorporate healthier meal options during lunch (in addition to increasing physical education time) but ultimately caused McDonalds as well as other fast food restaurants to now post nutritional information and ingredients on food packaging. McDonald’s also created the “Adult Happy Meal” and offered healthier alternatives in their happy meals for children. “Super Size Me” created enough awareness within the fast food community for action to actually take place. With any luck, Michael Moore’s documentary “Sicko” will do the same. Our country’s healthcare system desperately needs attention. If Michael Moore can draw enough awareness to this issue and turn up the heat on today’s political figures, than perhaps our nation’s fragmented healthcare system can begin to repair its fragile state.
References
Grover, R. (2007, June 4). Michael Moore Wants to Reform Healthcare. Retrieved on
June 7, 2007, from http://news.yahoo.com/s/bw/20070604/bs_bw/jun2007db20070604109406;_ylt=AgeaZ2tQjvqxrVXrAq1i9fzq188F
Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago: Health Administration Press.
Blog 3: The Dr. Death Debate
Picture yourself as a terminally ill person or someone living with a chronic and painful disease. Perhaps the disease is so debilitating that you are not able to perform every day functions such as taking a shower or making your bed. Maybe you are constantly feeling nauseated from weekly chemotherapy treatments and are so fatigued that even brushing your teeth becomes a chore. Even worse, your psychological condition is going down hill with each passing day. The thought of slowly dying and living with excruciating pain severely affects your mental state and you slip even deeper into depression. Perhaps you have no support during this difficult time. Maybe there is no one in your life to help you function and you ultimately find yourself going through each day alone and afraid. However, what if there was a way to escape the pain and psychological torment for good? What if you could choose to end your life in a less painful process than what your disease had in store for you? Would the idea of a medical professional assisting you with such a procedure seem appealing when faced with dying a slow and painful death? Is it your right as a human being to choose whether or not you want to live or die? Would the idea of “assisted suicide” even be ethical in the field of healthcare? There are thousands of people each day that are diagnosed with and/or are living with terminal and debilitating diseases. How many of these individuals have contemplated “assisted suicide?” According to Dr. Jack Kevorkian, more people than what one might think may want such assistance when it comes to ending their life.
As many of you know, Dr. Jack Kevorkian was released from prison a few days ago after serving an eight year sentence for helping end the life of a man with Lou Gehrig's disease. Kevorkian had also assisted with ending the lives of 130 people throughout the 90s (Hoffman, 2007). During this time, Kevorkian often challenged prosecutors (and the law) to charge him with a crime or make assisted suicide legal. Finally, he was convicted with second degree murder for helping end the life of Thomas Youk, a 52 year old man suffering from Lou Gehrig’s disease. When released from prison, Kevorkian was embraced by many supporters including his legal assistant, Ruth Holmes. According to Ms. Holmes in regard to Jack Kevorkian’s history of assisted suicides, “This should be a matter that is handled as a fundamental human right that is between the patient, the doctor, his family and his God” (Hoffman, 2007). Dr. Kevorkian has two years of parole to complete and during this time he is forbidden to assist anyone with dying. However, news reports claim that Dr. Kevorkian still believes that people have the right to die. Reports also suggest that the doctor will in fact continue to assist with ending the lives of ill patients after his parole is over in 2009.
The result of the above news has stirred up more controversy on whether or not human beings have the right to end their life if ill and/or in pain. Now, if a patient is residing in an actual hospital while suffering, the patient and his/her caregivers/family have the right to make a life-ending decision. If a patient’s treatment is found not to work, treatment may be withdrawn in an effort to stop the patient from suffering. Why is this not the case when an individual is suffering in the privacy of his/her own home and not in a hospital? How can members of a hospital staff legally withdrawal treatment from a patient (and thus resulting in a patient’s death) but individuals in their homes cannot legally end their lives if severely ill? Is not withdrawing treatment from a patient essentially helping them end their lives? Would this not be considered “assisted suicide” in some sense? Was Dr. Jack Kevorkian acting like other medical professionals when asked by a patient to “withdrawal” their treatment and help end their suffering? Was Kevorkian really acting that much different than medical professionals dealing with an ill patient within a hospital? Was Kevorkian really just acting in the best interest of the patient? Do not medical professionals at hospitals do the same?
According to Hofmann and Nelson (2001), “answering specific questions will help to determine when a treatment may be withheld or withdrawn [from a patient]: 1) Is it too painful? 2) Is it too physically damaging? 3) Is it psychologically repugnant to the patient? 4) Does it suppress too greatly the patient’s mental capacity? 5) Is the expense prohibitive?” Cannot these questions be applied to patients suffering at home? If so, why is it illegal for patients to end their lives if assisted by a medical professional? Is this act not the same situation that occurs within hospitals everyday with terminally ill patients? If assisted suicide was deemed legal in the U.S., how would such a law affect healthcare organizations? How would it affect the mindset of the general population? Would assisted suicide ever be tolerated in this country or is such an act just too unethical?
An ethical debate of this magnitude will most likely continue to be ongoing for many years to come. Perhaps human beings will never reach a decision and will continue to “agree to disagree.” In any event, it is my opinion that a human being should have control over his/her life under any circumstance. I do in fact see the similarities between what Dr. Jack Kevorkian did and what trained medical staff practice everyday. What distinguishes these two entities? Are clearer laws and/or regulations needed to define the two practices? Who is able to evaluate such ethical dilemmas and make a change if needed? The above questions may never be answered and for the purpose of today’s discussion serve as just “food for thought.” How do you all feel about the issue over whether or not to end a person’s life due to extreme suffering? Is it right or wrong? Feel free to leave me comments!
As many of you know, Dr. Jack Kevorkian was released from prison a few days ago after serving an eight year sentence for helping end the life of a man with Lou Gehrig's disease. Kevorkian had also assisted with ending the lives of 130 people throughout the 90s (Hoffman, 2007). During this time, Kevorkian often challenged prosecutors (and the law) to charge him with a crime or make assisted suicide legal. Finally, he was convicted with second degree murder for helping end the life of Thomas Youk, a 52 year old man suffering from Lou Gehrig’s disease. When released from prison, Kevorkian was embraced by many supporters including his legal assistant, Ruth Holmes. According to Ms. Holmes in regard to Jack Kevorkian’s history of assisted suicides, “This should be a matter that is handled as a fundamental human right that is between the patient, the doctor, his family and his God” (Hoffman, 2007). Dr. Kevorkian has two years of parole to complete and during this time he is forbidden to assist anyone with dying. However, news reports claim that Dr. Kevorkian still believes that people have the right to die. Reports also suggest that the doctor will in fact continue to assist with ending the lives of ill patients after his parole is over in 2009.
The result of the above news has stirred up more controversy on whether or not human beings have the right to end their life if ill and/or in pain. Now, if a patient is residing in an actual hospital while suffering, the patient and his/her caregivers/family have the right to make a life-ending decision. If a patient’s treatment is found not to work, treatment may be withdrawn in an effort to stop the patient from suffering. Why is this not the case when an individual is suffering in the privacy of his/her own home and not in a hospital? How can members of a hospital staff legally withdrawal treatment from a patient (and thus resulting in a patient’s death) but individuals in their homes cannot legally end their lives if severely ill? Is not withdrawing treatment from a patient essentially helping them end their lives? Would this not be considered “assisted suicide” in some sense? Was Dr. Jack Kevorkian acting like other medical professionals when asked by a patient to “withdrawal” their treatment and help end their suffering? Was Kevorkian really acting that much different than medical professionals dealing with an ill patient within a hospital? Was Kevorkian really just acting in the best interest of the patient? Do not medical professionals at hospitals do the same?
According to Hofmann and Nelson (2001), “answering specific questions will help to determine when a treatment may be withheld or withdrawn [from a patient]: 1) Is it too painful? 2) Is it too physically damaging? 3) Is it psychologically repugnant to the patient? 4) Does it suppress too greatly the patient’s mental capacity? 5) Is the expense prohibitive?” Cannot these questions be applied to patients suffering at home? If so, why is it illegal for patients to end their lives if assisted by a medical professional? Is this act not the same situation that occurs within hospitals everyday with terminally ill patients? If assisted suicide was deemed legal in the U.S., how would such a law affect healthcare organizations? How would it affect the mindset of the general population? Would assisted suicide ever be tolerated in this country or is such an act just too unethical?
An ethical debate of this magnitude will most likely continue to be ongoing for many years to come. Perhaps human beings will never reach a decision and will continue to “agree to disagree.” In any event, it is my opinion that a human being should have control over his/her life under any circumstance. I do in fact see the similarities between what Dr. Jack Kevorkian did and what trained medical staff practice everyday. What distinguishes these two entities? Are clearer laws and/or regulations needed to define the two practices? Who is able to evaluate such ethical dilemmas and make a change if needed? The above questions may never be answered and for the purpose of today’s discussion serve as just “food for thought.” How do you all feel about the issue over whether or not to end a person’s life due to extreme suffering? Is it right or wrong? Feel free to leave me comments!
References
Hofmann, P. & Nelson, W. (2001). Managing Ethically: An Executive’s Guide. Chicago:
Health Administration Press.
Hofmann, K. (2007, June 1). Kevorkian Leaves Prison After 8 Years. Retrived June 1, 2007,
from http://abcnews.go.com/US/WireStory?id=3233593&page=1
Friday, May 25, 2007
Blog 2: Truth Telling and Values
This week's blog reflects my class readings from the book, "The Tracks We Leave: Ethics in Healthcare Management" by Frankie Perry (2002). This week's readings provided a short vingnette about a medical center and its choice to withhold information regarding medical errors from patients and the results that were produced from such a decision. The readings also introduced the concept of values and how different value systems affect the day to day choices individuals make in all areas of life. The blog below will examine the importance of "telling the truth" in a healthcare environment in addition to why a strong set of values remains essential for today's healthcare manager.
Blog
In the case of Paradise Hills Medical Center, the truth behind the organization’s medical error was kept secret for fear of a tainted image and potential malpractice lawsuits. More specifically, patients of Paradise Hill were given excess dosages of radiation therapy by the center’s medical staff and as a result, many of these patients had adverse effects. Consequently, the medical center suffered a variety of negative outcomes as a result of withholding information from patients, including: lawsuit settlements, tension among the facility’s staff, a tarnished image, loss of a group practice, and a general sense of mistrust among the organization’s employees (Perry, 2002).
The decision to withhold information from patients was the result of the medical center’s CEO and medical staff. The controversy over whether or not to inform the patients of the center’s medical errors was initially taken to the organization’s ethics committee for consideration. The committee deemed that the medical staff should in fact notify the patients of the error and monitor them for adverse effects. However, the organization’s ethics committee is an advisory committee only and does not comprise the power to make final rulings in management’s decision making ability. Therefore, the center’s medical staff and CEO chose to ignore the committee’s recommendations and keep the information from the affected patients.
Now, a few elements of this situation strike me as odd and very unethical in nature. First, the fact that the medical center’s CEO was quick to side with the medical staff in covering up the medical errors was a good indication of the CEO’s values (or lack thereof). As stated in the ACHE Code of Ethics, “The healthcare executive shall uphold the values, ethics and mission of the healthcare management profession and conduct all personal and professional activities with honesty, integrity, respect, fairness, and good faith in a manner that will reflect well upon the profession.” Clearly, the CEO did not exemplify honesty nor did he show respect and fairness to his center’s patients. Informing patients of the medical error would have shown respect to the patient; such an act would have reflected well on the organization. Instead, the center chose to lie by omission to its patients in order to keep their reputation in tact.
Furthermore, why does an organization even have a well trained ethics committee if management does not have to adhere to the guidelines and/or recommendations given by this group of individuals? It appears to me that management chose to overlook the committee’s recommendations for the sake of their professional careers. I highly doubt the medical staff just wanted to “keep bad news” from the patients in an effort to make them “feel better.” Bottom line, management’s decision boiled down to revenue. Management feared that by releasing such information to the patients, the organization’s image would become tarnished and would thus result in fewer patients and less money for everybody. In this decision, money and job security outweighed the decision to respect the patient.
Perhaps the negative consequences that took place at Paradise Hills Medical Center could have been avoided by simply telling the truth and informing the patient of the medical error when it occurred. Instead, the organization chose to hide such information in hopes that it would never reach the patients and become news to the public. Obviously this decision backfired on the center and caused more harm to the organization (and patients) than good. I would imagine that Paradise Hills (and the center’s CEO) immediately lost its credibility with patients, the community and the organization’s various stakeholders (were the stakeholders even made aware of this decision?). Moreover, I believe that the facility ultimately lost credibility within its own institution among its staff.
Finally, what type of tone and/or example is the CEO setting for the organization by not telling the truth and going against the recommendations of his/her ethics committee and ACHE Code of Ethics? Could this type of conduct trickle through the rest of the organization and cause other employees to act unethically and dishonestly? If so, what types of consequences would that render for both employees and patients? A strong set of values and a good moral compass should be a requirement of any individual working with human beings and human life. Healthcare employees are not building cars or selling clothes, they are caring for people just like themselves. Should we not treat others the way in which we ourselves would like to be treated?
The decision to withhold information from patients was the result of the medical center’s CEO and medical staff. The controversy over whether or not to inform the patients of the center’s medical errors was initially taken to the organization’s ethics committee for consideration. The committee deemed that the medical staff should in fact notify the patients of the error and monitor them for adverse effects. However, the organization’s ethics committee is an advisory committee only and does not comprise the power to make final rulings in management’s decision making ability. Therefore, the center’s medical staff and CEO chose to ignore the committee’s recommendations and keep the information from the affected patients.
Now, a few elements of this situation strike me as odd and very unethical in nature. First, the fact that the medical center’s CEO was quick to side with the medical staff in covering up the medical errors was a good indication of the CEO’s values (or lack thereof). As stated in the ACHE Code of Ethics, “The healthcare executive shall uphold the values, ethics and mission of the healthcare management profession and conduct all personal and professional activities with honesty, integrity, respect, fairness, and good faith in a manner that will reflect well upon the profession.” Clearly, the CEO did not exemplify honesty nor did he show respect and fairness to his center’s patients. Informing patients of the medical error would have shown respect to the patient; such an act would have reflected well on the organization. Instead, the center chose to lie by omission to its patients in order to keep their reputation in tact.
Furthermore, why does an organization even have a well trained ethics committee if management does not have to adhere to the guidelines and/or recommendations given by this group of individuals? It appears to me that management chose to overlook the committee’s recommendations for the sake of their professional careers. I highly doubt the medical staff just wanted to “keep bad news” from the patients in an effort to make them “feel better.” Bottom line, management’s decision boiled down to revenue. Management feared that by releasing such information to the patients, the organization’s image would become tarnished and would thus result in fewer patients and less money for everybody. In this decision, money and job security outweighed the decision to respect the patient.
Perhaps the negative consequences that took place at Paradise Hills Medical Center could have been avoided by simply telling the truth and informing the patient of the medical error when it occurred. Instead, the organization chose to hide such information in hopes that it would never reach the patients and become news to the public. Obviously this decision backfired on the center and caused more harm to the organization (and patients) than good. I would imagine that Paradise Hills (and the center’s CEO) immediately lost its credibility with patients, the community and the organization’s various stakeholders (were the stakeholders even made aware of this decision?). Moreover, I believe that the facility ultimately lost credibility within its own institution among its staff.
Finally, what type of tone and/or example is the CEO setting for the organization by not telling the truth and going against the recommendations of his/her ethics committee and ACHE Code of Ethics? Could this type of conduct trickle through the rest of the organization and cause other employees to act unethically and dishonestly? If so, what types of consequences would that render for both employees and patients? A strong set of values and a good moral compass should be a requirement of any individual working with human beings and human life. Healthcare employees are not building cars or selling clothes, they are caring for people just like themselves. Should we not treat others the way in which we ourselves would like to be treated?
If I was a patient in this scenario, I would have liked for my medical provider to inform me of my own wellbeing or complications related to my care. In my opinion, such an act of dishonesty should not be tolerated in a medical facility regardless of the positive or negative outcomes associated with a decision. I would recommend that Paradise Hills fire their CEO and take a long, hard look at their mission statement and overall values of the organization. What is Paradise Hills really in business for? Is it to serve and protect their patients or to increase their “bottom line?” I sincerely hope the answer is not of the latter response. If so, as patients we are all in a world of trouble.
Subscribe to:
Posts (Atom)
