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Medicine is one of the disciplines that are closely governed by strict ethical obligations. Doctors and nurses are governed by rules, codes of ethics, and sometimes they are left to think and implement courses of action by themselves. Healthcare involves two primary parties – the patient and the healthcare personnel. Many are times that standard procedures need to be altered for the better of a situation. Principles come to play in this case to ensure that healthcare personnel do the right thing.
The right thing as discussed above is the requirement that one is supposed to deliver despite pressing matters. On the other hand, doctors, nurses and physicians are obligated to go against the guidelines and requirements of their field. Choices are made with respect to outcomes. Many of these choices involve customized procedures that according to nurses and the healthcare personnel in general involve results. According to the results consequences of these choices are predicted (Szydlik, 2000).
In the line of duty a nurse or a healthcare personnel is obligated to perform a certain number of duties within a criteria that addresses the patient’s interests to the latter. Given the nature of diseases and medical conditions, performance of duties is affected by the realities of the situation. The criterion for providing medical attention to a patient remains unchanged with respect to the kind of medical condition at hand. However, reasoning and use of common sense collide with the guidelines of such medical approaches (Kotlikoff, 1992).
Despite the above choices that have to be made by the healthcare personnel, it comes down to the interests of the patients. Patients as the payers of medical bills tend to control the medical operation. At this point, it is difficulty for a medical personnel to do the right thing and also address the issues a patient requests (Fishkin, 1992).
Patients do not suffer the same way even though they may be suffering from the same medical condition. On the case of critically ill patients, they require a different kind of medical intervention from that given to other patients. Ethically, medical personnel are supposed to monitor the conditions of these patient more and still check and provide their services to the other patients as well (Pierson, 2001).
Inside the clinical setting, everyone has an upper hand of a certain situation or field in respect to healthcare. Medical personnel are obligated to do all they can to keep their patients alive for as long as possible. On the other hand, patients tend to have different views about the doctor’s and nurses obligations. At times they argue that they have the right to make choices if their conditions don’t improve relative to the amount of healthcare intervention given to them.
The right to die is not an ethical obligation a nurse or a physician is entitled to honor anytime a patient requested to be euthanized. Physician/nurse assisted suicide is a call made by a patient whose heeding involves several people. For the medical personnel there are the issues of doing the right thing and the issues of complying with the patient’s request and living with the consequences. Either way, the interests of the patients and the obligations of the healthcare personnel collide (Preston, 1984).
Critical illness, right to die, and death with dignity are issues healthcare personnel are faced with daily. When attending to one patient in order to save their lives another requests to be euthanized in order to die with dignity. On the side of the patient, several elements come to play and mostly are the elements of belief. Traditions and religious beliefs are not supposed to hinder the obligations of medical personnel. However, if the procedures and the medical intervention as a whole affect or go against the beliefs and traditions of the patient, then doing the right thing or living with the consequences are no considerations to go with (Quadagno, 1996).
Beliefs of patients and the cultural ties that one is tied down to all affect health care ethics. A nurse or a physician is supposed to give care to the patient or give drugs to the patient respectively. A nurse if obligated to monitor taking of drugs ad making the living conditions of the patient in the ward as comfortable as possible in order to medical intervention to take effect properly. With obligations to do the right thing and the involvement of the patient to request what he/she wants, a nurse has to choose between conscience and consent before acting. The consent is given by the patient while the nurse uses his/her conscience to make a decision.
The reason why people choose to seek medical intervention to their conditions is because they need to be relieved from the pain the medical condition causes them. On the other hand, some medical conditions and their medical interventions tend to increase the pain of the patient for some time. Morally, a nurse is supposed to give the patient all attention and make sure that drugs are taken as prescribed. Drugs come in different forms, are taken in different ways, and taste differently. While accomplishing or at the process of accomplishing their duties, nurses find themselves sandwiched between morality and empathy. Morality in terms of monitoring and making sure that a patient takes a full dose. Empathy is witnessed when the patient experiences and expresses pain while going through these procedures (Tronto, 1993; Groenhout, 2004).
Palliative care is the care given to aged people with medical conditions. End-of-life care is care given to the terminally ill or those of whom age has gotten the better of them. Many are times that the two are treated the same therefore going against the code of ethics. Palliative care can be different from end-of-life care in that one cannot heal aging but the medical condition can be dealt with and eliminated. End-of-lie care on the hand is for terminally ill people and those of whom age has drained them. The latter makes sure that the patient is living well as he/she precedes towards his/her death. The former on the other hand makes sure that the person at hand lives as long as possible despite the medical condition.
In the process of giving medical attention to a patient, a nurse develops a close relationship with the patient. On the other hand, critically ill, terminally ill, those admitted for palliative care and the rest in general are likely to be attended to by several nurses. With ethics in play and what is considered right by one nurse; if patients change nurses or are transferred from one department to another, communication between the former and the new nurses should clarify what works for the particular patient (Pettersen, 2008).
In conclusion to the above ethical issues facing healthcare personnel, it should be known that healthcare ethics revolve around all parties involved. The choices and requests made by patients may or may not be right. To see them through, a nurse or a physician is obligated to countering the issue with clear mind to ensure that he/she does the right thing and if otherwise he/she can live with the consequences. Inspite of their nature of illnesses, patients are entitled to fair treatment and their rights honored. However, the right to death is not the nurse’s or physician’s responsibility to make happen (Slote, 2007).
ETHICS OF JUSTICE
The ethics of justice under the clause of healthcare can be referred to as social justice. For decades, governments and municipalities have drafted by-laws that make sure that people of all statuses access public facilities equally at their convenience. On the side of healthcare, social justice means equity of service, equality of treatment and care, and guarantee of favorable results for all parties involved (Kuhse, 1997).
Equity in health care is leveling of grounds for all people so that they access healthcare equally. Despite the many models that payment of bills for treatments may assume, delivery of the service is supposed to be reliable for one patient as it should for another. Equity goes a step further outside the medical premises to include the government, employers and insurance companies. The government’s role is to allocate funds, build more medical facilities, and ensure that qualified medical personnel are deployed at those medical facilities.
The employer and the insurance company vary from the government in that they do not invest but rather fund treatment and healthcare for individuals. Treatment of patients where the payer is a third party, justice comes to play at limited aggregates. This is because, many employers have policies that require healthcare benefits to be used or else be lost over a certain period of time. On the other hand, medical personnel may not have a say in these situations where third parties take a role to determine what kind of care a patient gets or not. Justice in this case is a vector entity whose direction is determined by the forces. The forces here are the third parties; an insurance company may decide to not cover a certain procedure due to its nature and expenses. An employer may decide to fund treatment and care with consideration of the position held by that particular patientat his place of work (Mooney, et al. 1992; Puffer, 1986).
The society is made up of people of different social and economic standards. Given that healthcare is an essential of good life, its quality differs from one person to the other with respect to social diversity. Healthcare can be compared with fashion; there are those of us who can afford designer clothes and those who cannot. Inspite of the fact thatwe all cannot afford designer cloths; we all must be clothed in one way or another. Healthcare is similar in that the less fortunate cannot afford the quality healthcare the fortunate ones can (Wagsta, 1991).
Delivery of healthcare has been spread along different age brackets and generations. As much as the young are the majority active players of the economy, the aged as well have a place and a role to play. Equity as described above is ensuring that all classes of people can access healthcare equally. If justice is to be present in consideration to generational differences, then the active roles that each of the generations play should not be an issue to go by (McFarland, 1998).
Contrary to equity in terms of healthcare, inequality is a form of health injustice. From the nurse’s office to the government ministry, health inequality affects the lives of those in need. In some contexts, nurses and government personnel define need as the most pressing issue. Those with minor health needs are regarded as less needy while those with more pressing issues are regarded as needy. Addressing this matter in terms of social justice and equity, everyone has the right to be treated and taken care of without regarding one minority group as less needy and another as much needy (Daniels, 1996; Swarte, et, al. 2005).
Justice in healthcare is hindered by age, ethnicity, gender, residence, and family considerations when applied either at the funding or treatment levels. Personal and family histories are essentials of treatment that assist doctors and medical personnel to identify the cause and effects of a medical condition. Other reasons behind these are regarded as healthcare injustices. The medical personnel are obligated to taking full responsibility of treating and taking care of patients. The government on the other hand is supposed to fund healthcare projects and ensure that all have access to it without requirement of what their ethnicity or social statuses are (Fry, 1969).
Going back to the issue of unequal distribution of wealth and socioeconomically rewarding resources; it will be found that justice and healthcare ethics can be observed, but the outcomes may differ. As a matter of logic, nurses agreeing as being obligated to care for a patient or the government choosing to fund treatment equitably doesn’t mean healthcare. Given the number of people who die while at the waiting list for treatment; it is clear that justice is not only the access to a waiting line but rather access to immediate and reliable healthcare procedures (Irkman-Liff, 1991).
The government, just like the medical personnel, plays a major role in granting or denying healthcare justice to patients. The government’s involvement with healthcare budget allocation plays the role of granting or denying justice to the sick and the needy. As much as ‘less needy’ and ‘needy’ terms are used, the government is likely to result to curative measures to address a predicament of one state while ignoring preventive measures of the same predicament to another state. The healthcare justice in budget allocation is supposed to address the health of the sick and the healthy. To the sick, the budget should be allocated in a way that medical response to the sick is quick and effective. To the healthy, the budget should make sure that they are well protected from acquiring the medical conditions the former group experiences (Ellman, 1990).
In healthcare, all players may participate by employing different strategies in order to meet the requirements of one another. These different strategies can tell whose interest one player is addressing. Some strategies can be disregarded as bluffs by one of the parties. Ethics of healthcare justice require that, having identified the problem and the persons faced by it, there must be a considerable capacity of benefit. Efforts can be made but without fruition of the indented objective. Capacity of benefit means that a patient or a group of patients should be given equal chances of accessing healthcare and that they should benefit from it equally (Nielsen, 1991).
Human Rights and human dignity are entities that medical practitioners, the government, and employers are obligated to protect. Ethics of healthcare and justice put the interests of the patient or the needy person before any other. One of the human rights that are mostly addressed by all these parties is the issue of life. Everyone has the right to live. However, the kind of life that one is entitled to live is not described in one clause of the law. The law and medicine as a discipline collaborate when decisions are to be made regarding the right of living (Gastmans, 2006).
The law gives people the right of choice but denies suicide. Medicine grants the rights of a patient to make choices but if the choices involve death it consults with the law. Given the diversity of choices that a patient can make and the type of response one can get, some patients choose to refuse medical intervention at will. If justice is to apply, the patient has the right to make that choice. On the other hand, despite putting the interests of the patient before any other, a nurse or medical personnel is obligated to observe law and its drift on the rights to life (Singer, 1993).
Treatment, unless offered as a form of first aid always requires funding. Funding may be provided by an insurance company or by the individual. Ethics of justice require that every dollar spend on healthcare should be reflected on the improvement of the patient. A relation between medical intervention and finance exists in that finance makes it possible for medical intervention to be facilitated. This facilitation is measured in terms of how well the intervention is conducted and how effective it is. As a matter of providing healthcare justice, a medical practitioner is obligated to terminate treatment if it proves futile. The patient has the right to know why treatment is terminated in order for him/her to choose whether to seek medical intervention elsewhere or be subjected to a different treatment at the same facility (Childress, 2009).
To conclude on ethics of justice, one should understand the parties that play the biggest roles in hindering or providing this kind of justice. Healthcare is not a responsibility of the patient and his/her doctor/nurse/physician but the responsibility of all parties from the minister of finance through the minister of health to the nurses in different health facilities. Equitable allocation of funds and fair distribution of the funds are some of the ethics of justice. Provision of justice without the consideration of gender, social status, family size, and ethnicity is a form of exercising ethical practice (Tronto, 1993; Olsen, 1994).
COMPARISON BETWEEN ETHICS OF HEALTHCARE AND ETHICS OF JUSTICE
Ethics of healthcare are provided by medical practitioners in terms of giving equal attention and providing quality services relative to the available resources. On the other hand, ethics of justice are provided by the governing system. In allocation of funds and distribution of facilities evenly make it easy for patients and those in need of medical attention to access healthcare. It also makes sure that the medical practitioners observe ethics without conditions (Fry, 1989).
The government chooses the size of facilities to put up in different demographical settings. The size of the population served by that facility should be of a considerable ratio to the number of medical personnel available at that facility. On the other hand, the number of patients a nurse or a medical practitioner is assigned to at a particular moment should be within his/her ability to attend to without difficulties. Ethics of justice differ from ethics of healthcare in that ratio of distribution, level or commitment, and investment of resources is different (Kittay, 2010; Noddings, 1984).
Ethics of justice and ethics of healthcare to the patient may not be different. However, going by the characteristics and requirements of each type of ethics; ethics of justice make a better term when referring to how healthcare should be delivered to the public. In nursing, ethics of justice should be adapted because they address all issues of ethics from the personal level to the government level. The entities of ethics of justice put the interest and welfare of the patient first by regulating the code of conduct of all involved parties.
Healthcare ethics and justice ethics are similar to one another in that they are both aim at providing sustainable healthcare to patients. The role of nurses and other medical practitioners is to balance reasoning with obligation. The reasoning of one nurse is different from that of another. The same way, different nurses are faced by different challenges in their line of duty. It is through choosing to do the right thing or to live with the consequences of doing a different thing that enable ethics to prevail in the provision of healthcare (Williams, 1981).
The government and employers will not take responsibility of deaths that occur due to unequal distribution of funds and resources. However, justice in healthcare is provided by these parties when the distribution of the available resources is done fairly ensuring that there is a balance in terms of generational elevation without leaning on economical backgrounds of the society (Williams, 1987).