It is impossible to separate science from ethics, not because science should not be allowed to have its way, but because it’s the one area that affects humankind drastically. For example, bionic body parts that replicate human abilities as well as senses are now available to the disabled. However, without a code of ethics, what can stop the development of an entire human replica by putting these parts together? And even with an established code of ethics that enable a defined code of conduct and practice in the field of healthcare and healthcare research, sometimes, making decisions based on these poses quite a conundrum.
Ethical Issues in Daily Healthcare
- There are certain ethical issues that have to be dealt with, in healthcare on a daily basis. These may include
- Prioritizing activities in order of importance – this may include giving preference to one patient over another.
- Maintaining a clear distinction between what is right and wrong.
- Deciding when patients are free to leave the hospital and being accountable for their decisions.
- Supporting a patient’s decision and choice (even if not in the patient’s best interests); not taking patients’ decisions for them;
- Taking decisions for patients when they are not fit to do so.
- Taking actions that will benefit the patient’s health.
- Taking decisions without any considerations of race, gender, class.
- Deciding how much time to give to each patient – based on their need, their ability to pay for services, how much they “deserve”, or equally among all patients.
- Maintaining the privacy of the patient – but disclosing information where necessary (in case of a crime, for instance).
Broader Ethical Issues in Healthcare
Apart from daily issues, there are graver issues that plague the healthcare system worldwide. These have been discussed below.
Access to Basic Healthcare for Everyone
A common issue that plagues the healthcare system is how much is “basic” healthcare? Public health insurance plans exist for those who cannot afford it, but there are some who earn just above the bare minimum because of which they do not qualify for these insurance plans. This poses the following questions.
- How are those, who don’t qualify for public health insurance but still don’t earn enough, to get their treatment?
- In order to develop a plan for such individuals, what kind of basic procedures and healthcare systems should the government provide, and where should it draw the line?
- How can one escape the circle that begins with a lack of finances to get routine check-ups, progresses to health problems and ends in enormous bills (that results from these two)?
Yet another debate that has been gaining momentum lately is that about the issue of assisted suicide. Proponents of assisted suicide believe that it is the moral right of every human being to decide when they want to end their own lives without causing harm to others. If one is handicapped, disabled, or knows that one is dying of a terminal disease, one may choose to end one’s pain and suffering than allow it to slowly take the life out of one. While most people can easily end their lives, others who are disabled may be unable to do so in a respectful manner. It is in such cases that their request for life to be terminated should be respected and adhered to. The questions this issue poses are as follows.
- Is it acceptable to reject a request such as this because it is society’s moral duty to protect life?
- Is it not the moral responsibility of every human being to end the suffering of another, particularly when asked for by the sufferer himself?
- Will the passing of a legislation that permits this system enable family and friends to merely “get rid of” someone because their illness is a hindrance in their lives?
- What if individuals who have signed their own death warrant change their minds at the last minute, and are unable to convey this message to those around because of their physical condition?
The relationship between a patient and a physician is seldom restricted to a mere appointment and discussion of health problems. Prolonged care under a physician may result in an attachment, a personal relationship, the desire for a sexual relationship, and the sharing of sensitive, personal information, that may or may not be in relation to the health problem/disease in question. In this regard, the line between what is ethical and what is not is blurred. Certain issues that may arise out of such situations have been discussed in this section.
Patient Privacy and Confidentiality
Healthcare practitioners are not only ethically/morally, but also legally bound to keep patient information confidential. This may include medical reports as well as personal conversations. Legally, doctors may not reveal patient information even in court, under oath. However, this issue demands a little more flexibility in certain cases. For instance, cases that involve crimes such as gunshot wounds are required to be reported to the police. Further, healthcare practitioners may be forced to break this rule when, for example, they discover a sexually transmitted disease in a patient and must reveal this to the spouse, even if the patient does not will it to be disclosed. Underage abortion must also be reported to parents. Issues may arise when morality prevails over rules. For example, in a case where the paternity of a child is under question, and the physician has been informed of it by the mother, is it his duty to report it to the father, particularly if the child is suffering from a genetic condition?
Another issue that crops up with regards to responsibility is the role of social media in healthcare. With the outburst of this trend, surgeons are now live-tweeting surgeries. However, it is possible that this aspect may result in a breach of confidentiality. For instance, a physician my reveal patient details when discussing or providing information about a particular case online. There was also a case reported where an injured person was rushed into an ER and instead of helping him, the nursing staff clicked his pictures and shared them on their social profiles. This may be viewed by some as the most enormous breach of confidentiality, and here is where ethical issues arise.
Differences in Opinion (Professional or Personal) and Informed Consent
A physician is entitled to a personal opinion about certain issues. For instance, some may believe abortion to be wrong. What are such physicians to do when they are approached by someone for an abortion? General medical ethics state that they are expected to be non-judgmental, and if they vehemently oppose something, they may direct the patient to another physician.
In a professional case, it may be possible that a patient may oppose a certain course of treatment proposed by the physician, again due to personal beliefs. Does the physician then impose the treatment procedure to save his life, or does he allow the patient to take the decision? This is where the rule of informed consent comes into play. Patients are given the right to make informed choices about the medical care they want to and do not want to receive. Informed consent also refers to how a doctor should talk about a condition to a patient. The physician is expected to be straightforward and enlist exactly all the risks and complications of a given medical procedure, its alternatives, and the risks of not undergoing the treatment. While it is not ethical for a doctor to impose treatment on a patient, even if it is for the better, it is possible that the patient may or may not want to even hear about the condition he is suffering from. Some may choose to provide treatment without informing the patient. This may though, affect the trusting relationship that a patient is meant to share with his physician.
Sexual relations between doctors and patients have been clearly deemed unethical and illegal. In some cases, a time lapse between the physician-patient relationship and the beginning of a romantic/sexual relationship is considered acceptable. In case of a therapist-patient relationship, at no point may the two indulge in any relationship outside the professional boundaries. It is believed that patients are not in the right frame of mind to take such decisions, that doctors are in a position of power when engaging in such relations, which may then be perceived as an abuse of this power, and that this kind of relationship is unacceptable because of the obvious “caring” nature that it entails.
Right to Abortion
The recent death of an Indian woman in Ireland because she was denied abortion, has brought to light the ethics that revolve around this procedure. Abortion has been under debate for a long time now, but the debaters are as staunch in their beliefs now as they were back then. The pro-life group argues that abortion is equivalent to killing of a human life, whereas the pro-choice group argues that a woman has the right to decide what she does with her body, and since the fetus is a part of the human body, she can decide whether she wants to keep it or abort it. Also, the right to abortion is viewed as a parameter of equality with men, and the right to decide whether or not a woman wants to be a mother is believed to be the ultimate freedom for her. To this date, abortion is banned in several countries except in extremely serious conditions. This may raise certain questions that are as follows.
- What if a woman has been raped and becomes pregnant as a result? Shouldn’t she be allowed the right to abort the child than live with it as a constant reminder of the horrific incident?
- In case of an underage pregnancy, can a relatively immature girl be entrusted with the life of a child?
- What if the fetus has been diagnosed with a birth defect or any other condition? Should the parents not be given the choice to avoid putting themselves and the child through the trouble that living with such a condition will entail?
- Can a family that is not financially prepared to handle another member be burdened with it and compromise with the quality of child care?
- On the other hand, does the ability to abort a child result in women seeking more and more casual relationships and harming themselves in the process too?
Risk of Contracting Communicable Diseases
In the United States, physicians are permitted to choose whom they wish to treat, and under this freedom is the right to choose to treat patients with communicable diseases. However, this freedom cannot be easily allowed in all hospitals as it will result in an imbalance of healthcare professionals available to treat a condition, and individuals who require the care. It thus becomes indirectly mandatory for physicians to treat patients with communicable conditions. Screening patients for infectious diseases before they are admitted into a hospital is considered illegal and unethical. However, this raises the question of safety of other patients and hospital staff, particularly where HIV is concerned. It is considered acceptable to screen a patient with a highly infectious disease such as tuberculosis or chickenpox before admission to check whether he really needs advanced medical treatment.
Several educational and training programs are available for healthcare providers to prevent themselves from the risk of contracting a communicable disease. These professionals are required to undergo regular training for this purpose, so that they may not resort to unethical practices like denying a patient in need the necessary care because he has a communicable disease.
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All healthcare institutions and providers are allowed to market their products or services, but there are certain ethical guidelines that they are required to adhere to. It is unethical for any healthcare institution or provider to advertise products or services with exaggerated claims, unsubstantiated statements, or claims made by omitting information. In simple terms, the patient-physician relationship is based on trust and this is where healthcare marketing requires standard ethical guidelines to prevent a breach of trust. Until recently, web marketing was avoided in the realm of healthcare due to several misconceptions about insurance laws. But as the world becomes more engaged on the Internet to find causes of and cures for their health problems, these practices cannot be avoided. In this realm, an ethical issue that can be raised is the revelation of personal information of patients in order to attract more patients. Confidentiality, as seen above, is legally and ethically mandatory, and this aspect may be exploited in the realm of healthcare marketing. In order to implement a marketing campaign, any healthcare institution or provider should answer the following questions.
- What is the purpose of the marketing campaign?
- How much does it benefit the community as a whole?
- Is the information provided in the campaign completely truthful, or is it biased or misleading?
- Can the amount of money spent on the campaign be justified as against its use for treatment for those who cannot afford it?
The main ethical issue that healthcare marketing is faced with is this: is it permissible for an organization that is deemed altruistic in nature to market its services like a commodity that only a few may be able to afford?
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A surrogate mother is used by couples to carry their child in return for a fee, when the couple is unable to do so for different reasons. Most people term this as a “womb to rent” or in the most straightforward way, “baby-selling”. While surrogacy is frowned upon by many religions across the world, it is even surrounded by medical, legal, and ethical issues. The main ethical issue that arises with this procedure is how it “commodifies” children. Ethical issues may also arise when people search for surrogates in low-income countries to afford the costs that the procedures entail. It is believed that women in such countries may not be completely aware of the risks and implications of the procedure and may enter it solely because of their financial condition.
Ethical Issues in Healthcare Research
Research in healthcare will never cease, and as technology advances, it is likely to raise greater ethical concerns in this ever-evolving field.
Embryonic Stem Cell Research and Human Cloning
Embryonic stem cell research, though proven to be useful in a variety of health issues, is mired in controversy that has heightened recently. Stem cells are basic cells that are helpful in the treatment of different health conditions. They are harvested from living embryos, and this is where the controversy sets in. While stem cells may be harvested from adults through the umbilical cord blood, bone marrow, and other adult tissue without any harm, their stability and flexibility in comparison to human embryos is still under question, though research is largely prevalent through the country. What is unethical about embryonic stem cell research?
- Can the destruction of a 5 or 6-day old embryo that does not have a brain or experience any feeling be considered the destruction of human life?
- Opposing parties argue that if an embryo possesses a human genome and has the potential to develop into a human being in the right environment, isn’t this the destruction of potential human life?
Human cloning is an offshoot of embryonic stem cell research and has always been a sensitive issue. The process of cloning has proposed to serve purposes such as cloning stem cells for research, cloning animals for experimentation, cloning to enable disease treatment (by using healthy cells to replace diseased cells in case of advanced medical conditions) and organ donation, cloning to enable infertile couples to have children, and even to replace them in case of their death. While these are the possible advantages, ethical issues will arise when we consider the following
- Are we playing with nature when we cross the line and start creating human beings ourselves?
- Will it lead to individuals such as entertainers and sportspersons wanting to clone themselves to preserve their genetic makeup.
- Will this not result in a lack of diversity in genetic makeup and a rather uniform and specifically designed human race?
- Will cloned individuals be given the same treatment and social standing as the humans they were cloned from?
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Ubiquitous technology employs small sensors and actuators, both environmental and for the patient, that monitor and help improve patients’ physical as well as mental conditions. These sensors are designed to monitor almost all physiological activity such as heart rate, blood pressure levels, blood glucose levels, etc. They may be implanted in patients or used externally. Actuators are implanted in the body, and are capable of releasing small amounts of medicine in case of a medical condition, to help regulate it. This technology will enable patients to be monitored more carefully and reduce patient-physician interactions by a substantial amount. This will also at some level modify patient records which will be continually updated for the physician’s benefit. Several ethical issues can arise from this extreme reliance on technology for well-being.
- Shouldn’t patients at some level be directly responsible for their health condition?
- Will the continuous health information update be more susceptible to privacy breach because it can easily be hacked into?
- Will it lead to a greater divide between the rich who can afford this technology and the poor who can’t?
- On what basis will insurance be provided, and up to what point in time will insurance providers be able to obtain a patient’s medical history?
- How much can this technology be relied on for proper dispensing of medicine? What if there are technical glitches? Who will be accountable for those?
While the healthcare sector in every country has a well-defined and established code of ethics, there are issues that continually arise and pose questions and problems before healthcare providers. Training and experience are the only ways in which these issues can be dealt with sensitively.