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                                                      Main Post

                                                        Ethical Issues

“Two traditional theories can be considered regarding health resource allocation: ‘macro-allocation’ – which is defined by respecting the public health policy allocation and distribution – and ‘micro-allocation’ – which supports the belief that individualized selection of those who should benefit from the available services are the beneficiaries” (Jonsen, A., Edwards, K., 2016). The micro-allocation problem suggests prioritization of patients for things such as limited vacancies, intensive care services, or prioritized organ transplant. The ethical questions become; is there a fair and equitable way of allocating health care resources and can a fair and just allocation really be implemented in our current social, economic and medical environment?  Some public policy supports devising an allocation system focused on the criteria of efficiency and cost-effectiveness. Are we better served by considering how cost-effectiveness can to be applied to persons with shorter natural life expectancies, such as the elderly? These questions are not easily answered but they must be considered whenever allocation is proposed.  Some forms of allocation are egregiously unethical in any society that values equality. However, it is also unethical when you make the ability to pay the only option for obtaining medical care or distributing medical resources to those in power. Many other problems are less obviously wrong but still need to be evaluated and debated.

Ideally, all persons should have access to a “standard” of health care to sustain life, prevent illness, relieve distress, and prevent injury. It is the responsibility of nurses and doctors to empower their patients by having a voice in how they die.  We need better education for our healthcare providers in the care of the dying, options for palliative care, and of hospice programs. Currently, 75 percent of the public, regardless of educational efforts, do not have a living will.  The majority of people only have vague talks with family members about how they want to die.  Most physicians still resist having an open discussion with patients and families about death; and by the time patients in hospice have these conversations it is much too late, often less than two weeks before they die. Many doctors, patients, and families are either in denial, emotional distress, or both when death is eminent or during the process of the patient dying. As healthcare providers, we have an opportunity, to create and sustain an open dialog with our patients and their families about advanced life directives.  Some statistics have shown that 58% of patients did not want to discuss their wishes with their doctors.  However, for those who did what was found to be significant is that 25% of the elderly did not want to be resuscitated.  In 50% of the advanced live saving cases, most were initiated by doctors and/or requested by the families without the patients’ consent. Therefore, it seems reasonable to say that rationing healthcare for elderly patients should be based on objective information and in the patient’s best interest and wishes (End of Life, 2016).

In my opinion, the ethical issues related to “resourcing” can be mitigated by healthcare workers doing a better job discussing advanced directives and end of life wishes with their patients, and whenever appropriate, their families.  Conversations should begin early in the doctor/nurse to patient relationship or at least upon hospital admission regarding the patient’s wishes regardless of their diagnosis or severity. Our present healthcare practices foster unnecessary, and more importantly, unwanted patient interventions that are better allocated for those who can benefit from these resources.

References

Ethical Issues with an Aging Population (2012). Researchomatic. Retrieved from http://www.researchomatic.com/ethical-Issues-With-An-Aging-Population-47844.html 

Jonsen, A., Edwards, K., (2016). ETHICS IN MEDICINE. University of Washington School of Medicine. Retrieved from https://depts.washington.edu/bioethx/topics/resall.html

Lawler, P., Callahan, D., (2012, July 24). Ethics and Health Care: Ethics and Health Care Rethinking End-0f-Life-Care. Retrieved from https://www.heritage.org/health-care-reform/report/ethics-and-health-care-rethinking-end-life-care

Milstead, J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 7, “Health Policy and Social Program Evaluation” (pp. 114-127)

Schütz GE. Quando o igual tratamento acaba em injustiça. Um paradoxo bioético das políticas sanitárias universalistas de alocação de recursos [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública, Fundação Fiocruz; 2003. Revista Brasileira de Terapia Intensiva. Print version ISSN 0103-507X. Rev. bras. ter. intensiva vol.21 no.4 São Paulo Oct./Dec. 2009 http://dx.doi.org/10.1590/S0103-507X2009000400014 

End of Life. (2016, Jul 29). Retrieved from https://studymoose.com/end-of-life-2-essay