Abstract
Ethics applies to many fields. It simply signifies a moral obligation to do right or wrong. Ethics in health care can be defined as moral principles that guide the medical care conduct between medical practitioners and patients. Ethics gives medical care choice of right and wrong and also outlines the duties that medical care has towards patients. People make their choice about what medical care to attend after considering, beliefs and practices in health care institutions. Four principles guide health care ethics: autonomy, beneficence, nonmaleficence, and justice. Autonomy entails allowing patients to make their decisions. Beneficence gives the patients the freedom to progress on their own. The Nonmaleficence principle provides guidelines that ensure no harm is done to patients. Finally, justice requires medical practitioners to be fair and treat all patients equally. The paper will focus on health care ethics and outline various dilemmas surrounding health care facilities, and propose a solution to these problems by leaders of health facilities in the United States.
Health Care Ethics in the U.S.A
The American Medical Association (AMA) organization guides health care ethics in health institutions in the U.S. It formulates the principles to be followed by all medical care institutions in the country. American Medical Association addresses a wide area of ethical concern to health care workers, patients, executive management of health care, and other external parties that influence medical care institutions. AMA contains standard rules and regulations that apply to all health care institutions. However, each institution can formulate its policies to govern its internal ethical issues that lack in the AMA. AMA primarily standardizes how ethics apply to all health care institutions in the United States (United Stated, 1995).
Historical Overview of Health Care Ethics in the United States
The U.S government spends on the health sector more money than in any other sector. Since 1960, the cost of health care has increased tremendously. This has been attributed to the rising number of old people from 60 years and above (Gillon, 1994). The cost of health care for this age bracket is higher since they constantly demand medical attention than younger people. The rising cost of health care has led to the establishment of health reforms, aimed at restructuring the U.S health system to meet the high cost demanded in health facilities. Despite this challenge, health care institutions have been able to provide efficient services and constantly reduced the mortality rate. A study revealed that cases of complaints about the services and cost of medical care have increased by 12% since 2005 (Wells, 2000).
Through a study conducted by Genao (2003), nurses remained silent about contradicting issues regarding ethics. One of the ethical principles in medical care requires nurses to speak out about any issues that affect their professionalism in the course of duty. Failure to report leads to a breach of ethics, and also denies the leader of the health institution the required information so that he or she can work on how to improve health care service. Statistics revealed that 34% of nurses in the U.S experienced challenges when executing medical care. There has been a lot of concern about the competency of nurses in performing their duties. Nurses fail to balance their, social, political, and economic issues during duties, thus acting unprofessionally and deviating from the expected code of conduct.
Provision of health care services by private and public heath institutions focuses on various considerations before they start offering services. They either consider offering medical services based on health concern of people or financial gain. However, most of the private health care facilities providers focus on financial gain. It is necessary for medical service provider to consider both health and financial ramifications before setting up health institutions. According to Genao (2003), in order for heath institutions to balance their ethical, moral and financial obligation, they must consider both the financial constraints and the health predicament of the patient.
Health facilities come up based on two motives: financial gain and offering services. Health facilities established within financial motives must fulfill ethical requirement as regulated by AMA. Most of them comply with the requirements and provide services far more rated than those health facilities established with a motive of providing medical services. According to Genao (2003), finance stands as the essential resource needed for health care institutions to comply with ethical principles. Well paid doctors and nurses provide quality and efficient services to their patients and work efficiently in other areas of duties. Nurses in private sector also take caution since their managers are keen about their performance. However, sometime private health institutions breach the code of ethics when they charge high medical fees. As a result of the current economic crisis in the U.S, only 46 percent of the U.S population can afford medical services from private health institutions on a regular basis.
The government has established most of the public health institutions. Public health institutions provide medical services without charging medical fees, or charging a considerable amount depending on the condition of the patient and the resources required to attend the patient. The law regulates public institutions to comply with health care ethics as stipulated in AMA. A study revealed that 62% of patients in the U.S constantly complained about the services offered in public hospitals. Most complains came from hash treatment of nurses to patients, 42% of the interviewed population complained about harassment by nurses on several occasions. The general public in the U.S prefers public hospitals because of their accessibility and low medical fees (Wells, 2000).
Dilemma facing Health Care Leaders in the U.S
The ethical significance of medical practitioners and leaders of health facilities have raised issues over the increase in complaints from both patients and medical care practitioners. These dilemmas have various roots that need to be established in order to devise the best strategies to eradicate them.
Culture is one of the main dilemmas surrounding health institutions. Patients, health practitioners, and health care leaders at times have confronting choices. The solution lies outside their medical skills and qualifications. Conflicting scenarios found in health facilities emanate from moral and ethical values. The behaviors and attitudes portrayed by nurses when performing their duties has a considerable effect to patients and the health institutions. If the nurses are arrogant it implies that they will handle patients in a cruel manner, this, in turn, affect the response of patients. In such incidences, the medical care code of ethics is breached and as a result, taints the reputation of health care. This leads to increase in complaints from patients who undergo harsh treatments. Therefore, the existing culture in health institutions is the cause of various problems experienced by patients and health practitioners. Leaders must have all the relevant knowledge concerning the attitude and the behavior of nurses towards patients. The cultural impact of the patient and the health practitioners explain their underlying dilemmas about their behavior towards each other. It is necessary for health practitioners to have all social details of the patient so that they devise the best strategy to handle patients.
Ethical conflicts are dilemmas that affect medical care ethics in the U.S. United States have many people from different cultural, economic and social background. This implies that they have different beliefs and practices. Health practitioners and patients also come from different cultures and thus have different beliefs and practices. This might leads to ethical conflicts in health institutions when conflicting cultures interact. Some of the behaviors and practices from medical practitioners and patients conflict as a result of their cultural difference when they interact. This provokes patients or medical practitioners and at times leads to deviation from the expected mode of conduct. For example in western bioethics, the idea of decision making centers on individual patients and not external influence can change the decision made. However, other cultures consider family as having autonomous decision over matters such as serious illness as opposed to the individual. Therefore, a conflict arises in such issues since the U.S code of ethics stipulate that confidentiality of patient’s information lies with individual only.
The changing demographic in the U.S has raised a number of concerns. It means that medical practitioners have to work with diverse category of patients and other workers in the health facilities. It implies that the practitioner serve a diverse category of people who have different beliefs and values. U.S health facilities offer the best medical care in the world. As a result, many people from different parts of the world come to U.S to get the best medical services they require. A dilemma arises on occasion where patients and doctors cannot communicate because of their language differences. Other incidences of dilemmas occur when patients and the health practitioners at times differ in terms of, race, religion, economic and social issues among others. This difference poses a great challenge and possibly leads to breach of ethical conduct between the patients and medical practitioners because of failure to understand each other’s values and beliefs.
Finance constraints in health institutions and patients, is becoming a persistent problem experienced in the United States. Over the last couple of years, U.S has experienced the worst economic crisis. A recent research revealed that only 56% of the United States population has a medical insurance cover. A lot of people depend on the government and their companies, to provide for medical cover (Cross, 1989). The cost of medical cover has tremendously increased because of the high demand of medical service by foreign patients. Annually 200,000 foreign patients come to the U.S for medical services. Furthermore, the number is rising by 27% (Iwana, 2003) every year. Health institutions have adopted modern technologies in offering medical services, which have resulted to increase in the cost of providing medical services. The number of old people between 65 years and above is rising significantly and currently stands at 23% of the total population and is expected to treble by 2040. This has posed a challenge to the government to reform their medical system in order to meet the financial obligation in the health sector (Cross et al, 1989).
Therefore, financial constraints have significantly affected the smooth functioning of the health sector. The dilemma of bridging the financial gap has resulted to breach of code of ethics by health facilities. It has emerged that one of the major reasons why public hospitals offer poor services is because of lack of adequate resources required for best services to be offered. Shortage of finance has also resulted poor working condition among health practitioners as a result of the increase in workload from the high number of patients coming to public hospitals. On the other hand, Private sector has resulted to charging high medical fees in expense of offering service so that they can meet their financial obligations.
Solutions to Health Care Problems
Leaders of health institutions and the country at large have been challenged to come up with solutions to curb these dilemmas. America Medical Association has committed itself to ensuring that health institutions oblige to ethical requirements. They have pressurized health facilities leaders to come up with practical solutions to contain any defects in health facilities pertaining to ethical issues. Despite the many challenges surrounding health facilities, various solutions can be applied to solve these problems (Cross, 1989).
Government leaders should step in to control the functioning of both the private and public health facilities. In the private sectors, health facilities management lies on the hands of the chief executives and the owners. Therefore, they have a principle role in decision making and hence can decide to charge high medical fees. The government should create a special panel of member to monitor the functioning of health institutions. The team should include auditors and professional medical practitioners, who will be responsible for evaluating and accessing the performance of private health institutions in terms of finance, and access whether they meet the expected standard in offering services as required by the ethical code of conduct. The government should also give incentives and reduce taxes to private health facilities. This will help reduce the cost, and thus demand the private health facilities to offer their services at an affordable rate to patients. The government should also impose a standard rate of medical fees according to various diseases and block private health care facilities emerging in the market with the view of making huge profits.
Government should monitor all the operations of the health institutions, since they play a crucial role to in ensuring the safety of population’s heath is maintained. The U.S government has reformed health system to raise resources required in health facilities, however, more need to be done to ensure that the money raised serve the intended purpose. Some of the leaders in the health institutions are corrupt. They embezzle a lot of funds allocated, by the government, to cater for various needs in the hospitals. The government should ensure that the leaders chosen to head the financial department, in the health institutions, go through the vetting process and ensure they are responsible to handle office (Ashcroft, 2007).
Cultural dilemmas have been persistent and difficult to eradicate because of their complex nature. Leaders should strategize possible ways to minimize these problems to their lowest level. Health facilities leaders should initiate strategies to make interaction between different cultures improve and reduce prejudices and perceptions held between patients and medical practitioners. Health facilities should also come up with policies that could bring different cultures together. One of the ways that health facilities can adopt this is through diversifying their workers by employing professionals from different cultural, social, economic, political, and different belief and values. This will create diversity of culture in the workforce and foster a better understanding of cross-cultural situations. Achieving this will ensure that ethical code of medical care is maintained since health practitioners can be able to understand their patients better (Ashely, 1997).
Cultural competence should be enhanced to understand the social diversity between patients and health practitioners. Culture influences the behavior of patients and health practitioners. Leaders should form a system that absorbs congruent behaviors, attitudes and beliefs of health practitioners and patients so as to develop a comprehensive understanding between them. Health facilities leaders should formulate a system of engaging medical practitioners in recreational activities on a regular basis. This will enable them to interact with people from different cultural settings and ensure that health practitioners are able to understand the varied belief and values of patients. Therefore, become keen while attending them.
Weaknesses
Implementing solutions to curb the dilemmas surrounding health facilities ethical issues would be hectic. Resources continue to be a problem in health facilities and to the government. Although the government has significantly reformed health system, it has failed to raise enough money to cater for the increasing needs in the health sector. Health institutions, on the other hand, cannot be able to offer quality service without using up-to-date technologies. Health facilities will contradict offering quality services if they lower their medical fees. It is hard to understand the diverse cultural differences that exist in the United States. More and more culture influx U.S every year and, therefore, understanding cultural diversity is a journey that cannot be attained in a specific time.
References
Ashley, B. M., & O’Rourke, K. D. (1997). Health care ethics: A theological analysis. Washington, D.C: Georgetown University Press.
Ashcroft, R. E. (2007). Principles of health care ethics. Chichester, West Sussex, England: John Wiley & Sons.
Cross, T. L., Bazron B. J., Dennis, K. W., & Isaacs, M. R. (1989).Towards a culturally competent system of care, volume 1.Washington, DC: CASSP Technical Assistant Center, Georgetown University Child Development Center.
Genao, I., Bussey-Jones, J., Brady, D., Branch, W. T., Corbie-Smith, G. (2003). Building the case for cultural competence. American Journal of the Medical Sciences, 326(3), 136-140.
Gillon, R., & Lloyd, A. (1994). Principles of health care ethics. Chichester [England: John Wiley & Sons.
Iwana, M. (2003). Toward culturally relevant epistemologies in occupational therapy. American Journal of Occupational Therapy,57(5), 582-588.
United States. (1995). Long-term care ombudsman report – FY: With comparisons of national data for FY. Washington, D.C.: Administration on Aging, Dept. of Health and Human Services.
VanDeVeer, D., & Regan, T. (1987). Health care ethics: An introduction. Philadelphia: Temple Univ. Press.
Wells, S. A., & Black, R. (2000). Cultural competency for health professionals. Bethesda, MD: American Occupational Therapy Association Press.