Health is not Healthcare

In regards to healthcare inequalities, Daniels writes, in his article “Justice, Health, and Healthcare”, that a society’s health is strongly affected by its social inequalities, such as unequal distribution of income; therefore, we, as a society, must bridge the gap between these social inequalities thereby eliminating health inequalities. He uses empirical evidence to support this argument, quoting studies that show the more unequal a society is in economic terms, the more unequal health is in that particular society. One strong suggestion he makes is that income inequality leads to educational inequality which leads to health inequality. Not only do these inequalities lead to poorer health but he states that it also “erodes social cohesion” within the society. Utilizing Rawl’s Theory of Justice, a supporter of Kantian Contractariansim, Daniels argues that since it is morally just to protect opportunity and distribution of goods, these social inequalities are unjust. Furthermore, since health inequalities are a result of these social inequalities and further limit opportunity, they too are unjust. Therefore, Universal Healthcare is necessary to promote equality.

Sreenivasan, criticizes Daniels argument in his article, “Opportunity is not the Key”, stating that Daniels has missed an important factor by assuming that health and healthcare are essentially the same thing. He argues that health is indeed special in terms of equality but “access to healthcare” is not the same moral right and therefore, is not unjust. Using Daniels own empirical evidence, he states that since health inequalities are a result of socioeconomic inequalities and the fact the universal healthcare has been shown not to work in terms of equalizing health, such as in the UK, then a just society has a duty not to provide universal healthcare access. Instead, it should utilize all its resources to equalize socioeconomic inequalities.

Although I have in the past been a strong proponent for Universal Healthcare, our discussions in class on the sheer complexity of what would be necessary to provide minimum healthcare to all and what exactly the definition of “ decent healthcare” would entail, I find myself agreeing with Seerivasan that the socioeconomic inequalities are the true culprit in an unequal society and that we must work on closing the gap between these inequalities first and foremost. Thinking of these inequalities, I found myself stuck on Daniels suggestion that income inequality leads to education inequalities which leads to health inequality. Is this the correct cause and effect order or do they blend together? I do see how income can lead to education inequalities through unequal distribution of state resources. However, I believe income inequalities ultimately stem from generations of individuals being lost in a poor education system. As a result, they do not have the same resources as others and cannot find a job with equal income. Both inequalities are so strongly tied together that how does a just society chose which inequality needs to be fixed first? Furthermore, I think it would take generations to fix these inequalities in any society. For example, fixing the education system now will not show economic results until those children enter the workforce. So, in the meantime, what do we, as a society, do while we wait for the inequalities to diminish. Can we stand by and let the current generation suffer so that in the long run future generations have greater opportunity?

Revised Schedule March 25 - May 5

Here is the revised schedule for March 25th through May 5th. I’ve written in the bloggers assigned to particular days, but Lebenswelt, mighty skunk, Wasabi, and my_silent_orchestra will each have to pick a new set of readings to blog about.

Mar 25 (Wallace)
Brock, “Cloning Human Beings: An Assessment of the Ethical Issues,” 6th Ed., 631-643

Apr 1 (Wallace)
Steinbock, “Respect for Human Embryos,” 6th Ed., pp. 668-671
Ryan, “Creating Embryos for Research,” 6th Ed., pp. 672-683
Theory: Religious Ethics, pp. 20-23

Apr 8 (Lebenswelt)
Marquis, “Why Abortion is Immoral,” pp. 547-555
Thompson, “A Defense of Abortion,” pp. 567-576

Apr 15 (ILoveLucy)
Arras, “Physician-Assisted Suicide: A Tragic View,” pp. 484-487
Dworkin et al, “The Philosophers Brief,” pp. 488-495
Theory: Nonmoral Considerations, Modes of Moral Reasoning, pp. 35-41

Apr 22 Review Day

Apr 29 Final Exam

May 5 Papers Due (Tuesday, 5pm)

Why equalitarian proposal is morally wrong in Health Care System?

It is ideal to have a health care to every body's benefit; however, there are limitation resources knowledge and also disagreement what is right or wrong in peopl's mind because of limitation and disagreement. so we need accept the policy that has both moral diversity and inequality.

We have to recognize that people who want to have better quality of basic health care benefit through private resources by their own freedom of choice that is a way to purchase their health benefit; however, if people who can't afford to purchase their own private insurance, then, there should have a state system for funds, for those people, for their basic health care benefit. People should agree and accept that our health care system would not be equalized same as moral diversity and disagreement in our social setting.

In equalization in health care system would have limits people who like to purchase private insurance by their own ability. Our disagreement about equalization in health care system is similar to those people who disagree about abortion right, artificial insemination, assist suicidal euthanasia that not resolvable in general moral secular terms and lot of disagreement in public norms for fairness.

Is There a Right to a Decent Minimum of Health Care?

Author Allen E. Buchanan for this essay is professor of philosophy in public policy at Duke University since 2002 and written 6 books in biomedical ethic, social justice, international justice including international law. he served staff philosopher for president's commission on Medical Ethic 1983, and 1996 to 2000. I am giving you author's back ground information that it help us understand better his article.

Definitely, Buchanan is favor of having Universal health care that "our government to guarantee a decent minimum health care for every body(p:525)." not only certain people but for every body to all person with backing up coercive power and policy by state or federal to succeed for this application.

we have already has had special rights for health care for man and women who served country that sacrificed for the good society and social welfare for the country, and people can argue for other group that injustice argues for American African and Native American. There are many clinics already for indigent groups through all of the United States with enforced principles requiring toward familiar public good by rotating physician to participate for runing clinic smoothly beside their own practice.
If our societyin health care change to all one category of Universal health care then poeple who want go freedom of choice to pick their own health care for better treatment, there will be very unhappiness among the lot of people who diminishing their freedom by that. Also where all these cost of Universal health care will be coming from even if it would be working in the future?

Health Care Irrespective of Socioeconomic Status?

In the commentary "Class, Health and Justice"many different possible solutions to the inequalities in health care distribution are listed. It is a known fact that in most societies, there is a definite difference in the health care distribution which is the direct result of a difference in socioeconomic status. Simply put, money rules everything. It governs not only the opportunities available to us (with regards to things such as education) but also the treatments that we are able to receive (for example, health care).

Four possible solutions to resolving this inequality were listed:
1. Maximizing the total sum of health of a society
2. Equalizing levels of health between classes
3. Maximizing the health of the lowest socioeconomic class
4. Give priority to eliminating and treating the sickest individuals

Before reading this commentary, I will admit that I was 100% for universal health care. I didn't see any issues with equalizing the health care provided to all socioeconomic statuses until the point was brought up of how underlying egalitarianism would have to extend far beyond just issues of health. This would only result in a socialist society, which in theory seems morally just, but we know it just does not work.

After completing the commentary, my position had changed to my believing that the fourth solution would be the best. I however must mention that I could not ignore the consideration listed towards the end of the commentary: "any attempt to locate the source of injustice in class inequalities in health is the notion that people bear some responsibility for their own morbidity and mortality."I strongly agree with the statement that each individual is somewhat responsible for their health. I know there are definite exceptions, especially when considering genetic predispositions, but why should health care be equalized when we don't know for sure that everyone has the same goals and life plans? Many individuals may not care about their health and may engage in activities that deteriorate their health, so I do not believe that they should receive equal treatment as someone who chooses not to engage in such behaviors.

Even in agreeing with this statement, I think that the fourth option is still the best as it gives advantages to those who really need it. Not only this, but in attempting to help those that are the "worst-off", we are also eventually helping ourselves by directing our resources towards diseases that desperately need cures.

The Haves Get Sick Too

There is no denying that there are vast differences in the longevity, healthfulness and availability of adequate health care between those in high income brackets as opposed to those in low ones. Political pundits offered their opinions on this subject for months during the recent race for our nation's newest President. This disparity is no longer considered the big pink elephant in the room, but rather one that has bore it's way to the forefront of our attention as our nation's jobless rate climbs, insurance rates sky-rocket and diseases like heart disease and cancer loom over our aged thoughts. In the article Class, Health And Justice, authors Marchand, Wikler and Landesman weigh in on this topic and offer four main points of justice/equality and health.

Point 1 - Equity as Maximization (moral assumption: everyone is treated the same as a matter of justice regardless of how this might effect other social programs)

Point 2 - Equity as Equality (moral assumption: everyone deserves to live a long, healthy life, therefore "improvements for those who are better-off financially are not as valuable as improvements in health for those who are worse-off")

Point 3 - Equity as Maximin (moral assumption: the poorest amongst us should have the best health possible without regard to "equality")

Point 4 - Equality as Priority to the Sickest (moral assumption: socioeconomic differences are not taken into account at all - whomever is suffering the most should be treated with the best available resources)

The authors also skimmed the idea of the causation of and individual responsibility for illness and how diversity of culture can play a role in both, but left that discussion in a rather neutral position.

I agree with the fourth point because who doesn't value being healthy particularly when we are sick? I appreciate how the authors redirected the attention not on the obvious disparities that class causes in health care, but on the actual needs of the sickest and how their needs could best be met. Ultimately even if one favors the idea of creating equality by providing a leveled field for the "Have-Nots", given the evidence, often it is the Have-Nots who suffer from the worst health and live the shortest lives so their needs would be best met with point 4 as would anyone who was seriously suffering from illness. Equality in health care to me is the opportunity to help those who need it the most, regardless of race, creed, religion or economic status or lack and I think point 4 brings that idea home. What do you say?

Equal Opportunity in Health Care Can = Individuals' Successes or Failures

Daniels argues that equal opportunity in health care is relative to how one views "justice" in health care and the question of justice in health care poses other questions like - should health care be viewed as a commodity like owning a TV or automobile, or should it be categorized separately and viewed as "special"?

For me, the author's most interesting argument was the one most developed, the normal opportunity range as a consideration for health care differences. Daniels asks us to take into account people's life plans and how their health might contribute to their success or lack. This is ultimately (according to Daniels) is how health care should be judged, if it is fair or equal really depends on whether or not it allows individuals the opportunity to reach their life plans without being hampered by illness.

Vaccination and Autism

Since the subject came up in class, I thought some of you might be interested in this article from US News & World Report: Court Says Vaccine Not the Cause of Autism.

Death or Impotence -- Tell the Truth

I favor the full Kantian Categorical Imperative approach against paternalism, there should be 100% informed consent with Mr. Williams. Dr. Kramer should tell the truth and have a serious discussion with Mr. Williams about the small risk of temporary impotance from taking the antihypertensive medicine. The good doctor is showing respect to Mr. Williams by telling him the truth!

Kantians Can't?!

In medicine both Kantian and utilitarian ethics need to be employed to reach solutions to complex and difficult problems. In the ideal world, Kantian ethics would be morally superior to utilitarianism an consequentialism -- the right act is not always the one with the best consequences; Kant argued that this can never make an action right or wrong.

Kant's formulas: (1) act as to treat people always as ends in themselves, never as mere means -- people deserve respect -- the ends do not justify the means; (2) act only on that maxim whereby you can at the same time will that it would be a universal law -- refrain from making exceptions of ourselves -- universalization. Kant argues that all persons must be treated equally. In our reading regarding the 5 innocent people who need organ transplants (p. 14), the killing of one person for the distribution of organs to the others is morally wrong. This act would certainly be making an exception and treating a person as a mere means! I could not justify this act. However, I can see that Kantian ethics are much more challenging to implement in medicine, to decide what is morally right or wrong and to treat people as "ends" themselves not "means." People do not exist simply to fulfill our purposes...are ther not exceptions? What if he or she is not a rational being? All cases are not ruled out! Utilitarianism can use its belief as an excuse to do something morally wrong in saying it is in the best interest of the whole, like cloning body parts.

I see the Kantian test for universalization similar to the "Golden Rule"-- treat others as you would like others to treate you -- it is not a personal policy but a principle for everyone. I agree with Kant that consistency and universality are part of a concept of moralilty and duty. Thus patients and research subjects must give informed consent before they are treated, also that they are shown respect by telling them the truth...even when the knowledge might be painful. This allows the patient/subject to make their own moral choices. This is good, I agree because Kantianism does not provide a decision procedure for deciding which out of all morally permissive acts is right. Thus giving less guidance to the patient/subject and encouraging autonomy and self-determination.

Pain and anesthesia could be a concern involving Kantian ethically following doctors. Should a doctor allow a patient to sufferwith out pain medicine if he/she believes they deserve pain? Pain depends on whether it is deserved (according to Kantian ethics), and it is morally right that the wicked should suffer?! I stronglly disagree with Kant here; who is to decide who is truely morally right, wrong, or wicked in society? Should the woman have an epidural for her pain during labor or not? How did she get pregnant, maybe she should not according to Kant?

What type of Physician-Patient Relationship Do You Want?

According to Ezekiel and Linda Emanuel there is a struggle between patients and physicians regarding the amount of control that patients have in the decision making process when it comes to their medical care. This struggle arises because of the unbalanced nature of human rights of the patient verses the physicians duty to keep patients from harm even if its from themselves. So in order to give a solution to the problem they have outlined four types of physician-patient interactions that have occurred in clinical settings.

The first of the models is the Paternalistic model. This model only ensures that the patients receive the best interventions solely based on their health and well-being. The physician has no regard for the patients values or desires. The second model is the Informative model, where as the physician gives the patient all the vital information to make their own choice in the type of medical intervention that he or she wants and then the physician follows through with what the patient has chosen. The physician in this case only does what the patient wants(not bothering to ask the patient of his or her values and/or desires) and does not suggest his or her own thoughts as to what the patient should do. Thirdly, you have the Interpretive model where the physician tries to elucidate the patients values and desires of what he or she actually wants and then tries to help the patient select the best possible medical option that correlates to the patients values. In this case the physician seems to care about the values of the patient and tries to offer some advice as to what should be done.

Lastly, you have the Deliberative model where you have the patient and physician both collaborating with one another on the best medical care and the best course of action in order to make the patients values come to life( or give them a more realistic view of the situation) for overall optimum health. In each one of this case the patient can also be an issue in regards to their own health. Patients can range from not being able to voice their desires to being blatantly defiant with what the physician suggests, or waiting on the doctor to tell them what they should do and not questioning what other possible solutions there may be.

In my opinion the deliberative model is the best in terms of physician-patient relationships. I want a physician that is not only going to give me information, but listen to my desires and values and help me try to facilitate my views in a realistic sense.And I want to be able to grasp the knowledge that the physician as given in order to be able to satisfy my level of autonomy. But all to often I hear stories of physicians and patients being the latter. I have a best friend that is diagnosed with Ehlos-Danlos Syndrome and she has had doctor's that have represented each one of the models that have been named. Also, I have seen patients that refuse to act right when it comes to their own health and medical care that they have gotten from the doctor. Then in the same breath ask why do I have to feel like this or why me? And now are running to the doctor and asking what can they do "now " to make the issue that they have go away.(because they have made the problem worse.)

All in all, I believe that a physician would have to embody all of the models because it depends on the type of patient that he or she encounters. And be able to discern the type of patient that you have before you so that they will be able to give diagnosis, prognosis, and possible treatment solution in certain manners with regards to the patient that they are treating. With out this knowledge the patients autonomy could be in trouble.

So what should be the ideal Physician-Patient relationship for you? And where does you level of Autonomy fit in?