[This prompt is in response to Paul Farmer's article "New Malaise: Bioethics and Human Rights in the Global Era" (p. 293 - 304).]
The term bioethics or medical ethics tends to cause people to think about issues such as genetic testing, doctor-patient relationships, end-of-life care, life-prolonging technologies etc. which are at the forefront of modern ethical dilemmas in medicine in many industrialized nations like the US. However, Paul Farmer's article from the Journal of Law, Medicine and Ethics, "New Malaise: Bioethics and Human Rights in the Global Era," asserts that medical ethics must take on a broader scope to consider the ethical implications of the millions of people who live in poverty without access to healthcare at all. Modern medical ethics discussion tends to focus on technologies and services that are available only to those who can pay for them and who live in places where these services are accessible. But what about everyone else?
Farmer suggests that the ethical considerations of distributing healthcare globally should be the forefront of bioethics, rather than focusing on the ethical implications surrounding advanced medical technologies which only pertain to a select group of people who have the resources to obtain them.
As Farmer cites in his article, the international code of Medical Ethics (Geneva, 1949) states that medical professionals "will not permit considerations of religion, nationality, race, party politics or social standing to intervene between [their] duty and [their] patient." However, it is exactly these factors which in many cases deny thousands of people any care at all. If the international code of Medical Ethics establishes high standards of care and obligates doctors to act upon their duties to their patients, are we to say that only the people who have access to obtain care under a doctor deserve the high standard of care which this code calls for?
It makes sense that all humans have a right to healthcare, and the fact that economic and geographic factors deny many humans from these basic rights seems innately unjust and wrong. I would argue that denying treatments to people (whether life-saving or basic in nature) when we have the technology to treat those people is morally wrong, regardless of the socioeconomic status of that person. But how do we as a global healthcare system provide healthcare for everyone? Who is obligated to pay for it and provide it? Are we as a society held morally responsible creating a system in which not everyone has the equal opportunity to receive the same quality of healthcare or to receive care at all? And to the same extent, how do we not allow race, socioeconomic status, geography and nationality to determine who receives healthcare and who doesn't?
(Submitted by Michelle Kielty)
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I agree that denying treatments to people when we do have the technology to do so is wrong regardless of socioeconomic status. I also agree that there should be a global coverage, everyone should be covered. On the other end however, I believe that the society cannot provide global coverage and cannot fully allow race, socioeconomic status, geography, nationality, and so on to not have any affect when determining who receives care and does not due to a "circle" that the society seems to be following. Looking back to history, race was a huge problem segregating colored to non-colored, but that was resolved - but in the end, we still are segregating the population, not by race, but by income and socioeconomic etc, which minorities are usually the majority in the lower class. Because the lower class have a poor income, living in bad conditions and environment, and areas further away from access to health care etc., they can't afford healthcare and/or even if they have healthcare, they seek attention when it's too late. As long as there is a social class, the higher and middle class will always be living in better conditions, closer access to care, pushing the lower class further and further away making it harder and worse for them. One way to try and resolve this may be trying to clean up and improve poor areas, building more healthcare facilities in the area with a high salary to hopefully attract many skilled practitioners; modify the healthcare system just for residents living in the area, but one of the big issue becomes cost and money. Source of the money to pay for the cost may come from the high class by raising their taxes (for example), but then the high class will disapprove, complain, and so alternative source is needed, which so far, seems like it's hard to do. I think that no matter how hard we try, it is practically impossible to find a source for the cost while keeping everyone content, there is a far advancement in the setting of the economy/the world (for example, social class), that the only way to fix anything is by hitting the "reset" button and resetting the world.
ReplyDeletePaul Farmer raises an important issue in illuminating the need for bioethical discussion concerning access to healthcare. I would say it is a case in point that many students who take a class on bioethics expect to see issues on the syllabus like genetic discrimination, and not equal distribution of healthcare. However, just because this issue is valid does not mean that it needs to take precedence over issues that affect richer countries. Farmer states that the healthcare access problem should be the new focus of bioethics. I believe that neither focus undermines the other and that both are important.
ReplyDeleteIt is unfortunate, but true, that there cannot be a global healthcare system that can provide care for every person. Resources will always be limited and we will have to make tradeoffs, but what matters is the awareness of how we make decisions concerning access to resources. Ethically, how do we make these tradeoffs? Would a parent rather spend $1 million on a treatment for their sick child or on a drug that could save 1,000 people from AIDS? It is impossible to envision a world in which every patient, community, and nation was able to equally distribute resources.
Just because orphan drugs are given to very small populations of patients with rare diseases does not mean we don’t develop these drugs for them.
Farmer says we must change the fact that there are millions of people who are denied the chance to be patients. This is true, but I think it is ineffectual to imply that the only fair course of action is to divide our healthcare resources equally through the world. If polio had not been eradicated from rich countries such as the United States, the vaccine would never have reached the poor in third world countries. Yes, it took much longer to reach poorer nations, but polio campaigns by organizations like Rotary International have come very close to eradicating the disease. We should not eliminate a focus on developing technology and advancements that save individual lives because the advancements will ultimately benefit everyone.
-Rebecca Fink
I agree that all individuals should be able to seek and recieve healthcare on an immediate basis regardless of geographic location or race. But to imply that our primary focus of bioethics should now be shifted towards a broader scope is not only unrealistic but nieve. First and foremost, as a nation, we should focus on realistic matters that pertain to "here and now situations."
ReplyDeleteEthical dilemmas should be concerned with decisions and options that can be realistically rationed. In modern day US, as well as many other nations, there are a significant amount of individuals that suffer from illnesses and injuries. Also, many of these individuals are uninsured and cannot recieve the proper medical treatments due to this lack of or acceptance/payment. But to what extent should we hold ourselves ethically responsible for subsidizing others healthcare? I mean, don't we to an extent already contribute to developing the healthcare system through taxes and other donations? Although it has obviously not been enough, what is? I am all for providing care to each and every individual on this planet, but I just believe it is unattainable at this moment.
Ethical dilemmas should be based on what is right or wrong, best or worst intention, but it also ought to hold precedence to immediate realistic situations rather than plans for reform. And although I believe that this issue should be approached with all seriousness and persistance, we are just not there yet.
As for now, we must continue to advance medical technologies and our healthcare treatment options to those who qualify. Our obligation to uphold nationwide healthcare is relinquished due to the fact that we simply have no way of achieving this goal as of yet. Regardless of an individuals kindness and consideration for those unable to receive treatment, the health of our entire population will not be decided by one or a couple individuals. Therefore I feel it's unjust to consider it an ethical priority over advanced treatments that are currently saving lives everyday. Although it may not effect as many individuals on a daily basis, the use and developement of advanced medical technology is still a largely beneficial process. These technological advancements have continued to flourish and provide cures to illnesses thought to be fatal years ago. Providing the best care with the best intentions is the forefront of bioethics and I believe these medical advances are key. While we wait for a miracle to one day arrive and give every individual subsidized coverage, we must settle for the treatment and rationed care we now recieve.
I believe that the issues that are raised within Farmer's article pertain to Michael Moore's Film that we are watching in class, “Sicko.” In the movie, Michael Moore notes that almost fifty million Americans are uninsured so they do not have ready access to medical care due to high prices for medicine and treatment. Furthermore, he notes that those who are covered are often victims of insurance company. Most notably is the discovery that bonuses are given to insurance company physicians who find reasons for the company to avoid paying for medical insurances.
ReplyDeleteThe facts that Michael Moore addresses are quite baffling. It seems almost ridiculous that many Americans do not receive the adequate care simply due to their socioeconomic standing. When a country has the technology to help other individuals, the health care physicians of that country should give treatment regardless of the socioeconomic status of these individuals. As a whole there is more good in the world and many people benefit from a transition into a universal health care system. However, I feel that the transition of America, from a profit earning non-universal healthcare system to a universal healthcare system will not be an easy process.
Playing the devil’s advocate, transitioning from the current healthcare policies to a universal healthcare system will be at the expense of individuals who pay taxes to the government – almost everyone. Is it right for citizen A to give up more of her hard earned money that she earned for her family so that citizen B might get aid for lung cancer when citizen B is clearly a heavy smoker? Many issues such as this would be raised if the transition were to occur. Should individuals who live healthily be required to pay for individuals who clearly are a harm to themselves, such as alcoholics and smokers? What if the individual is constantly in the hospital due to an illness where he or she has no control? Is this any different from the smoker scenario? Through a universal healthcare system, the biggest losers are insurance companies and tax payers. It’s important to recognize that while given universal healthcare might at first seem like a great idea (and I believe that it still is), there are also many drawbacks as well.
~Tully Cheng
With all due respect to Dr. Paul Farmer, his argument that we commit too much argument to advanced medicine and not enough to the ethical issues of health disparities commits a classic ethical failing: taking multiple ethical problems and treating them as one issue. That is to say that the two issues are mutually exclusive and each deserve adequate attention so that health care providers, policy-makers, patients, and general citizens can make the most ethical decision in any situation. This can be further understood in the sense that there really is no ethical dilemma in debating one topic over the other because they do not directly contradict in terms of ethical principles. While Farmer may be frustrated from the media attention that is given to hot topic issues such as abortions, cloning, etc., that feeling does not invalidate the need to act ethically given a certain circumstance.
ReplyDeleteThe article seems to look at argument and discussion on bioethical issues as a resource that must be allocated to either advanced medicine or health disparities; this is just not the case. Discussion is one of the few resources that is theoretically unlimited. By noting this, however, Farmer taps into the idea that the time spent in discussion and in the media breeds more resources and efforts to solve the issues at hand. (That, however, is an ethical debate for another day.) In this sense, Farmer argues on the point that the right to healthcare is a given (which is still in debate for many people) and deserves more attention to higher medical issues so that we can allocate resources appropriately.
Disregarding the effect of media and discussion on the allocation of resources, we can more clearly understand why Farmer’s ethical argument is not based on reason and more rooted in passion for his cause. From a purely ethical stand-point, Farmer is not debating that the problem of health disparities is a larger insult on ethics and thus the media acts unethically for spending less time discussing the ‘worse’ issue or the issue that is a larger offense to the right to happiness. In this sense, Farmer is saying that it is most ethical to discuss the issues that cause the most harm yet he is discussing the issue of what we discuss, getting caught in a circular thought process that falls apart quite quickly.
Paul Farmer's article from the Journal of Law, Medicine and Ethics, "New Malaise: Bioethics and Human Rights in the Global Era," asserts that medical ethics must take on a broader scope to consider the ethical implications of the millions of people who live in poverty without access to healthcare at all. Modern medical ethics discussion tends to focus on technologies and services that are available only to those who can pay for them and who live in places where these services are accessible. Paul Farmer, however, strives to illustrate the difficulties of obtaining even the most basic healthcare for those who do not have the money to pay for it or those who live in countries where medical advancements are not even considered due to lack of resources. I agree with Farmer when suggests that the ethical considerations of distributing healthcare globally should be the forefront of bioethics, rather than focusing on the ethical implications surrounding advanced medical technologies which only pertain to a select group of people who have the resources to obtain them. The problem lies in how we can provide even the most basic healthcare to those who are unable to obtain it.
ReplyDeleteIt makes sense that all humans have a right to healthcare, and the fact that economic and geographic factors deny many humans from these basic rights seems innately unjust and wrong. I would argue that denying treatments to people (whether life-saving or basic in nature) when we have the technology to treat those people is morally wrong, regardless of the socioeconomic status of that person. The question and the problem is how do we as a global healthcare system provide healthcare for everyone. This is an extremely challenging task that does not have a simple solution. It will take years and numerous contributions of resources from numerous countries to create an effective global healthcare system. Legally, no one is obligated to pay for it and provide it; however, morally each and every person and country are obligated to pay and provide for it since we have a moral obligation to help those in the greatest need. Therefore, we as a society are held morally responsible for creating a system in which everyone has the equal opportunity to receive the same quality of healthcare. I do not feel race, socioeconomic status, geography, and nationality would greatly influence who receives healthcare and who doesn't. I strongly believe it is the resources both monetary and non-monetary that restrict the amount of healthcare that is obtainable to all. Regardless of these obstacles, we must strive to obtain a system in which everyone has the equal opportunity to receive the same quality of healthcare.
If anyone has any further interest in Paul Farmer or global healthcare, I highly recommend reading “Mountains Beyond Mountains” by Tracy Kidder which is a book about Paul Farmer. Paul Farmer is by far one of the most influential people in the world and in the WHO, in regards to global healthcare. In the book Tracy Kidder follows Paul Farmer down to his clinic that he established in Haiti that he visits frequently to provide care to those who otherwise would not have access to it. He speaks about the global healthcare issues and truly opens your eyes to the injustices in healthcare and leaves you wondering what you can do to make a difference. It is a truly inspiring account and I assure you that you will not regret reading it.
-KEENAN