Another NY Times article, which uncovers a recently discovered health disparity.
In reading this article we must think about whether or not doctors treating poorer patients can, in an ethically defensible manner, change the course of treatment? Do the duties of doctors change to patients of different financial means? If a patient has unlimited funds for treatment, what duties does the doctor have to that patient, and his others? Are doctors motivated by principles of justice and equability when treating the poor?
(Submitted by Jane Tingley)
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When discussing the over-diagnosis of antipsychotic medications in poorer patients, I can see a couple ethical issues. First, it is important to note, as it said in the article, that this problem could be due to the fact that lower income families are subject to a lot more stress for various reasons than middle class families. However, although medication is the quick, easy, cost effective "cure" for these children, medication is not always necessary, and usually not the best treatment. For many incidences, especially in the case of more minor disorders, a behavioral intervention or long-term counseling is more effective treatment of a psychiatric disorder, and leaves the patient with effective ways of dealing with the stressors in their environment, thus making intervention a more successful treatment. Long term counseling is generally more expensive than medication, but once completed can be maintained throughout life, whereas medication is an easy treatment of symptoms but will never get rid of the condition, or help the patient to deal with the condition on their own. Over time, the money saved by counseling eliminating the need for medication could even balance out the cost.
ReplyDeleteAdditionally, over-prescribing medication when the patient doesn't truly need it violates the principle of nonmaleficence, to do no harm. Although the medications treat symptoms of psychiatric disorders, they often cause side effects such as weight gain or physical problems due to metabolic changes. If the patient can overcome their disorder without medication, but medication is prescribed, then the physician prescribing the medication is causing these symptoms to occur unnecessarily. For severe disorders that require medication for the patient to overcome it, the benefits of the medication outweigh the potential consequences of the symptoms, but for low-income patients with minor disorders, prescribing medication is not ethical.
This can also be seen as a discrimination/class issue. Since behavioral interventions/counseling are generally more effective treatment of any disorder, low-income children are receiving the "easy way out treatment - their symptoms go away, but they still have the disorder, whereas middle class children receiving behavioral intervention have more potential to overcome the disorder. This keeps the disorder in the lower class population, while eliminating it in the middle/upper classes. Perhaps insurance companies such as Medicaid should consider covering some counseling programs as well as medication, in order to eliminate overdiagnosis of medication in lower income families, and making more permanent treatments of counseling become affordable for poorer patients.
Depending on the situation that the patient on Medicaid is in, this solution might be more or less ethical. The doctor has a responsibility to do what is best for the patient overall. If the patient is in school and has been having troubles for a long time, they may be in danger of having to drop out. If the doctor was to give them the antipsychotics, it is one of the cheaper and quicker solutions to the problems. Even if they are only described for a short time, it is the solution that works the most efficiently. If the doctor was to tell the patient to participate in a different treatment that would take longer, the child might be unable to stay in school. If that happens, then the poor children will continue to stay in poverty, which will only make the problems grow for everyone.
ReplyDeleteI don’t think there is any proper defense for prescribing a child heavy drugs that doesn’t need it. Anti-Psychotic medications have serious side effects that can ruin a child’s will to go to school. These drugs will keep the child out of school, more than keep him in there. Moreover, these drugs have a high dependency rate. To put a child on anti psychotic medication is like erasing his future. Human beings, by nature are selfish. Doctors prescribe these medications solely because Medicaid won’t pay for all of the therapy and other intervention sessions. It is the doctor’s duty to keep his patient healthy, whether they are having emotional problems or physical. It’s the doctor’s duty to treat all of his patients equally no matter the circumstance. The duty of a doctor should never change due to a persons economic status, however, they do. Doctors are motivated by selfish reasons, and want the highest possible pay. Children that come from poor families don’t have a chance to get better due to the lack of care the doctor gives them.
ReplyDelete-Alyshia