Healthcare Distribution & Justice

Distribution and Justice

• Disease is a social concept influencing healthcare policies.
• Disease definitions vary across societies, impacting healthcare distribution and complicating justice in this area.

Goals of Healthcare & Issues

• Improving public health can conflict with individual rights, like mandatory vaccinations.
• Treating the sick may become inefficient when using resources on costly, unsuccessful treatments.
• Providing equal access can be impractical due to resource limitations.

Minimal Level Healthcare: Requirements

• Requires 3 out of these 5 aspects:
• Basic preventive care like vaccinations and screenings
• Emergency medical care for life-threatening conditions
• Access to essential medications for chronic and acute illnesses

Need vs. Contribution in Distributive Justice

• Need prioritizes healthcare for those who require it most.
• Contribution rewards individuals based on their effort, work, or societal impact.
• Tension exists between basing healthcare on need, which may ignore effort, and contribution, which may exclude the most vulnerable.

Approaches to Justice

• Utilitarianism maximizes overall well-being.
• Egalitarianism provides equal access for all.
• Libertarianism considers healthcare an individual responsibility.
• Communitarianism views healthcare as a shared social good.

Triage & Utility

• Triage prioritizes treatment based on urgency and survival likelihood.
• Utility maximizes benefits by treating those with the best survival odds.
• Ethical Dilemma: Denying care to those with lower survival chances raises justice concerns.

Political Perspectives on Healthcare

• Republicans focus on personal responsibility and market-driven solutions, potentially overlooking social inequalities.
• Democrats emphasize universal access but may overlook efficiency and financial sustainability.

Two Aspects of Truthfulness

• Lying is intentionally providing false information.
• Right to Truth involves patients deserving truthful information, but full disclosure isn't always necessary.

Placebos and Truthfulness

• Placebos are ethical with informed consent or measurable therapeutic benefits.
• Using placebos without patient awareness violates truthfulness.

Confidentiality vs. Privacy

• Confidentiality is the obligation to keep patient information secure, like medical records.
• Privacy is the broader right to control personal information.

Justifications for Confidentiality & Privacy

• Deontological ethics: Professionals have a moral duty to keep secrets.
• Consequentialism: Breaking confidentiality can cause harm, like loss of trust.
• Virtue ethics: Healthcare providers should respect patient autonomy.

Types of Secrets

• Natural secrets are private but not legally protected.
• Promised secrets are shared under an agreement of confidentiality.
• Professional secrets are protected by law and ethical codes (e.g., medical records).
• Breaking professional secrets may lead to lawsuits, loss of license, and criminal charges.

Exceptions to Confidentiality

• Consultations allow doctors to share information with colleagues for better treatment.
• Statutory law requires disclosure in some cases, like reporting infectious diseases.
• Court orders can override confidentiality.
• Proportionality involves balancing harm vs. benefit when deciding to break confidentiality.
• Views on informing family members is subject to changing legal and ethical considerations.

Judging Healthcare Quality

• Effectiveness: Does the treatment work?
• Efficiency: Is it cost-effective?
• Patient-Centeredness: Does it respect patient values and needs?

Self-Limiting Conditions

• Self-limiting conditions improve on their own, like the common cold.
• Judging treatment success is challenging when improvement occurs naturally.

Mission Statements

• Mission statements define an institution’s ethical and professional values.
• Also guide decision-making and patient care priorities.

Due Process in Peer Denunciation

• Investigation is the first step, gathering facts and testimonies.
• Hearing involves reviewing evidence in a fair manner.
• Appeal Process allows accused individuals a chance to defend themselves.

Conscientious Refusal: Conditions for Validity

• Moral Justification must be based on deep ethical principles, not personal preferences.
• No Harm to Patients: Refusal cannot jeopardize patient care.
• Referral to Another Provider: If refusing, a provider must direct the patient elsewhere.

Role of Ethics Committees

• Educate healthcare providers on ethical guidelines.
• Consult on difficult cases like end-of-life decisions.
• Review policies to ensure they align with ethical standards.
• Controversially, some committees make binding decisions in ethical disputes.

Self-Policing

• Self-policing maintains professional integrity.
• Secrecy exists due to fear of legal consequences, to protect hospital reputation, and to avoid public panic over medical errors.

Whistleblowing

• Whistleblowing is reporting misconduct within a healthcare system.
• Whistleblowing can damage careers and relationships.
• Legal protections may not be strong enough.
• Can lead to institutional cover-ups instead of reforms.
• Should only be done after internal efforts fail.

Problems with the U.S. Market-Based Healthcare System

• High Costs prevent many patients from affording necessary treatments.
• Inequality in Access causes those without insurance face worse health outcomes.
• Profit Over Care leads some healthcare providers to prioritize profit over patient well-being.