Evaluation of ethics and health care.
Evaluation of ethics and health care should also analyze medical ethics. A common framework utilized is the four principles approach postulated by Tom Beauchamp and James Childress in their textbook entitled Principles of Biomedical Ethics. The text recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of application.
The four principles are:
Respect for autonomy: The patient has the right to refuse or choose their treatment.
Beneficence:Practitioners should act in the best interest of the patient.
Non-maleficence:The principal that first and foremost the practitioner should cause no harm to the patient.
Justice:This concerns the distribution of scarce health resources and the decision of who gets what treatment.
Other values which are discussed include:
Respect for persons:Patients and the person treating the patient have the right to be treated with dignity.
Truthfulness and honesty:There must be informed consent. This concept has increased importance since the use of medical experimentation upon criminals, detainees during war, and incidences of government and military abuse of citizens. “The Doctors Trial of the Nuremberg Trials” and the “Tuskegee Syphilis Experiment” are but two examples. If you are not familiar with these cases, it is recommended that you research them independently.
Moral values can come into conflict, creating ethical dilemmas. At times there are no good solutions to our dilemmas in medical ethics. Occasionally, the values of the medical staff conflict with the values of the individual patient, family, or larger nonmedical community. Conflicts can also arise between health care providers, or among family members. Issues can range from decisions about blood transfusions to decisions about whether to end a life. Many argue that mandatory national health care will expand these conflicts and take them beyond the realm of the conflict between the individual and his or her medical provider. Some fear that mandatory national health care could give government an expanded role in the determination of decisions that impact the patient, the family and the physician. Others would argue that government must play a role in this process to adequately protect the rights of all parties involved.
The Constitutional Debate
What does the Constitution of the United States say about health care?
The Constitution states that there are certain fundamental liberties which are conferred on us at birth and that no government is permitted to take away: free speech, religion and conscience, property, assembly and petition, bodily self-determination, self-defense and the like. Nowhere in that list is there anything which must be given to you by others.
In 1854 President Franklin Pierce vetoed a bill to provide federal assistance to help the mentally ill. He stated that to do so was not provided in the Constitution. Despite such conservative beginnings in the interpretation of the Constitution, at many times in our history we have expanded our definition of what is or is not constitutional. As stated earlier in the course, perhaps no president in the nation’s history tested the narrow definition of constitutional power, as stated by Pierce and many others, than did Franklin Delano Roosevelt.
Those opposed to mandated health insurance for all Americans base their constitutional argument largely on the 10th amendment. The 10th amendment in part reads:” the powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people”. The 10th amendment has been used many times to argue against such things as federal laws to ban slavery in states that made slavery legal. The amendment was used to argue against the Civil Rights Act of 1964 and the Voting Rights Act of 1965. The 10th amendment is often cited by states in arguing that issues such as abortion, same-sex marriage, legal use of marijuana and many other issues should not be decided at the federal level. Opponents of mandatory health insurance argue that it is unconstitutional, based upon the 10th amendment, and that decisions about health care should be left to the individual states to decide.
Interestingly enough, the 10th amendment has also been used as a legal basis for mandatory national health insurance. The commerce clause of the 10th amendment in article 1, section 8, states that among Congress’ specifically enumerated powers is the power to”regulate commerce with foreign nations, and among the several states, and with the Indian tribes”. If a federal action is properly taken within congress’ interstate commerce power, then it does not violate the 10th amendment. The debate circles around what federal action is deemed to be “properly taken”.
Proponents of national health insurance also argue for its constitutionality based upon their broad interpretation of the Declaration of Independence which states: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty, and the pursuit of happiness”. Many supporters of national health insurance would state that in order to protect our unalienable rights to life and the pursuit of happiness it is the responsibility of government to assure that all American citizens have access to adequate and affordable health care.
Ultimately, the Supreme Court ruled in favor of The Patient Protection and Affordable Care Act neither through conservative nor liberal interpretations of the 10th amendment but rather based upon the Congressional power to enact the health care mandate as part of its taxing and spending power. President Obama consistently disagreed with opponents of the health care legislation who termed it to be a tax. Ironically, the Supreme Court utilized the argument of opponents of the bill, that it was in effect a tax, to support the constitutionality of the president’s health care act, due to Congress’ legal ability to impose new taxes.