Ethical Issues in Health Care Delivery

Due to the fact that the health care industry has a certain charge over life and death decisions, pain and nutrition and other areas of intimate concern for all human life, the ethical issues involved in the delivery of health care are proportionately serious and deserving of wide attention. The basic issues of health care ethics, like so much else, come down to the preference for a utilitarian-based or a rights-based approach.

Rights and Utility

• Most major public policy ethical issues are based on the distinction between rights and utility. The latter is based on a cost-benefit analysis where the minimum standard of care is meant to be spread over the widest possible area. In this case, it is consequences that matter. On the other hand, a rights based approach holds that each individual has a right to the care they need at any given time. In this approach, the rights of the individual, not the whole, matter. The moral center in the rights based approach is that consequences do not so much matter other than that the rights of the individual are respected. Putting this distinction differently, the utilitarian approach stresses the good of the whole, while the rights based approach stresses the autonomy of the individual.

Autonomy and Communication

• Rights are applicable in terms of communication and autonomy. Doctors have the obligation to disclose all relevant information about a condition, insurance relations and possible treatments and side effects. At the same time, the patient has a right to accept or refuse such advice given the expertise of the physician. The right of the patient to autonomy is enhanced by the doctor's level of communication skills, expertise and general “bedside manner.” What is most important here is that the doctor communications problems and alternative treatments and provides tools for the patient to make an informed choice.

Resource Allocation

• Utilitarianism seems to find a place in the area of resource allocation. Resources are finite, and therefore a certain form of rationing is built into the system. Ethically, the problems arise in dealing with the terminally ill, the very aged and those who have not cared for their health during their lifetime. Can doctors refuse treatment for all or any of these cases? If a doctor does refuse, can he claim that he is serving the greater good? In other words, is the violation of the right to health care for those cases permissible?

Drugs

• Is it ethical for drug firms to advertise directly to the patient? The problem here is that the firms themselves seek market share and profit, while doctors, ideally, seek the welfare of the patient. An argument can be made that only doctors should be in charge of recommending medications relative to their specialization. In other words, a cardiologist should be the sole authority for heart medication, a psychiatrist the sole authority for behavioral medication.

Disparities

• Another central issue is health care disparities based on race, region and lifestyle. Rural patients get less care than suburban ones, rich patients get better care than poor. Both the rights-based and utility-based approaches see these disparities as morally wrong (since they both violate rights and do not serve the common good), and the public authority should be in charge of dealing with this disparity.