|
Health
Decision Making: Sick People Versus Politicians Chan, Lik Hang Nick Course title: Contemporary
Bioethics Date: October 2007 To
meet the demands and standards of contemporary society, people's
views and values, particularly moral, ethical and political,
continue to evolve gradually. Promises made by a politician during
election campaign are sometimes differed from what he actually did
after the election. Governments' policy concerning public health
and medicine is especially more significant than others, like
economic and transportation planning, because it deals with human
life. Messer discusses, in his article 'Health Decisions Must
Benefit Sick People, Not Politicians', the decision of the federal
Government to take over a hospital (2007, internet). His key points
will be addressed briefly in this essay, with eyes on health ethics
issue. Ethical implications will then be canvassed,
backed by ethics theory. The
chair of the Consumers' Health Forum of Australia Mitch Messer
(2007, internet) reports the following affair. The federal
Government took over the Mersey Hospital in Devonport, Tasmania.
Many residents in Devonport welcomed the decision and the federal
Government claims that the services offered by the hospital will be
scaled down and the decision was made after they had listened.
However, experts alerted that health care would become sub-standard.
Messer then raises the question that "how do we make sense of
these conflicting views, and ensure that decisions made about health
funding deliver the best outcomes for consumers?" Messer also
states that higher priority is given to some groups of consumers
during election campaigns. He then paraphrases
the English journalist and writer George Orwell's line, some
consumers are definitely more equal than others when it comes to
election campaigns. Messer argues that consumers should have input
into health resource decisions, so that the interests of consumers
overall will be taken into consideration when those decisions are
made. As a result, as consumers and payers we have the right and
incentive to scrutinize political promises and make sure certain
health resources are used to consign health outcomes for consumers. The
first ethical issue worth discussing is Messer's question that how
can health funding decision be made to ensure best outcomes for
consumers? Maximising good is the underlying dogma of
utilitarianism. Consider the following classical hypothetical
example. A train is heading towards a tunnel, where five workers are
working inside and they do not know what the train is approaching.
There is another tunnel, with two workers working inside. Now,
suppose a switch is available for you, but the train must go to
either tunnel. Workers in either tunnel are going to die. The
question is, two or five? In the utilitarian viewpoint, a switch
should be made so that two workers will die, instead of five. This
is simple, real world practical example is often more complicated. In
the Mersey Hospital case, the conflict should be resolved by taking
quality of medical care as first priority. To illustrate this point,
the preventive testing budgets exercise given by Ubel, DeKay, Baron,
and Asch (cited in Berglund,
2007, p.49) may be helpful. Two tested are offered: test one is
inexpensive and every low risk people can receive the test, but it
does not always detect early cancers; test two is more expensive and
only half of low risk people, selected randomly, can receive the
test, but it detects better. This is an uneasy scenario,
good and number cannot be maximised altogether. Test one can be
supported by the followings. If utilitarian
viewpoint is adopted, and the number of people has to be maximized, test
one is preferable because every low risk people can receive the
test. According to John Rawls's concept of justice as fairness,
"all people should end up roughly equal" (Berglund,
2007, p.36-37), so every one should receive the test. However, the
downside is the reliability of test one. Even everyone receive test
one, no one is sure about the result because it is incapable
of detecting cancer. Is a test helpful if it does not always detect cancers? Put it
the other way, should a medicine be taken if it seldom overcome
illness? Although only half of people can receive test two, the test
is reliable and result with certainty can be obtained. Selecting
people randomly so that everyone has the same probability of
receiving test two, hence it is fair. The implication of this
exercise is, quality matters. It is pointless to apply a medical
treatment merely because of low price, but it hardly helps. It is
meaningless to talk about equality for the sake of equality. Going
back to Messer's question, whether health services funding comes
from governments via taxes or private health insurance should not be
decided without examining a bit further. Several factors, like the
quality of health services, resource allocation, payment and budget,
should be taken into consideration. The
next issue concerns with politicians. Messer mentions it seems that
politicians listen to the community when election promises are made,
but interests of particular groups are often given a higher priority
because of their influence over election campaigns (2007, internet).
For example, the Chief
Executive
of Hong Kong Donald Tsang
was likely to impose a new policy to extend free education from nine
years to twelve years (Lee, 2007, internet). It is generally believe
that the extension of free education overtakes the demand of small
class education partly because it sounds better to the public.
Despite small class allows better quality of education, twelve years
of free education sounds better to the public so Tsang will get
better reputation. Messer raises the question, how "to make sure
that election commitments are made in the best interest of
consumers, not just as a short-term way of buying votes?" He
suggests that consumers should have input into health resources
decisions at both national and local levels (Messer, 2007,
internet). This is an optimised idea. The problem is, politicians
break their promises after the election. To prevent this, imposing
legal law may be considered as the last solution. It
is worthwhile to take a closer look at the difference between law
and ethics at this point. The Greek philosopher Aristotle thinks
that ethics and politics are closely related (Clayton, 2006,
internet). Law consists of basic rules and regulations of
interactions in certain society, while "[e]thics is about both
basic standards and optimum aims or objectives of thoughts and
actions, standards, and behaviour" (Berglund,
2007, p.24-25). In the modern world, it is widely believed that
people should agree to certain fundamental values. These principles
may include beneficence, non-maleficence, autonomy, justice, and
respect for persons. Law indicates the minimum of what can and
cannot be done in the society. It sets the lower limit. Ethics, on
the other hand, represents and strives the upper or optimal level of
standard (Berglund, 2007, p.175). Furthermore, law, as an empowering
force in health care ethics, can be used "to give professions
authority and mandate over their skill and the trade in that
skill." It can also be used to constrain professionals to make
sure they meet the standard. A complaints mechanism is introduced to
one who think health care service standard are not met (Berglund,
2007, p.175). Inspired by this, similar mechanism may be installed
to rule politicians. When politicians make promises during an
election campaign, such promises should be kept. If the politician
wins in the election, his promises should be brought up and reviewed
by general public. If the promises are unsatisfactory, people have
power to take over the politician. No doubt such mechanism can only
be achieved in a democratic society, but not under totalitarian
dictatorship. After
all, health decisions should be made so that it benefits sick
people. One basic assumption has been made throughout this essay,
human life outweighs votes for politicians or the will to power. If
one rejects this fundamental assumption, one's argument will not
be widely accepted and there is less point to discuss further. May
this essay ended with following quotation by David B. Resnick:
"I
do not think the field [bioethics] itself should be committed to any
particular ideology or political agenda. Bioethics is fundamentally
a discursive, reflective activity carried out in the Socratic
tradition… Bioethics is philosophical reflection on medicine; it
is not medical politics carried out under another name" (cited in
Andre, 2002, p.78). Bibliography Andre, J. (2002) Bioethics as Practice. Chapel Hill and London:
The University of North Carolina Press. Berglund,
C. (2007) Ethics for Health Care. (3rd ed.)
Melbourne: Oxford University Press. Clayton, E. (2006) Aristotle - Politics. The Internet Encyclopedia of
Philosophy. Retrieved October 5, 2007, from http://www.iep.utm.edu/a/aris-pol.htm#H2 Lee, D. (2007) Surplus Likely to Make 12 Years' Free Education a Policy. The
Standard. October 4, 2007. Retrieved October 5, 2007, from http://www.thestandard.com.hk/news_detail.asp? Messer, M. (2007) Health Decisions Must Benefit Sick People, Not
Politicians. The Australian. August 25, 2007. Retrieved
September 22, 2007, from http://www.theaustralian.news.com.au/story/ |
|
|
