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Ethics as it is being used in the health sector is a concept that has evolved over time. There is no doubt that every player in the sector seeks to continually improve their services delivery as well as attaining maximum patient satisfaction in the process. In the last few years, ethics in health has developed through a number of stages. Hippocratic culture dominated traditional ethics in the 1960s where health care providers established relationships with patients. The core values of this relationship were derived from culture. The technological advancements and intensive research has seen developments in biological sciences and biotechnology. With such changes, a new ethical dimension was introduced.
Ethical principles of human dignity, compassion, non-malfeasance and social justice
However, with time a dilemma arose from the liberalization of health care industry. There emerged a need to harmonize the differences in health needs and resources availed for filling the gap. The scope of health ethics was thus expanded to include quality control, economics, policy formulation and implementation as well as massive research and development. Such efforts and resource harmonization gave birth to an era of health policy and ethics. As time advances there are debates on human rights protection and respect of human dignity (Bryant, Hyder and Kauser, 2007). It is now a fundamental right for every individual to enjoy quality health care without discrimination of any kind. The most recent dimension of health ethics is the fusion of lauded human rights and the fundamental right to obtain quality health services.
Contrary to direct definition of health, as the entire state of well being in terms of mental social and physical status of an individual, ethics and human dignity issues are more complicated to completely expound on them. Ethics is solidly founded on cultural convictions developed over time. It derives its relevance and strength from religious and philosophical advocacies deeply embedded on the present leadership systems. It is considered as the ability of a community to clearly and amicably draw a boundary separating what is perceived as wrong and what remains a right thing.
Such a boundary touches on the aspects of life right from the way of doing things to the general perception of life. It becomes a big understatement to define ethics without mentioning the famous dimensions used to describe it. It is a cumulative approach of respect to humanity with specific focus on maintenance of autonomy of a person, delivery of justice, rights and upholding of human dignity. Ethics in health policy formulation and implementation focuses on the most cost effective means of delivering a quality health care to all. It is in this light therefore, that ethics attempts to strike a balance between the policies and values cherished by an entire community.
Equity is another paramount aspect of importance which cannot be neglected. It is about all that appertains to fairness in the ultimate distribution of gains derived from a robust health advancement which is socially acceptable. It is a concept that goes beyond just accessing health care products but touches on the response aimed at meeting the needs of all persons. Equity aims at ensuring that no one individual is favored in the allocation of resources as well as availing of equal chances of accessing health care (Bankowski, Bryant and Gallagher, 2007).
It is therefore a process justified by the outcome. It is important to examine the impact of decisions made on equity. The specific health decisions must go a long way in fostering equity in access to health care services. The health status of most vulnerable groups remains the action points of equity development. There are no specific parameters of determining a group to be classified as vulnerable. However, there are general features which help us in this. There are those who are vulnerable due to social construction while others are as a result of congenital disability. It is usually possible to get an overlap between the two possible causes of vulnerability.
The United Nations charter identifies the promotion of human dignity to be one of its core principles. This is evident in the ratifications, conventions and declarations of numerous international agreements in respect of this. One thing that we cannot fail to talk about at the mention of health care is this core principle of promotion of human rights and upholding of human dignity. A good example is the right to information an individual is entitled to on everything that affects his or her health. It is this right that compelled cigarette manufacturing companies to put an information label on their packets. In the recent past, efforts have been put on the reduction of public health burden on the rights of individuals (Sen, Germain and Chen, 2004).
Trampling on the rights of a few individuals through quarantine, mandatory testing and isolation in the name of benefiting the majority is no longer ethically acceptable. A good and most recent example is United Nations' advocacy of elimination of discrimination against people living with HIV. Together with human rights, dignity is considered an inherent and universal concept. Wide scopes of research in the biomedical field have continued to become the center of discussion on the inherent issues on human dignity. Law enforcers must also expand their focus to other sources of human dignity violation originating from areas outside medical field. Such determinants as political influence, economic factors, technological innovations, environmental concerns and changes in demographics must be looked into.
It is important to note that advances have been made so far in the maintenance of human dignity and respect of human rights. Majority of institutions dealing with human health care services have a deliberate way of issuing instructions aimed at improving ethics amongst their staff members. The extent at which ethics instructions are being given is a clear indication of a continuous increase in the expansion in respect of human dignity. The unprecedented attention given to research on health care ethics cannot be attributed to one particular factor. There are a number of reasons as to why every player is shifting focus to this study.
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To start with, the knowledge explosion on the biotechnology field has availed a number of avenues available for a medical professional in the fight against diseases. It is now possible to handle situations which were once thought to be untreatable. However, this milestone in medical field has not been a bed of roses. A series of mixed reaction continue to emanate from various sections of the society on how ethical are some of these methods.
Secondly, the cost of accessing basic health care is sky rocketing across the world. Most governments of the day are spending a substantial portion of their Gross Domestic Product on health care expenses yet most citizens cannot get the care they need. This leaves us in total agreement with Howard Hiatt who say that we have a few resources to use in provision of health care and therefore as a society, we need to ask ourselves two important questions. That is how we spend and allocate them. It is as a result of financial constraints that have made us witness denial of adequate health care, limited access and unfair rationing (Hiatt, 2005).
Issues of ethics in health care are numerous. They range from an individual responsibility to the entire corporate obligations. That is why such issues can be approached from two distinct sides. To start with, macro ethical situations entail what cannot be addressed by a specific practitioner. Such issues are those in which the entire body of health professionals and the community at large must deal with in a bid to ensure that health care ethics are defined and respected. As an illustration, issues such as termination of pregnancy, health care resources allocation and organ transplants are in the category of macro situations. On the other hand, micro situations lie squarely on the hands of a single individual health care professional. It must be realized that ripple effects of macro issues are flow into micro situations.
Ideally, the topic of health ethics should commence from the generally accepted responsibility a medical officer have towards meeting the needs of patients. This brings to our thoughts the issues of competence and trustworthiness of the health care practitioners. Competency goes beyond possessing enough knowledge to deal with a situation. It includes the ability to articulate issues of health and deliver the services timely and accurately. It is also equally important for a patient to have confidence in the person he or she has entrusted his or her body to. Trustworthiness therefore forms a core factor in the satisfaction of patients which finally culminate to enhancement of health care ethics (Berger, 2003).
Legal and ethical rights
We are living in an era with serious awakening in discovery of personal rights. The medical professionals have always been assumed to be an all knowing class. A patient would accept to undergo a surgery, take drugs and have a laboratory test without any question or hesitation. This trend referred to as medical paternalism is gradually dying. Patients are becoming consumers with a right to choose what they perceive to best suit them. It is therefore a mandatory standard practice to seek a patient's consent before carrying out any procedures aimed at restoring health. Doing anything different from this will not only be unprofessional but totally unethical. The overstepping of a practitioner's mandate in administering health care can also attract serious legal action whose far reaching effects can be detrimental in the career of a defendant. Just like any other customer, a patient desires to attain a definite level of satisfaction. Health professionals who are unable to meet the needs of their patients may not be such attractive in future if they survive legal actions.
The legal rights of individuals are what we cannot avoid to talk about at the mention of health care ethics. The rights are those privileges a person enjoys as provided and defended in the Constitution of a country. Several legislations avails a patient with a series of rights. A patient seeking the attention of health care providers expects that clinical officers will utilize their gained experience coupled with their knowledge in striving to meet their needs. The patient's rights ensure that independent individuals can expect the health care providers to meet their wishes of getting well without fear of otherwise.
From a broader view, health care systems are primarily based on the rights of individuals seeking treatment. Patients have a sole responsibility of selecting who or what best suits them in terms of health care facilities and doctors. It is required that the patient gives a go ahead of any process through a fairly attained informed consent. This scheme may look very attractive to a person whose has enough economic muscle to meet the cost of treatment. The patient's right assumes that everyone patient can comfortably settle hospital bills. On contrary, this right is as good as not being there for the patient who does not have a medical cover or enough money to pay (Bankowski, 2006). Although the UN Declaration of Human Rights stipulates "that all persons have a right medical treatment" you cannot walk to a health care facility and demand for treatment. It is not enough to receive medical treatment; safety and effectiveness of the services are two paramount features that a treatment seeker is entitled to put into consideration.
Ethical rights impose a responsibility on health care practitioners. The Hippocratic Oath results in a duty by the health professionals to do all they can in benefiting the patients and avoidance of any foreseeable harm. It can be argued that the health care providers must act at the best interest of the patients with disregard to how others are affected by their actions. A legality dilemma created by this Hippocratic Oath is diffused by the controversial exposition by Rem Edwards who claims that the health care providers are obligated to alleviating the aching and suffering of health care seekers.
The defects in this point of view are evident on the side of health professionals who operate under strict constraints of laws. The responsibilities of health professionals are thus in conflict with earlier mentioned rights of the patients in the light of ethical and legal correctness. Ordering a health care expert to pursue a personal approach and do what contradicts the law, yet ethical, process in the patient with total disregard of what may befall them legally is as good as telling them to suppress what is important to them in favor of the patient.
It is important for a health care provider to continually examine his action so as to uphold what is ethically right. In 1989, Robert Veatch proposed a four step blueprint which can be used by the health practitioners. This method of analysis involves making sure that there is sufficient knowledge backed by facts for every situation. The second step is bringing in to play whatever is morally upright in relation to the situation at hand. Ethical principles are given a consideration it deserves at the third step. Once the three steps have been taken care of, a fourth and last step of looking in to ethical theories is done.
This provides health practitioners with a reliable, powerful tool available for use when faced with a situation demanding an ethical decision making. This theory formulated by Veatch approaches situation in a chronological manner. He goes ahead to argue that an ethical dilemma can be sorted not necessarily through the four steps but by just laying down the actual facts about a condition. If the application of step number one cannot provide a way out, step two is considered. This focuses on the moral rules guided closely by confidentiality or patient's consent. At the event that dilemma persists, ethical guidelines of step three are used.
The ethical principle encompasses aspects such as maintenance of autonomy, fidelity, nonmaleficence and beneficence. At this point, the stalemate must have been broken. However, it is possible to have unclear solutions even with the application of ethical principles. It is because of such a situation that a health care professional is compelled to use an ultimate tool available in step four. Ethical theories are the final solution finder in a hard decision making procedure.
A particle and most recent example is seeking of consent of an organ donor. There have been several conflicting issues surrounding organ transplants. The ever growing imbalance between the number of organs demanded and those available for sale has played a major role in heightening the differences between proponents and opponents of this process. It is the obligation of clinicians to make sure that the wishes of prospective organ donors are respected to the later (Beauchamp and Childress, 2009). Various regulations have been put in place to ensure the respect of free will and human dignity of a donor whether death or alive.
The challenges facing health care professionals continue to rise with technological advancements and sky rocketing costs of health care. It is therefore of paramount importance to equip them with sufficient knowledge of ethical tools for use in such situations today or in days to come. Totally relying upon ethical codes, principles and theories may not be enough in decision making but serves by providing a rough idea.