Ethical Issues in Managed Health Care
Managed health care is saturated with . Death, pain, sickness, treatment, rationing are just a few of the major variables that interface with the familiar distinction between rights and utility. Current debate about rationing and the role of the state only increase the ethical severity of these issues.
Discrimination
Like any insurance plan, the company needs to bet that the healthy will always be able to pay for the sick. This is the simple source of wealth for the insurance firms. The ethical question that first arises is whether or not this means that these firms will go out of their way to recruit healthy people and discriminate against those who are ill.
Age
In addition, since old people are sicker than younger ones, age discrimination issues become paramount. Modern societies value wealth and economic production, and old folks are seen, in many cases, as a drain on the system. Will euthanasia be a part of future health care rationing? Is it worth spending a fortune on assisting someone in their 90s? Will the rich be able to pay their way to excellent health care regardless of rationing?
Doctors
The present managed care system forces doctors into a terrible situation: they become "double agents," forced to care for patients, but only within the parameters laid down by the insurance firms. If the patient is to get all they need, is the doctor forced to manipulate data so as to ensure coverage? Will following health insurance guidelines to the letter harm patients, leaving doctors open to lawsuits?
Patient Rights and Responsibilities
Most would agree that patients have the right to health care that suits their specific health needs. At the moment, they are given what health insurance will pay for. But what of patient responsibility? Is there an ethical difference between refusing coverage to one who has neglected their health for decades and refusing coverage for one who has cared for themselves?
Utility versus Rights
All of these issues come down to the familiar distinction between utility and rights. Ethical utilitarianism holds that any health care system should serve as many people as possible at a minimum level to maintain social and public health. A rights-based approach says that any individual patient has the right to all they require for a healthy life, one free from pain. The former approach is more or less consistent with rationing, while the latter is a more expensive option. Rights, however, are not subject to cost-benefit analysis, as they are inalienable. As it seems right now, the public health service (speaking generally) is forced to the utilitarian option to save money and treat more patients.
Tags: health care, care system, distinction between, Ethical Issues,