Health Care Ethics Textbook

1. What is Health Care?

2-6. What is Ethics?

7. Informed Consent in Health Care
          7.1 Liberty and the Childhood Measles Vaccine

8. Reproductive Ethics

9. Euthanasia and Suicide

10. Allocation of Resources

What is "access" to health care? http://freedomsphilosopher.blogspot.com/2009/06/access-to-health-care.html

What is "quality" of health care? http://freedomsphilosopher.blogspot.com/2009/06/quality-of-health-care.html

What is "cost" of health care? http://freedomsphilosopher.blogspot.com/2009/06/cost-of-health-care.html 

12. Affordable Care Act

Reading #8: Informed Consent in Health Care

In health care, the concept of "informed consent" has two primary applications: Informed Consent in Research and Informed Consent in Treatment.  In any Liberal Society these applications relate to the concept of "Human Agency," or the philosophical questions that underlie what kinds of persons can be held morally responsible for their actions.  There are two conditions: rationality and free will. In health care two questions dominate moral and legal debate. 1.) Was the research subject or patient given enough information to make a rational choice? and 2.) Once provided with this information, does the research subject or patient, have the ability to act "freely" on the basis of that information... in short, does that person possess free will.

There are many conditions that might impede a research subject/patient's ability to process information. First of all: much of the language associated with health care is highly technical and derived from Greek or Roman nomenclature, and therefore most of us do not understand what the researcher or physician is saying. And most researchers/physicians have not been trained in how explain medicine in laymen terms. Therefore, many research subjects/patients are vulnerable, and rely on third-party agents, usually nurses. The most vulnerable classes include: young children, persons suffering from mental diseases, persons with very low IQs, persons with little education, persons that do not speak English, and elderly patients suffering from varying degrees of dementia. In these cases, proxies, or other rational persons must make those rational decisions. But who... family or friends, physicians, lawyers, judges, or juries?  

There are also conditions that might impede a research subject or patient's ability to exercise free will, and consent to serve as a research subject or undergo costly, high-risk, medical treatments. Many potential research subjects/patients tend to defer these decisions to authorities who possess a Ph.D.  or an MD degree. Many research subjects/patients are vulnerable to outside interference because they are desperately seeking to avoid and/or remove pain and or disability. 

Informed consent has become an important moral/legal problem because researchers and physicians often have a stake in securing informed consent from prospective subjects/patients; and therefore may operate under a conflict of interest. Researchers need many research subjects in order to conduct clinical trials. Many researchers are college/university professors seeking tenure and promotion, researchers that are also pursuing lucrative patents for themselves or their respective corporation. Most physicians get paid for their services, and (like everyone else) needs to payoff student loans, feed, clothe, and shelter their families etc. Therefore, researchers and/or physicians might to tempted to misrepresent the known costs and benefits of serving as a  research subject or undergoing an expensive treatment. Sometimes these misrepresentations rise to the level of legal fraud. Sometimes these misrepresentations are paternalistic, and therefore serve the greater interests of the subject or patient, but sometimes these misrepresentations are predatory and serve, primarily the interests of the researcher or physician.  Research subjects may also be bribed into participation in a research project by offering either free health care or monetary reward. At what point does providing an incentive become bribery and/or economic predation (Kant)?    

Reading #9: Reproductive Ethics

Introduction:

Questions concerning the moral and legal foundations of human reproduction are enormously complex. Some of the most important questions have become public issues that address the following: the moral/legal limits of reproductive assistance, the moral/legal limits on contraception, moral/legal limits on reproductive control by individuals, religious groups, and political regimes; and a cluster of issues that involve abortion. All five moral principles (utility, beneficence, non-maleficence, liberty, and justice) are often invoked in reproductive ethics.  

As an initial observation, let's all acknowledge that our individual and collective beliefs about human reproduction have been shaped by culture, religion, science, and politics. Today, all of these factors are also filtered through the media, especially social media.  

Reproductive Assistance and Control:

Since the 1970s, reproductive assistance has been shaped almost entirely by both "low tech" and "high tech" reproductive technologies. Low tech include simple procedure such as artificial insemination, that employ little more than a glorified turkey-baster; high tech, include in vitro fertilization, sperm injection, and cloning. 

Reproductive control includes who decides whether to have children, how many children, and on what basis might they decide, Hence "reproductive control" might include the use of contraception, the decision to continue a pregnancy, or abort a zygote, fetus, or infant, who decides and on what basis? 

Three Moral/Legal Perspectives

Reproductive ethics in the United States is most often reduced to two extreme views: the EXTREME LIBERAL POSITION (Liberty-Based): Anything goes, individuals decide whether to have kids, how to have kids, how many kids to have, and whether to terminate pregnancies at various stages of development. No laws are necessary. And the EXTREME CONSERVATIVE POSITION (Natural Law or Roman Catholic View).  

According to the Roman Catholic Church (via papal decrees), all sexual activity must take place within the "sanctity of marriage" between a male and a female via "natural" sexual intercourse." Three "sins" are to be avoided: sex outside of marriage (fornication) and sex outside of reproductive purpose via sexual intercourse (perversion), and abortion of a any fertilized ova, from zygote to birth. Thus, reproductive assistance within the church consists in making sexual intercourse more productive. Therefore, almost everything associated with In Vitro fertilization is regarded as immoral: donated ova and sperm, masturbation (to secure sperm), fertilization within a petri dish rather than within a uterus, and selective abortion in the case of multiple fertilized ova. Genetic testing, sex selection, gamete selection and storing frozen embryos are all regarded as an affront to "human dignity." In the case of blocked fallopian tubes, Roman Catholic fertility clinics may transfer those immobile embryos to the uterus. 

There are a variety of what we might call "MODERATE POSITIONS that fall midway between extreme liberalism and extreme conservatism. Most reflect intermediary views on the status of the fetus and/or utilitarian concerns with IVF. Many libertarians regard zygotes a "persons subject to moral concern," others identify personhood with various stages of fetal development, usually the developmental stages where fetuses can experience pain and pleasure. Others, argue that abortion of fetuses that will lead a short life of pain and suffering may be aborted at the earliest stages of development. Others, accept infanticide as well. Utilitarians might object to the cost of reproductive medicine in an "over-populated" world and/or the inability to regulate reproduction in a global context.   

Finally, it is important to distinguish between legality and morality. Libertarians tend to limit legal bans and mandates to major crimes such as murder, theft, and fraud. Many observe that fertility clinics commit fraud, when they "sell" IVF by overstating the likelihood that one or "cycles" of IVF will result in a "live birth," and that the cost of IVF is often obscured by charging patients per procedure, rather than per live birth. Many ultra conservative Roman Catholic scholars seek to legally ban IVF and abortion in all contexts, while others do not pursue legal bans and mandates for non-Catholics. Thus, many seek to distinguish between sins and crimes. 

Problematic Technologies    

In recent years several reproductive technologies have proven to be morally controversial: abortion drugs, genetic testing (for diseases, disabilities, and or sex), infant sex change operations, cloning, and the artificial uterus.