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One of the most important components that determine the state of public health is medical ethics, which plays a significant role in the daily treatment and prevention activities. Defining the reliability and the real reason of ethical challenges that occur after the start of healthcare reform is possible only with a comparative assessment of success and drawback diagram of its development. Ethical issues, moral aspect and cultural level are the basis of the general image of public health, and while these elements are highly leveled, their significance, at the same time, is minimized. This situation is observed especially in the process of fast implementation of health care reform, which is the main sector of work of the current government. The situation is becoming even sharper in its urgency as healthcare system is now in a state of constant development, together with the economy, active implementation and development of modern caregiving and analysis technologies, biomedical research and pharmaceutical therapy. For all these aspects and conditions, medical ethics problematic segment is particularly important. The most evident issues include the rights of patients who are on the constant treatment of their chronic illnesses and those who prone to acute pathological conditions to know their real situation and receive the necessary medical aid. Other problems include patients' rights to get qualified medical assistance as well as information including the patient's consent to the use of certain diagnostic and therapeutic measures. This question is currently acquiring special importance. Nowadays, the problem of protecting the rights of patients is under active consideration of the World Health Organization (WHO); besides this organization, Council of Europe is also involved in research on this aspect. Legal issues of health and medical ethics are the priorities of the Committee on Health and Medical Ethics of the United States.
Health care reform in the United States causes a number of ethical issues that can be determined and solved by nurses what they have been successfully doing historically in a number of conflictive questions in the medical sphere.
As it was already mentioned, the provision of skilled care to patients is the main criterion for protection of their interests and rights. The ability to use modern diagnostic and treatment technologies to minimize diagnostic errors is the basic requirements for the competence of health professionals. Medical training and medical education should be further improved, particularly with regard to the control of knowledge and skills, creation and use of effective educational programs and modern teaching technology (Lachman, 2012). All of this should help to improve the quality of medical-diagnostic work that is necessary to meet the needs of the population.
Ethical problems and questions in medicine existed earlier and developed during the time. They transformed from not losing their relevance so-called "old" issues of ethics in medicine in testing pharmacological drugs and medical equipment that take place actively involving patients into "modern" ones like easy access to fake medicines on the market of pharmaceutical products, the receipt and usage of the stem cells that are actively promoted in medicine. Increasing the number of illegal drugs and medicines causes a significant danger and risk to patients who decide to take such medications not knowing about their illegal origin and risk to be harmful. Usage of developed stem cells is not scientifically sound and creates a significant number of questions in medical and cosmetics spheres. In such a way, the earlier existed and the newly developed problems of ethical questions in medicine have a significant role in the system of health care during the time of reform implementation.
Commercialization and Medical Insurance
In recent years, the commercialization of health care has created new ethical problems. High rates of commercialization alter the psychology of medical workers. Some US policy makers believe that gaining profits is the main goal of health care and that health care is fully subjected to the market philosophy, although it is a well-known fact that the main goal of health care is health (Cooper, Frank, & Shogren, 2014).
When the patient-doctor relationship becomes based on the idea of money worthiness, there occurs a distorted perception of professional nature and produced services rendered. It should be noted that the expansion of medical insurance necessity causes an additional barrier to the social layers with the lower level of income making it impossible for them to be sure they can get all the necessary aid in case they require it. Paid medical services in the country were introduced many years ago. Initially, they were seen initially as a progressive element of the health care reform. However, these developments did not affect significantly on the health of the population. The result of these reforms was the enrichment of individual health professionals working in the field of commercial health.
Among other negative examples of health reform results are the cultivation of the need and the introduction of higher medical education of nurses. Considerable materials and human resources were spent to implement this new version of education. Certainly, the improvement of nursing education remains a very important issue, but it should not become a higher education. At the same time, medical specialists argue that higher education will cause no harm and will enrich the professional level of nursing staff in the country. Speaking about medical ethics and its place in health care it is advisable to refer to the international experience, extracting useful information for optimal construction of national health care and the formation of its philosophy.
Vicky D. Lachman, the author of the article “Ethical Challenges in the Era of Health Care Reform”, mentions the following ethical conflicts: right for privacy, chronic disease management and the position of nurses and their role in the society (2012).
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The most important negative issue concerning ethics and health care reform is a problem of personal right for privacy. The leading assumption here is that people have a need and priority right to privacy. This means the need and the right to hide and reveal, to know and to remain ignorant about various aspects of life in the society and of their own relations with the outside world. The society also needs to know some things about individual citizens; however, the need for other information may not occur (Lachman, 2012). In the workplace or enterprise level, issues of productivity and health involve employer and employees, both collectively and individually. There are also situations where public interests are affected, and in such cases, government agencies or other institutions declare their legitimate right to information. The problem became evident in the process of testing of the governmental project, a website healthcare.gov. During the first days of testing, the developers saw a problem of poor protection of customers’ information and people could easily become victims of hackers who could easily reveal all the private information of individuals throughout the US, including not only their personal information but also financial and insurance situation.
In health care, both personal and social human rights play a significant role. The right to life, the right to physical integrity and the right to privacy are of particular importance.
Information on particular importance for workers, occupational safety and health as well as codes of conduct are formulated and adopted by the World Medical Association (American College of Emergency Physicians, n.d.). Among these documents are International Code of Medical Ethics (1949-1968) and the Declaration of Geneva (1948-1968); Declaration of Helsinki: Recommendations to physicians to conduct biomedical research related to human objects (1964-1975-1983) (American College of Emergency Physicians, n.d.).
Another significant problem is chronic disease management that arises specific moral questions. According to Nell Noddings and her ideas in the book Caring: A Feminine Approach to Ethics and Moral Education, living according to the rules leads to inadequate morality, thus questioning one more aspect of healthcare reform (Lachman, 2012). The thing is that when a person requires constant observation and the periodical taking of analyses and other procedures, the whole process of life for such people becomes structured, causing them to lose their usual ability to make decisions and act according to their will. In the case of chronic disease, treatment to such patients becomes very much alike to the treatment for elder people who are on end-of-life care.
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The next idea is that nurses have to be loyal to all their patients no matter the medical insurance coverage of the latter. They have to protect the health care system, provide high quality services and help the patients of all levels of income, despite the race, color of their skin and deal with special issues that can occur due to religious beliefs (Lachman, 2012). However, it is important to mention that nurses had to face all the above mentioned problems earlier and they always found the ability to overcome the issues with privacy, reduced the tension for those who experienced constant disease treatment and solved many other problems.
Importance of Nurses’ Work
A nurse provides patients with care within the established professional relationships. This requires an attention of nurses being focused on the needs of the ill. In the context of professional attitude, nursing care aims to ensure that the patient receives the treatment prescribed by the doctor. In addition, a nurse aid should be directed on the provision of information or education to the patient and his/her relatives (Cooper et al., 2014). These actions play a key role in establishing the professional relationship among the nurse, the patient and the members of his/her family. Most common activities of nurses since the time when healthcare reform was obsolete included listening to the questions and concerns of the patients, assessment of the need for information and provision of professional medical interview. The nurses could also help the ill to determine their needs related to additional information about the diagnosis and treatment choices, and then help them address their medical issues (Cooper et al., 2014). Nurses were usually responsible for helping ill people better understand their diagnoses and alternative therapies. While the doctor reports patient the diagnosis and prescribe the treatment, the main task of the nurse is to assess what information the doctor relieved to the patient and to help him/her understand it and determine the need for additional information.
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Ethical challenges of privacy and confidentiality that keeping electronic records cause became a significant ethical issue as soon as the healthcare reform started its implementation. Chronic disease management, which is taking care of patients providing them with the life-long medical protection and aid, is good, but when it comes to living according to specific rules and taking definite medicine all the time, this is a question of morality. Thus, nurses and nursing associations are facing the additional ethical challenge to stand firm for patients and ensure the long-term productive development and sustainability of health care system in the US. Nurses need to take care of all people including those who have problems or issues with their status of health and those who do not have a possibility to have medical insurance covering all their health care expenses. In fact, nurses became the linking chain between the society and patients on the one side and health care reform and government on the other, helping to solve the arising challenges and ethical issues with the help of their professional attitude and knowledge.