Final Paper

Cultural, Legal, and Ethical Issues in Health Care

Dividing Up Health Care Resources

• Allocating Scarce Resources

o Something significant I learned: I found out that the allocation of scarce resources
during times of emergency such as a hurricane, pandemic, earthquake, war, etc.
are not distributed equally. These resources are distributed more so based on two
critical criteria: how much of that resource we have and who will get the most out
of it. Throughout the learning of the intricacies of this topic, the dynamics
between giving these resources based on immediate need and the probability of
survival. This decision process goes beyond just the plain distribution of
essentials; it includes coming up with medical conclusions of defining those who
have a greater need and those who have a higher chance of survival – an ethical
challenge few can come to an agreement on. A significant part played when
discussing the ethical dilemma this situation poses is utilitarian ethics. Utilitarian
ethics poses that we should choose the choice that gives us the greater good for
the greatest number of people, something that I do view positively when
discussing a topic such as this. However, while learning about these ethics I found
that conflicts arise depending on how a resolution using utilitarian ethics is posed.
This lead me down a path of revisiting Kantian ethics and how they could be
applied to this situation. It gives an alternative standpoint of how instead of
looking at people as dispensable for the greater good, it delves into why we treat
them equally since every person deserves the same measure of respect and care as
any other person.
o How my opinion has been affected: Throughout these discoveries, I find myself
not so much tossing the idea of how we can help everyone in these times, but how
we can help the most amount of people with the greatest outcomes. The utilitarian
versus Kantian ethics broadened my understanding of why we would choose to
give a certain person a resource over someone else. These are dire times where
 not everyone can be helped. Say in the instance of two people with identical
symptoms come to a hospital during a pandemic, but only one of them has a
DNR. The person who does not have that DNR is more likely to be given the
resource than the person who did. Some would argue that this is because the
person with the DNR has “less to lose,” or they “have a terminal or irreversible
condition.” In any case, there’s an underlying reason as to why that person has
that DNR and there isn’t time to discuss if it’s a good one or not during those
emergencies.
o Description of how my ability to discuss/analyze issues related to this topic has
improved: I’ve come to realize that the allocation of resources goes above my
original idea that it’s about the money needed to obtain those resources; it’s about
deciding the quantity of resources available that we can distribute to the public.
Furthermore, I’ve concluded that to effectively make such decisions with
objectivity we must avoid bringing in the emotional attachments one might have
to a potential patient as it could cloud their judgement. We need to acknowledge
that these decisions about allocation are not solely decided by the immediate need
a person has, but also are contingent on factors such as a DNR as mentioned
previously. These things add a complexity that requires balancing the allocation
decision on the different probabilities that people pose when looking at their
survival rate. Overall, my focus has shifted from just the planning aspect of
distribution to a more widened understanding of the ethical areas that surround the
allocation of resources during times of scarcity.

Life and Death

• Euthanasia and physician-assisted suicide

o Something significant I learned: When learning about this topic, there was a
significant emphasis on the ethical considerations and regulations that need to be
in place for euthanasia and physician-assisted suicide. There is an almost
universal understanding that there are people throughout the world that are
suffering from incurable and debilitating illnesses that make pain management
 extremely difficult. This topic had me delve into the ideas of what safeguards
could be put into place for those choosing to use PAS. Those safeguards include
things such as notifying next of kin, age restrictions, psych evaluations, physician
training, and providing detailed information to potential patients. By trying to
follow those precautions we can recognize the potential for abuse, especially
among vulnerable groups like depressed teenagers. There are many downsides
and open-ended laws that create avoidable situations such as those in Canada
where safeguards like the ones mentioned aren’t taken or necessarily considered.
o How my opinion has been affected: My opinion on euthanasia and physician-
assisted suicide (PAS) has grown when thinking about the considerations that
surround this issue. My belief that these situations should be approached with the
utmost seriousness still holds strongly. The perspective I hold now has grown
with the knowledge of the factors that must be considered when addressing these
situations. I have the understanding that whether a person’s ailments are physical,
mental, or other does not dismiss the need to recognize the severity of it nor
should it dismiss the exploration of alternative routes a person should look into
before turning to PAS. My views involve a more in-depth understanding of the
ethical, medical, and legal aspects that come with PAS. All those things bring an
emphasis on how there should be a balanced and thought-through approach when
one is considering PAS due to their ailment(s).
o Description of how my ability to discuss/analyze issues related to this topic has
improved: Throughout this semester, my ability to discuss and analyze issues
related to euthanasia and physician-assisted suicide (PAS) has improved. The
course made me consider aspects that I may have initially overlooked, particularly
the sensitive topic of children potentially being approved for PAS. When learning
about this aspect, I was introduced to the statement that “suffering knows no age
limit.” Children lack the reasoning to make end-of-life decisions on their own.
This realization led me to the idea that there should be a minimum legal age for
PAS approval, around 21 years in the U.S. The idea led me to think that this could
uphold a more mature and informed decision-making process.

Medical Professional and Patient

 • Human research (Conducting medical research on humans)
o Something significant I learned: There is a delicate balance to human research
when it comes to risk and reward. From simple procedures like a nose swab, to
more complex scenarios like testing new drugs, there is always the need to
consider the ethics of the research. Those who are involved should know what
they’re getting into and have informed consent. There should be two-way
communication for any needs or concerns that arise during the study. Information
of those in the study should be held under confidentiality. And most importantly,
there should be a high level of respect for everyone involved. Researchers are
responsible for ensuring the safety and well-being of those who participate in the
study. Researchers and participants should also be aware of any long-term health
effects that may come up from the study. Overall, the understanding and
adherence of these ethical considerations shows the complexities that come with
human research.
o How my opinion has been affected: After learning about the awful history of
human research during World War II, my appreciation and understanding as to
why safeguards are put in place has grown immensely. People MUST be
informed about what they are getting involved with otherwise consequences arise
– whether they be personal, medical, or legal.
o Description of how my ability to discuss/analyze issues related to this topic has
improved: This course, and particularly this section of the course, showed me the
importance of informed consent. By following the safeguards put in place due to
the unfortunate past of human research, we recognize the importance of
minimizing harm, especially to those who are vulnerable populations. It doesn’t
matter if many people could benefit from a potentially harmful study, that does
not justify the unethical means of obtaining that information if it means harming
others for the public’s benefit.

Medical Professional and Patient

• Paternalism and patient autonomy (The right to decide for one's self)
o Something significant I learned: When considering the aspects of Paternalism and
patient autonomy, there is a fine balance between when a decision needs to be
made by someone. We need to recognize that patients possess the right to make
independent judgments about their health and treatment. However, the
acknowledgment that medical professionals, due to their expertise and resources,
may be better equipped to make informed decisions benefits medical paternalism
in certain scenarios. There are also situations where some patients may be in
denial or lack sufficient health knowledge to fully comprehend their condition.
This leads to support the argument for medical professionals guiding decisions.
On the flip side, the acknowledgment that patients with rare diseases, with
information from the internet, may surpass their doctors' knowledge. This
understanding provides a perspective on the complexities of shared decision-
making in healthcare.
o How my opinion has been affected: When it comes to recognizing that patients
may lack the necessary knowledge, that also includes the struggle with identifying
realistic treatment goals. Those struggles could include obstacles such as health-
related anxieties or depression. In certain cases, patients might be in a vulnerable
state, and relying on the expertise of physicians becomes a prudent choice. When
looking at the potential risks that are associated with allowing patients to make
decisions when they are not in the right state of mind due to either underlying
anxieties or the progression of their illness allows us to see that a more cautious
approach should be taken when addressing them – both patients and the
treatments. Family members can also have weight in what happens with the
decision-making process. Emotions can run high and cause potential harm when
the long-term viewpoints aren’t considered. Overall, the balance between patient
autonomy and the recognition that there are situations where outside decisions,
particularly from physicians, are necessary to ensure the best possible outcomes
for patients.
o Description of how my ability to discuss/analyze issues related to this topic has
improved: There are shortcomings when it comes to both extremes — not
 advocating for total physician control or complete patient autonomy. When
patients make decisions based on information from the internet, they do get some
information that could help with their choices in terms of their treatment, but that
also comes with the risk of misinformation coming into play. There are also
complications that can come when outside decisions are made by someone other
than the patient. Patients are also not all-knowing beings. Some may lack the
competency to consider their treatment plans.

Life and Death

• Reproductive technology (Egg and sperm donation, assisted reproductive techniques)

o Something significant I learned: There is a need to emphasize the importance of
women being fully informed and consenting to participating in egg donation.
Something that I hadn’t thought about until this part of the course was the
possibility of women resorting to selling their eggs as a means to help with their
financial situations. This aspect of egg donation shows a crucial factor that could
be getting overlooked due to the monetary incentives that are attached to the
donation processes. There are also risks that come into play besides the monetary
motivations. Some women could have adverse reactions to the treatments they
need to go through for the donations. There’s also the risk that they give an
incomplete or false medical history for a better chance of being accepted for the
donation process.
o How my opinion has been affected: My opinion has grown to prioritize ethical
considerations, honest practices, and the well-being of all parties involved in the
egg donation process. I support egg donation when the women involved
participate willingly, with full consent, and without financial desperation. I also
recognize the potential risks associated with financial motivations and the need
for honesty about medical history. Furthermore, the primary motivation for most
women is the desire to start a family rather than pursuing "designer babies" as
some may believe.
o Description of how my ability to discuss/analyze issues related to this topic has
improved: There should be careful considerations regarding egg donation, such as
the importance of women's full consent, avoiding financial desperation, and the
importance of honesty regarding medical history. There are challenging common
misconceptions about "designer babies" when discussing egg donation and
accepting it. The genuine motivations of most women seeking egg donation for
the primary purpose of starting a family, not creating the next star athlete or
model. Lastly, there needs to be careful monitoring to ensure the well-being of
those involved in the egg donation processes.