Decisions regarding right and wrong happen on a day to day life. Therefore, ethics are concerned with every level of life, like behaving correctly as a person, establishing responsible institutions, and making a more ethical society as a whole. Decisions about right and wrong can be challenging. Ethics, however, provides a set of standards and regulations for behavior that help individuals decide how to act in various situations. Generally, ethics is all about making choices and offering a reason for choosing an absolute path of action.
Making good ethical choices demands a trained sensitivity to ethical issues and a skilled method for examining the moral factors of a decision and evaluating the deliberations which ought to impact the preferences of an individual's course of action. Therefore, it is critical to have a framework for making ethical decisions, especially in healthcare, as people's lives depend on it. When exercised consistently, the methods become customary to work through them without looking up the particular steps automatically. An ethical framework is an easily adaptable tool structured to facilitate ethical behavior in healthcare choices (Mandal et al., 2016). A solid framework will, therefore, address every issue that the facilities face frequently. Though it may fail to provide a step-by-step checklist, it offers an overview of the main elements that will help discover ethical solutions to issues that may arise every day. Nonetheless, there will always be unique problems that will require an individual or organization to think out of the box. Therefore, utilitarianism, deontology, and Rawls' distributive justice frameworks provide a unique approach to the conflict.
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Medical ethics is a vital branch of virtuous philosophy that handles conflicts in obligations and their possible consequences. Ethics deals with actions grounded on healthcare providers' decisions and duties in the best interest of patients and their families. For example, when a doctor owes an obligation to their patients and the community, a breach of confidentiality may arise. That is why utilitarianism is an approach that is useful in healthcare as it offers an alternative approach to resolving conflict. Utilitarianism states that actions are morally right if they minimize the bad while maximizing the good. The 'good' is perceived to be anything pleasurable or well-being, as Seven Pillar Institute (2017) observed. Therefore, actions are morally upright if they get the best of pleasure or well-being or reduce suffering. Such an approach is, at times, referred to as hedonistic utilitarianism, which emphasizes that the justness of an individual's actions is solely dependent based on repercussions of delight or pain ( Seven Pillar Institute, 2017 ). Like preference utilitarianism, other considerations consider pleasures and the gratification of any of the choices made.
Consequently, utilitarianism can also take into account other forms, such as act- utilitarianism. This form maintains that every person has to apply a utilitarian calculation to every action. Then one can determine the moral uprightness or wrongness of each measure they plan to partake. Rule- utilitarianism is another form that relieves one of the utilitarianism places on practical consideration by setting up moral rules ( Seven Pillar Institute, 2017 ). When these rules are adhered to, they bring about the best impacts. For instance, the rule 'do not kill' would yield the best results if this regulation was strictly adhered to by everybody.
On the contrary, utilitarianism has been objected because one cannot always predict the outcome of their decisions accurately. An action may seem to produce the best outcome, but humans are prone to error; hence, the results are faulty. However, the best that one can do is predict the short-term consequences of a person's actions.
For instance, a doctor may face a dilemma on whether a patient suffering from level four colon cancer should face killing or continue with treatment. First, survival chances for level four cancer patients are almost negligible. It is also a painful treatment experience for the patient and the family at large, particularly financially and emotionally. Lastly, the resources used to cure the patient could be saved and used on another patient with a higher probability of survival. Therefore, using euthanasia would have more benefits, but the consequences can only be evaluated in the short term. What if the patient survives after a year of treatment? No one can tell. Finally, act utilitarianism leads to time wastage and energy and is often prone to bias ( Seven Pillar Institute, 2017 ). While analyzing the benefits or harms of a course of action to take, the patient is addressed with the possible outcomes without evaluating past experiences or evidence.
Philosopher Immanuel Kant introduced deontology, widely referred to as Kantian Deontology (Mandal et al., 2016). It was derived from the word duty or Deon in Greek. It defines ethics that base morality on specific tasks or obligations and ascertain that given deeds are fundamentally right or wrong irrespective of those actions' consequences. What makes a decision or activity right is the manner it conforms with a moral norm. Therefore, healthcare providers must behave following conventional morals regardless of the impacts of acting contrary or possible benefits from their decision (Mandal et al., 2016). According to the deontological view, some deeds cannot be justified by their outcomes. Simply put, the end does not justify the means.
Some deontological choices might be beneficial for a given person but fail to produce a better social outcome. Medical teaching practices instill the deontological tradition to enhance the doctor-patient relationship by nature. Whenever there is a breach in the deontological course, it leads to medical negligence of the patient. This customary relationship drives health providers to do good to patients, thus strengthening the doctor-patient connection and enhancing trust (Mandal et al., 2016). However, sometimes doctors and medical staff are driven towards the utilitarian approach by the situations they encounter. For instance, involving a third-party regarding a patient's condition is wrong as it breaches confidentiality. However, some third parties, such as payment systems or health insurance, have to be notified for hospital bills to be cleared. According to deontological ideology, this doesn't seem right by it is acceptable by the utilitarian approach since it benefits the patient and the health facility as well. Deontological and utilitarian perspectives have their significance in medical ethics. From this scenario, it is evident that the two ethical frameworks contradict one another hence creating moral dilemmas (Mandal et al., 2016). When a balance between the two is achieved, it brings harmony and justice into the healthcare system.
Due to significant improvements and advancements in medical technology, there is a crucial role in allocating scarce resources to society. The advances have changed the concept of the right to health and demand for health services. Currently, it is about claiming to have access to all social determining factors of health. Thus, it has led to an ethical issue in the fair allocation of scarce health resources and social determinants (Daniels, 2017). Thanks to John Rawls, he has provided healthcare with a theory for justice to solve this ethical problem. His ideology indicates that individuals' standards of justice should be resolved in a supposed initial state (Daniels, 2017). While in the original position, a person agrees on the principles of justice. He proposes that one should allocate unused resources to individuals in a community.
Consequently, justice as fairness thus depends on two presumptions regarding the society in question. One, social cooperation is achievable and can benefit everybody's mutual merit; two, there is a moderate supply of available resources divided by Daniels (2017) notes. However, when there are scarce resources, justice as fairness may fail to determine the distribution of sacrifices that society members should make.
Rawls proposes that a medical institution should be framed according to these principles to achieve a fair health system. Health is a social good, as Daniels (2017) records. The right to good health is a critical right that every person is entitled to. Therefore, there is a need to have a well-administered healthcare community that establishes a fair distribution of medical facilities or social goods (Daniels, 2017). He focuses on the significance of emphasizing fairness rather than total equity of the distribution. From the principle of equal liberty, Rawls concludes that every individual should have an equal right to the most extensive fundamental freedoms scheme with others' similar strategy. Social and economic inequalities have to be organized reasonably, which benefits all, and they are readily available.
Medicare is a universal coverage scheme that pays based on utilization and not income, ethnicity, status, or gender. Recently, healthcare for the elderly in the United States has caused a lot of controversies. As the elderly population rises, so does their life expectancy. Therefore, there is a rising demand for medical care, which increases the cost in the government healthcare budget. Consequently, it raises ethical dilemmas on the meaning of the values of life, the rights and obligations of families, and the distributing scarce resources among the generations. However, Rawls proposes equal distribution of resources disregarding utilitarianism.
Though the ethical frameworks sometimes contradict one another, they offer a moral guideline to solve healthcare providers' ethical issues. What is best for the patient matters most and is always put into consideration.
References
Daniels, N. (2017). Justice and Access to Health Care https://plato.stanford.edu/entries/justice-healthcareaccess/#WhenAcceCareEqua
Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5. doi: 10.4103/2229-5070.175024
Seven Pillar Institute (2017). Utilitarianism. https://sevenpillarsinstitute.org/glossary/utilitarianism/
