Philosophy of healthcare
Encyclopedia
The philosophy
of healthcare is the study of the ethics
, processes, and people
which constitute the maintenance of health for human beings. (Although veterinary concerns are worthy to note, the body of thought regarding their methodologies and practices is not addressed in this article.) For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon
of human civilization
whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of his or her life.
The philosophy of healthcare is primarily concerned with the following elemental questions:
However, the most important question of all is 'what is health?'. Unless this question is addressed any debate about healthcare will be vague and unbounded. For example, what exactly is a health care intervention? What differentiates healthcare from engineering or teaching, for example? Is health care about 'creating autonomy' or acting in people's best interests? Or is it always both? A 'philosophy' of anything requires baseline philosophical questions, as asked, for example, by the philosopher Professor David Seedhouse.
Ultimately, the purpose, objective, and meaning of healthcare philosophy is to consolidate the abundance of information regarding the ever-changing fields of biotechnology
, medicine
, and nursing
. And seeing that healthcare typically ranks as one of the largest spending areas of governmental budgets, it becomes important to gain a greater understanding of healthcare as not only a social institution, but also as a political one. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems; be it nurses, doctor
s, allied health professionals, hospital
administrators, health insurance
companies (HMOs and PPO
s), the government
(Medicare
and Medicaid
), and lastly, the patient
s themselves.
, then the decision must come from elsewhere. And defining that "elsewhere" has proven to be a very difficult endeavor in healthcare philosophy.
tends to deal with more broadly-based issues like the consecrated nature of the human body and the roles of science and technology in healthcare, medical ethics is specifically focused on applying ethical principals to the field of medicine
. It is a large and relatively new area of study in ethics. And one of the major premises of medical ethics surrounds "the development of valuational measures of outcomes of health care treatments and programs; these outcome measures are designed to guide health policy and so must be able to be applied to substantial numbers of people, including across or even between whole societies." Terms like beneficence
and non-maleficence
are vital to the overall understanding of medical ethics. Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a doctor-patient relationship.
(ANA) endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession. And since moral issues are extremely prevalent throughout nursing, it is important to be able to recognize and critically respond to situations that warrant and/or necessitate an ethical decision.
and some parts of Europe
, democratic governments play a major role in determining how much public money from taxation should be directed towards the healthcare process. In the United States and other parts of Europe, private health insurance corporations as well as government agencies are the agents in this precarious life-and-death balancing act. According to medical ethicist Leonard J. Weber, "Good-quality healthcare means cost-effective healthcare," but "more expensive healthcare does not mean higher-quality healthcare" and "certain minimum standards of quality must be met for all patients" regardless of health insurance status. This statement undoubtedly reflects the varying thought processes going into the bigger picture of a healthcare cost-benefit analysis
. In order to streamline this tedious process, health maintenance organizations (HMOs) like BlueCross BlueShield
employ large numbers of actuaries
(colloquially known as "insurance adjusters") to ascertain the appropriate balance between cost, quality, and necessity in a patient's healthcare plan. A general rule in the health insurance industry is as follows: This generalized rule for healthcare institutions "is perhaps one of the best expressions of the practical meaning of stewardship
of resources," especially since "the burden of proof is on justifying the more expensive intervention, not the less expensive one, when different acceptable treatment options exist." And lastly, frivolous lawsuits
have been cited as major precipitants of increasing healthcare costs.
of healthcare, the debate between universal healthcare and private healthcare
is particularly contentious in the United States
. In the 1960s, there was a plethora of public initiatives by the federal government to consolidate and modernize the U.S. healthcare system. With Lyndon Johnson's Great Society
, the U.S. established public health insurance for both senior citizens and the underprivileged. Known as Medicare and Medicaid, these two healthcare programs granted certain groups of Americans access to adequate healthcare services. Although these healthcare programs were a giant step in the direction of socialized medicine
, many people think that the U.S. needs to do more for its citizenry with respect to healthcare coverage. Opponents of universal healthcare see it as an erosion of the high quality of care that already exists in the United States.
with the field of healthcare. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the healthcare industry. Standardizing the nature of healthcare institutions in this manner proved provocative. In fact, many interest groups, including the American Medical Association
(AMA) and Big Pharma
came out against the congressional bill. Basically, having hospitals provide emergency medical care to anyone, regardless of health insurance
status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the two biggest stumbling blocks for the bill. As a result of this intense opposition, the initiative eventually failed to pass Congress
in 2002.
Health insurance is the primary mechanism through which individuals cover healthcare costs in industrialized countries. It can be obtained from either the public
or private
sector of the economy. In Canada
, for example, the provincial governments administer public health insurance coverage to citizens and permanent residents. According to Health Canada, the political philosophy of public insurance in Canada is as follows: And the driving force behind such a political philosophy in Canada was democratic socialist
politician Tommy Douglas
.
, from which th research question is derived, and only subsequent to this can decisions be made as to the most appropriate research methodology
, design, and methods to fulfill the purposes of the research." This statement on research methodology places the researcher at the forefront of his findings. That is, the researcher becomes the person who makes or breaks his or her scientific inquiries rather than the research itself. Even so, "interpretive research and scholarship are creative processes, and methods and methodology are not always singular, a priori, fixed and unchanging." Therefore, viewpoints on scientific inquiries into healthcare matters "will continue to grow and develop with the creativity and insight of interpretive researchers, as they consider emerging ways of investigating the complex social world."
(FDA) typically conducts appropriate trials on new drugs coming from pharmaceutical companies. Along with the FDA, the National Institutes of Health
sets the guidelines for all kinds of clinical trials relating to infectious diseases. For cancer
, the National Cancer Institute
(NCI) sponsors a series or cooperative groups like CALGB and COG
in order to standardize protocols for cancer treatment.
(QARC) is just one example of a QA facility that seeks "to improve the standards of care" for patients "by improving the quality of clinical trials medicine."
or Cerebral Palsy
. In fact, obstetricians have the most medical malpractice
lawsuits filed against them. As a result, they have to pay the highest premiums for malpractice insurance. These high costs inevitably become a hindrance not only to the doctors, but also to the healthcare industry as a whole. And although patients and their families have the right to appeal and confront a physician regarding the quality of treatment received, there must be a limit as to how far they can go.
The ecophilosophy of Garrett Hardin
constitutes one perspective from which to view the reproductive rights of human beings. For the most part, Hardin argues that it is immoral to have large families, especially since it does a disservice to society in the sense that there is only a finite number of resources in the world. In an essay entitled The Tragedy of the Commons, Hardin states, This statement essentially summarizes Hardin's major point concerning the negligible right of all human beings to procreate. Moreover, Hardin is a vocal critic of the United Nations
' Universal Declaration of Human Rights
(UDHR), which states that "any choice and decision with regard to the size of the family must irrevocably rest with the family itself, and cannot be made by anyone else."
As for healthcare philosophy, Hardin's ecophilosophical views may seem like a stretch. Nevertheless, they are important to keep in mind, especially when considering the call for healthcare as a universal birth right of all people. The increasing strains placed on healthcare systems are primarily the result of a growing human population. One way of mitigating healthcare costs is to moderate population growth. The fewer people there are to take care of, the less expensive healthcare will become. And to apply this logic
to what medical ethicist Leonard J. Weber previously suggested, less expensive healthcare does not necessarily mean poorer quality healthcare.
in order to cleanse the gene pool of what were perceived to be unwanted or harmful elements. This "race hygiene movement in Germany
evolved from a theory
of Social Darwinism
, which had become popular throughout Europe" and the United States during the 1930s. A German
phrase that embodies the whole nature of this practice is lebensunwertes Leben or "life unworthy of life."
In connection with healthcare philosophy, the theory of natural rights
becomes a rather pertinent subject. After birth, man is effectively endowed with a series of natural rights that cannot be banished under any circumstances. One major proponent of natural rights theory was seventeenth-century English
political philosopher John Locke
. With regard to the natural rights of man, Locke states, Although partially informed by his religious
understanding of the world, Locke's statement can essentially be viewed as an affirmation of the right to preserve one's life at all costs. This point is precisely where healthcare as a human right
becomes relevant.
The process of preserving and maintaining one's health throughout life is a matter of grave concern. Once alive, how should people exercise their natural right to preserve their life through good health? At some point in every person's life, his or her health is going to decline regardless of all measures taken to prevent such a collapse. Coping with this inevitable decline can prove quite problematic for some people. For Enlightenment
philosopher René Descartes
, the depressing and gerontological implications of aging pushed him to believe in the prospects of immortality
through a wholesome faith
in the possibilities of reason
.
claim that it is particularly necessary for patients suffering from a terminal illness. However, opponents of a self-chosen death purport that it is not only immoral, but wholly against the pillars of reason.
In a certain philosophical context, death can be seen as the ultimate existential
moment in one's life. Death is the deepest cause of a primordial anxiety
(Die Anfechtung) in a person's life. And it is in this emotional state of anxiety that "the Nothing" is revealed to the person. According to twentieth-century German existentialist
/phenomenologist
philosopher Martin Heidegger
, And thus, for Heidegger, humans finds themselves in a very precarious and fragile situation (constantly hanging over the abyss
) in this world. This concept can be simplified to the point where at bottom, all that a person has in this world is his or her Being
. And no matter how individuals proceed in life, their existence will always be marked by finitude and solitude
. The prospect or self-realization that one's life is about to end is quite frightening to say the least. But why is this the case? When considering near-death experiences, humans feels this primordial anxiety overcome them. It robs them of speech and thought, but not feeling. Therefore, it is important for healthcare providers to recognize the onset of this entrenched despair in patients who are nearing their respective deaths.
Another philosophical inquiry into death centers on the heavy reliance on science
and technology
in the healthcare profession. This reliance is especially evident in Westernized medicine, as it is difficult to make apt connections to primitive means of healthcare in the developing world. Even so, Heidegger makes a rather fascinating allusion
to this reliance in what he calls the allure or "character of exactness." In effect, man is inherently attached to "exactness" because it gives him a sense of purpose or reason in a world that is largely defined by what appears to be chaos and irrationality. And as the moment of death is approaching, a moment marked by utter confusion and fear, he tries to locate a sense of meaning and purpose behind it all.
Aside from the role that science and technology plays in death, palliative care
constitutes a specialized area of healthcare philosophy that specifically relates to patients who are terminally ill. Similar to hospice
, this area of healthcare philosophy is becoming increasingly important as more patients are preferring to receive healthcare services in their homes. Even though the terms "palliative" and "hospice" are typically used interchangeably, they are actually quite different. And the major difference resides in the fact that hospice care is a benefit associated with Medicare
while palliative care is not. As a patient nears the end of his life, it is more comforting to be in a private home-like setting instead of a hospital. Palliative care has generally been reserved for those who have a terminal illness
. However, it is now being applied to patients in all kinds of medical situations, including chronic fatigue and other bothersome symptoms.
Philosophy
Philosophy is the study of general and fundamental problems, such as those connected with existence, knowledge, values, reason, mind, and language. Philosophy is distinguished from other ways of addressing such problems by its critical, generally systematic approach and its reliance on rational...
of healthcare is the study of the ethics
Ethics
Ethics, also known as moral philosophy, is a branch of philosophy that addresses questions about morality—that is, concepts such as good and evil, right and wrong, virtue and vice, justice and crime, etc.Major branches of ethics include:...
, processes, and people
People
People is a plurality of human beings or other beings possessing enough qualities constituting personhood. It has two usages:* as the plural of person or a group of people People is a plurality of human beings or other beings possessing enough qualities constituting personhood. It has two usages:*...
which constitute the maintenance of health for human beings. (Although veterinary concerns are worthy to note, the body of thought regarding their methodologies and practices is not addressed in this article.) For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon
Phenomenon
A phenomenon , plural phenomena, is any observable occurrence. Phenomena are often, but not always, understood as 'appearances' or 'experiences'...
of human civilization
Civilization
Civilization is a sometimes controversial term that has been used in several related ways. Primarily, the term has been used to refer to the material and instrumental side of human cultures that are complex in terms of technology, science, and division of labor. Such civilizations are generally...
whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of his or her life.
The philosophy of healthcare is primarily concerned with the following elemental questions:
- Who requires and/or deserves healthcare? Is healthcare a fundamental right of all people?
- What should be the basis for calculating the cost of treatments, hospital stays, drugs, etc.?
- How can healthcare best be administered to the greatest number of people?
- What are the necessary parameters for clinical trials and quality assuranceQuality AssuranceQuality assurance, or QA for short, is the systematic monitoring and evaluation of the various aspects of a project, service or facility to maximize the probability that minimum standards of quality are being attained by the production process...
?
- Who, if anybody, can decide when a patient is in need of "comfort measures" (euthanasiaEuthanasiaEuthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
)?
However, the most important question of all is 'what is health?'. Unless this question is addressed any debate about healthcare will be vague and unbounded. For example, what exactly is a health care intervention? What differentiates healthcare from engineering or teaching, for example? Is health care about 'creating autonomy' or acting in people's best interests? Or is it always both? A 'philosophy' of anything requires baseline philosophical questions, as asked, for example, by the philosopher Professor David Seedhouse.
Ultimately, the purpose, objective, and meaning of healthcare philosophy is to consolidate the abundance of information regarding the ever-changing fields of biotechnology
Biotechnology
Biotechnology is a field of applied biology that involves the use of living organisms and bioprocesses in engineering, technology, medicine and other fields requiring bioproducts. Biotechnology also utilizes these products for manufacturing purpose...
, medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, and nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
. And seeing that healthcare typically ranks as one of the largest spending areas of governmental budgets, it becomes important to gain a greater understanding of healthcare as not only a social institution, but also as a political one. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems; be it nurses, doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, allied health professionals, hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
administrators, health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
companies (HMOs and PPO
Preferred provider organization
In health insurance in the United States, a preferred provider organization is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced...
s), the government
Government
Government refers to the legislators, administrators, and arbitrators in the administrative bureaucracy who control a state at a given time, and to the system of government by which they are organized...
(Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
and Medicaid
Medicaid
Medicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
), and lastly, the patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s themselves.
Ethics of healthcare
The ethical and/or moral premises of healthcare are complex and intricate. To consolidate such a large segment of moral philosophy, it becomes important to focus on what separates healthcare ethics from other forms of morality. And on the whole, it can be said that healthcare itself is a "special" institution within society. With that said, healthcare ought to "be treated differently from other social goods" in a society. It is an institution of which we are all a part whether we like it or not. At some point in every person's life, a decision has to be made regarding one's healthcare. Can he/she afford it? Does he/she deserve it? Does he/she need it? Where should he/she go to get it? Does he/she even want it? And it is this last question which poses the biggest dilemma facing a person. After weighing all of the costs and benefits of her healthcare situation, the person has to decide if the costs of healthcare outweigh the benefits. More than basic economic issues are at stake in this conundrum. In fact, a person must decide whether or not his/her life is ending or if it is worth salvaging. Of course, in instances where the patient is unable to decide due to medical complications, like a comaComa
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
, then the decision must come from elsewhere. And defining that "elsewhere" has proven to be a very difficult endeavor in healthcare philosophy.
Medical ethics
Whereas bioethicsBioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
tends to deal with more broadly-based issues like the consecrated nature of the human body and the roles of science and technology in healthcare, medical ethics is specifically focused on applying ethical principals to the field of medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
. It is a large and relatively new area of study in ethics. And one of the major premises of medical ethics surrounds "the development of valuational measures of outcomes of health care treatments and programs; these outcome measures are designed to guide health policy and so must be able to be applied to substantial numbers of people, including across or even between whole societies." Terms like beneficence
Beneficence
Beneficence is a bronze statue on the campus of Ball State University, located in Muncie, Indiana. It is referred to as "Benny" by the students.-History:...
and non-maleficence
Primum non nocere
is a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as .Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical...
are vital to the overall understanding of medical ethics. Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a doctor-patient relationship.
Nursing ethics
Like medical ethics, nursing ethics is very narrow in its focus, especially when compared to the expansive field of bioethics. For the most part, "nursing ethics can be defined as having a two-pronged meaning," whereby it is "the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice." This definition, although quite vague, centers on the practical and theoretical approaches to nursing. The American Nurses AssociationAmerican Nurses Association
The American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
(ANA) endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession. And since moral issues are extremely prevalent throughout nursing, it is important to be able to recognize and critically respond to situations that warrant and/or necessitate an ethical decision.
Business ethics
Balancing the cost of care with the quality of care is a major issue in healthcare philosophy. In CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
and some parts of Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
, democratic governments play a major role in determining how much public money from taxation should be directed towards the healthcare process. In the United States and other parts of Europe, private health insurance corporations as well as government agencies are the agents in this precarious life-and-death balancing act. According to medical ethicist Leonard J. Weber, "Good-quality healthcare means cost-effective healthcare," but "more expensive healthcare does not mean higher-quality healthcare" and "certain minimum standards of quality must be met for all patients" regardless of health insurance status. This statement undoubtedly reflects the varying thought processes going into the bigger picture of a healthcare cost-benefit analysis
Cost-benefit analysis
Cost–benefit analysis , sometimes called benefit–cost analysis , is a systematic process for calculating and comparing benefits and costs of a project for two purposes: to determine if it is a sound investment , to see how it compares with alternate projects...
. In order to streamline this tedious process, health maintenance organizations (HMOs) like BlueCross BlueShield
Blue Cross and Blue Shield Association
The Blue Cross Blue Shield Association is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. The history of Blue Cross dates back to 1929, while the history of...
employ large numbers of actuaries
Actuary
An actuary is a business professional who deals with the financial impact of risk and uncertainty. Actuaries provide expert assessments of financial security systems, with a focus on their complexity, their mathematics, and their mechanisms ....
(colloquially known as "insurance adjusters") to ascertain the appropriate balance between cost, quality, and necessity in a patient's healthcare plan. A general rule in the health insurance industry is as follows: This generalized rule for healthcare institutions "is perhaps one of the best expressions of the practical meaning of stewardship
Stewardship
Stewardship is an ethic that embodies responsible planning and management of resources. The concept of stewardship has been applied in diverse realms, including with respect to environment, economics, health, property, information, and religion, and is linked to the concept of sustainability...
of resources," especially since "the burden of proof is on justifying the more expensive intervention, not the less expensive one, when different acceptable treatment options exist." And lastly, frivolous lawsuits
Frivolous litigation
In law, frivolous litigation is the practice of starting or carrying on law suits that, due to their lack of legal merit, have little to no chance of being won. The term does not include cases that may be lost due to other matters not related to legal merit...
have been cited as major precipitants of increasing healthcare costs.
Political philosophy of healthcare
In the political philosophyPolitical philosophy
Political philosophy is the study of such topics as liberty, justice, property, rights, law, and the enforcement of a legal code by authority: what they are, why they are needed, what, if anything, makes a government legitimate, what rights and freedoms it should protect and why, what form it...
of healthcare, the debate between universal healthcare and private healthcare
Private healthcare
Private healthcare or private medicine is healthcare and medicine provided by entities other than the government. The term is generally used more in Europe and other countries which have publicly-funded health care, to differentiate the arrangement from the usual system.Ethical issues relating to...
is particularly contentious in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. In the 1960s, there was a plethora of public initiatives by the federal government to consolidate and modernize the U.S. healthcare system. With Lyndon Johnson's Great Society
Great Society
The Great Society was a set of domestic programs in the United States promoted by President Lyndon B. Johnson and fellow Democrats in Congress in the 1960s. Two main goals of the Great Society social reforms were the elimination of poverty and racial injustice...
, the U.S. established public health insurance for both senior citizens and the underprivileged. Known as Medicare and Medicaid, these two healthcare programs granted certain groups of Americans access to adequate healthcare services. Although these healthcare programs were a giant step in the direction of socialized medicine
Socialized medicine
Socialized medicine is a term used to describe a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation. It is used primarily and usually pejoratively in United States political debates...
, many people think that the U.S. needs to do more for its citizenry with respect to healthcare coverage. Opponents of universal healthcare see it as an erosion of the high quality of care that already exists in the United States.
Patients' Bill of Rights
In 2001, the U.S. federal government took up an initiative to provide patients with an explicit list of rights concerning their healthcare. The political philosophy behind such an initiative essentially blended ideas of the Consumers' Bill of RightsConsumer Bill of Rights
Before the mid-twentieth century, consumers were without rights with regard to their interaction with products and commercial producers. Consumers had little ground on which to defend themselves against faulty or defective products, or against misleading or deceptive advertising methods.By the...
with the field of healthcare. It was undertaken in an effort to ensure the quality of care of all patients by preserving the integrity of the processes that occur in the healthcare industry. Standardizing the nature of healthcare institutions in this manner proved provocative. In fact, many interest groups, including the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
(AMA) and Big Pharma
Pharmaceutical lobby
The pharmaceutical lobby — also known as the drug lobby — refers to the paid representatives of large pharmaceutical and biomedicine companies in the United States who seek to influence federal government policy.-Political influence in the U.S.:...
came out against the congressional bill. Basically, having hospitals provide emergency medical care to anyone, regardless of health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the two biggest stumbling blocks for the bill. As a result of this intense opposition, the initiative eventually failed to pass Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
in 2002.
Health insurance
Health insurance is the primary mechanism through which individuals cover healthcare costs in industrialized countries. It can be obtained from either the public
Government
Government refers to the legislators, administrators, and arbitrators in the administrative bureaucracy who control a state at a given time, and to the system of government by which they are organized...
or private
Corporation
A corporation is created under the laws of a state as a separate legal entity that has privileges and liabilities that are distinct from those of its members. There are many different forms of corporations, most of which are used to conduct business. Early corporations were established by charter...
sector of the economy. In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, for example, the provincial governments administer public health insurance coverage to citizens and permanent residents. According to Health Canada, the political philosophy of public insurance in Canada is as follows: And the driving force behind such a political philosophy in Canada was democratic socialist
Democratic socialism
Democratic socialism is a description used by various socialist movements and organizations to emphasize the democratic character of their political orientation...
politician Tommy Douglas
Tommy Douglas
Thomas Clement "Tommy" Douglas, was a Scottish-born Baptist minister who became a prominent Canadian social democratic politician...
.
Research and scholarship
Considering the rapid pace at which the fields of medicine and health science are developing, it becomes important to investigate the most proper and/or efficient methodologies for conducting research. On the whole, "the primary concern of the researcher must always be the phenomenonPhenomenon
A phenomenon , plural phenomena, is any observable occurrence. Phenomena are often, but not always, understood as 'appearances' or 'experiences'...
, from which th research question is derived, and only subsequent to this can decisions be made as to the most appropriate research methodology
Methodology
Methodology is generally a guideline for solving a problem, with specificcomponents such as phases, tasks, methods, techniques and tools . It can be defined also as follows:...
, design, and methods to fulfill the purposes of the research." This statement on research methodology places the researcher at the forefront of his findings. That is, the researcher becomes the person who makes or breaks his or her scientific inquiries rather than the research itself. Even so, "interpretive research and scholarship are creative processes, and methods and methodology are not always singular, a priori, fixed and unchanging." Therefore, viewpoints on scientific inquiries into healthcare matters "will continue to grow and develop with the creativity and insight of interpretive researchers, as they consider emerging ways of investigating the complex social world."
Clinical trials
Clinical trials are a means through which the healthcare industry tests a new drug, treatment, or medical device. The traditional methodology behind clinical trials consists of various phases in which the emerging product undergoes a series of intense tests, most of which tend to occur on interested and/or compliant patients. The U.S. government has an established network for tackling the emergence of new products in the healthcare industry. The Food and Drug AdministrationFood and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) typically conducts appropriate trials on new drugs coming from pharmaceutical companies. Along with the FDA, the National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
sets the guidelines for all kinds of clinical trials relating to infectious diseases. For cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
(NCI) sponsors a series or cooperative groups like CALGB and COG
Children's Oncology Group
The Children’s Oncology Group , a National Cancer Institute supported clinical trials group, is the world’s largest organization devoted exclusively to childhood and adolescent cancer research...
in order to standardize protocols for cancer treatment.
Quality assurance
The primary purpose of quality assurance (QA) in healthcare is to ensure that the quality of patient care is in accordance with established guidelines. The government usually plays a significant role in providing structured guidance for treating a particular disease or ailment. However, protocols for treatment can also be worked out at individual healthcare institutions like hospitals and HMOs. In some cases, quality assurance is seen as a superfluous endeavor, as many healthcare-based QA organizations, like QARC, are publicly funded at the hands of taxpayers. However, many people would agree that healthcare quality assurance, particularly in the areas cancer treatment and disease control are necessary components to the vitality of any legitimate healthcare system. With respect to quality assurance in cancer treatment scenarios, the Quality Assurance Review CenterQuality Assurance Review Center
The Quality Assurance Review Center is a research program within the University of Massachusetts Medical School that provides radiotherapy quality assurance , diagnostic imaging data management, and clinical research support...
(QARC) is just one example of a QA facility that seeks "to improve the standards of care" for patients "by improving the quality of clinical trials medicine."
Reproductive rights
Everybody who wishes to have a child wants it to be perfect (at least at birth). Nobody wants and/or wishes for their child to be born with Down SyndromeDown syndrome
Down syndrome, or Down's syndrome, trisomy 21, is a chromosomal condition caused by the presence of all or part of an extra 21st chromosome. It is named after John Langdon Down, the British physician who described the syndrome in 1866. The condition was clinically described earlier in the 19th...
or Cerebral Palsy
Cerebral palsy
Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....
. In fact, obstetricians have the most medical malpractice
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...
lawsuits filed against them. As a result, they have to pay the highest premiums for malpractice insurance. These high costs inevitably become a hindrance not only to the doctors, but also to the healthcare industry as a whole. And although patients and their families have the right to appeal and confront a physician regarding the quality of treatment received, there must be a limit as to how far they can go.
The ecophilosophy of Garrett Hardin
Garrett Hardin
Garrett James Hardin was an American ecologist who warned of the dangers of overpopulation and whose concept of the tragedy of the commons brought attention to "the damage that innocent actions by individuals can inflict on the environment"...
constitutes one perspective from which to view the reproductive rights of human beings. For the most part, Hardin argues that it is immoral to have large families, especially since it does a disservice to society in the sense that there is only a finite number of resources in the world. In an essay entitled The Tragedy of the Commons, Hardin states, This statement essentially summarizes Hardin's major point concerning the negligible right of all human beings to procreate. Moreover, Hardin is a vocal critic of the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
' Universal Declaration of Human Rights
Universal Declaration of Human Rights
The Universal Declaration of Human Rights is a declaration adopted by the United Nations General Assembly . The Declaration arose directly from the experience of the Second World War and represents the first global expression of rights to which all human beings are inherently entitled...
(UDHR), which states that "any choice and decision with regard to the size of the family must irrevocably rest with the family itself, and cannot be made by anyone else."
As for healthcare philosophy, Hardin's ecophilosophical views may seem like a stretch. Nevertheless, they are important to keep in mind, especially when considering the call for healthcare as a universal birth right of all people. The increasing strains placed on healthcare systems are primarily the result of a growing human population. One way of mitigating healthcare costs is to moderate population growth. The fewer people there are to take care of, the less expensive healthcare will become. And to apply this logic
Logic
In philosophy, Logic is the formal systematic study of the principles of valid inference and correct reasoning. Logic is used in most intellectual activities, but is studied primarily in the disciplines of philosophy, mathematics, semantics, and computer science...
to what medical ethicist Leonard J. Weber previously suggested, less expensive healthcare does not necessarily mean poorer quality healthcare.
Birth and living
The concept of being "well-born" is not new. On the whole, it takes on a fairly racist undertone. The Nazis practiced eugenicsEugenics
Eugenics is the "applied science or the bio-social movement which advocates the use of practices aimed at improving the genetic composition of a population", usually referring to human populations. The origins of the concept of eugenics began with certain interpretations of Mendelian inheritance,...
in order to cleanse the gene pool of what were perceived to be unwanted or harmful elements. This "race hygiene movement in Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
evolved from a theory
Theory
The English word theory was derived from a technical term in Ancient Greek philosophy. The word theoria, , meant "a looking at, viewing, beholding", and referring to contemplation or speculation, as opposed to action...
of Social Darwinism
Social Darwinism
Social Darwinism is a term commonly used for theories of society that emerged in England and the United States in the 1870s, seeking to apply the principles of Darwinian evolution to sociology and politics...
, which had become popular throughout Europe" and the United States during the 1930s. A German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
phrase that embodies the whole nature of this practice is lebensunwertes Leben or "life unworthy of life."
In connection with healthcare philosophy, the theory of natural rights
Natural rights
Natural and legal rights are two types of rights theoretically distinct according to philosophers and political scientists. Natural rights are rights not contingent upon the laws, customs, or beliefs of any particular culture or government, and therefore universal and inalienable...
becomes a rather pertinent subject. After birth, man is effectively endowed with a series of natural rights that cannot be banished under any circumstances. One major proponent of natural rights theory was seventeenth-century English
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
political philosopher John Locke
John Locke
John Locke FRS , widely known as the Father of Liberalism, was an English philosopher and physician regarded as one of the most influential of Enlightenment thinkers. Considered one of the first of the British empiricists, following the tradition of Francis Bacon, he is equally important to social...
. With regard to the natural rights of man, Locke states, Although partially informed by his religious
Religion
Religion is a collection of cultural systems, belief systems, and worldviews that establishes symbols that relate humanity to spirituality and, sometimes, to moral values. Many religions have narratives, symbols, traditions and sacred histories that are intended to give meaning to life or to...
understanding of the world, Locke's statement can essentially be viewed as an affirmation of the right to preserve one's life at all costs. This point is precisely where healthcare as a human right
Human rights
Human rights are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being." Human rights are thus conceived as universal and egalitarian . These rights may exist as natural rights or as legal rights, in both national...
becomes relevant.
The process of preserving and maintaining one's health throughout life is a matter of grave concern. Once alive, how should people exercise their natural right to preserve their life through good health? At some point in every person's life, his or her health is going to decline regardless of all measures taken to prevent such a collapse. Coping with this inevitable decline can prove quite problematic for some people. For Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
philosopher René Descartes
René Descartes
René Descartes ; was a French philosopher and writer who spent most of his adult life in the Dutch Republic. He has been dubbed the 'Father of Modern Philosophy', and much subsequent Western philosophy is a response to his writings, which are studied closely to this day...
, the depressing and gerontological implications of aging pushed him to believe in the prospects of immortality
Immortality
Immortality is the ability to live forever. It is unknown whether human physical immortality is an achievable condition. Biological forms have inherent limitations which may or may not be able to be overcome through medical interventions or engineering...
through a wholesome faith
Faith
Faith is confidence or trust in a person or thing, or a belief that is not based on proof. In religion, faith is a belief in a transcendent reality, a religious teacher, a set of teachings or a Supreme Being. Generally speaking, it is offered as a means by which the truth of the proposition,...
in the possibilities of reason
Reason
Reason is a term that refers to the capacity human beings have to make sense of things, to establish and verify facts, and to change or justify practices, institutions, and beliefs. It is closely associated with such characteristically human activities as philosophy, science, language, ...
.
Death and dying
One of the most basic human rights is the right to live, and thus, preserve one's life. But what about the right to die, and thus, end one's life? Needless to say, this is a very controversial topic. Often, religious values of varying traditions tend to seep into the picture in one fashion or another. Terms like "mercy killing" and "assisted suicide" are frequently used to describe this process. Proponents of euthanasiaEuthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
claim that it is particularly necessary for patients suffering from a terminal illness. However, opponents of a self-chosen death purport that it is not only immoral, but wholly against the pillars of reason.
In a certain philosophical context, death can be seen as the ultimate existential
Existential crisis
An existential crisis is a stage of development at which an individual questions the very foundations of his or her life: whether his or her life has any meaning, purpose or value...
moment in one's life. Death is the deepest cause of a primordial anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
(Die Anfechtung) in a person's life. And it is in this emotional state of anxiety that "the Nothing" is revealed to the person. According to twentieth-century German existentialist
Existentialism
Existentialism is a term applied to a school of 19th- and 20th-century philosophers who, despite profound doctrinal differences, shared the belief that philosophical thinking begins with the human subject—not merely the thinking subject, but the acting, feeling, living human individual...
/phenomenologist
Existential phenomenology
Existential phenomenology is a philosophical current inspired by Martin Heidegger's 1927 work Sein und Zeit and influenced by the existential work of Søren Kierkegaard and the phenomenological work of Edmund Husserl....
philosopher Martin Heidegger
Martin Heidegger
Martin Heidegger was a German philosopher known for his existential and phenomenological explorations of the "question of Being."...
, And thus, for Heidegger, humans finds themselves in a very precarious and fragile situation (constantly hanging over the abyss
Abyss (religion)
Abyss refers to a bottomless pit, to the underworld, to the deepest ocean floor, or to hell.The English word "abyss" derives from the late Latin abyssimus through French abisme , hence the poetic form "abysm", with examples dating to 1616 and earlier to rhyme with "time"...
) in this world. This concept can be simplified to the point where at bottom, all that a person has in this world is his or her Being
Being
Being , is an English word used for conceptualizing subjective and objective aspects of reality, including those fundamental to the self —related to and somewhat interchangeable with terms like "existence" and "living".In its objective usage —as in "a being," or "[a] human being" —it...
. And no matter how individuals proceed in life, their existence will always be marked by finitude and solitude
Solitude
Solitude is a state of seclusion or isolation, i.e., lack of contact with people. It may stem from bad relationships, deliberate choice, infectious disease, mental disorders, neurological disorders or circumstances of employment or situation .Short-term solitude is often valued as a time when one...
. The prospect or self-realization that one's life is about to end is quite frightening to say the least. But why is this the case? When considering near-death experiences, humans feels this primordial anxiety overcome them. It robs them of speech and thought, but not feeling. Therefore, it is important for healthcare providers to recognize the onset of this entrenched despair in patients who are nearing their respective deaths.
Another philosophical inquiry into death centers on the heavy reliance on science
Science
Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe...
and technology
Technology
Technology is the making, usage, and knowledge of tools, machines, techniques, crafts, systems or methods of organization in order to solve a problem or perform a specific function. It can also refer to the collection of such tools, machinery, and procedures. The word technology comes ;...
in the healthcare profession. This reliance is especially evident in Westernized medicine, as it is difficult to make apt connections to primitive means of healthcare in the developing world. Even so, Heidegger makes a rather fascinating allusion
Allusion
An allusion is a figure of speech that makes a reference to, or representation of, people, places, events, literary work, myths, or works of art, either directly or by implication. M. H...
to this reliance in what he calls the allure or "character of exactness." In effect, man is inherently attached to "exactness" because it gives him a sense of purpose or reason in a world that is largely defined by what appears to be chaos and irrationality. And as the moment of death is approaching, a moment marked by utter confusion and fear, he tries to locate a sense of meaning and purpose behind it all.
Aside from the role that science and technology plays in death, palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
constitutes a specialized area of healthcare philosophy that specifically relates to patients who are terminally ill. Similar to hospice
Hospice
Hospice is a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient's symptoms.In the United States and Canada:*Gentiva Health Services, national provider of hospice and home health services...
, this area of healthcare philosophy is becoming increasingly important as more patients are preferring to receive healthcare services in their homes. Even though the terms "palliative" and "hospice" are typically used interchangeably, they are actually quite different. And the major difference resides in the fact that hospice care is a benefit associated with Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
while palliative care is not. As a patient nears the end of his life, it is more comforting to be in a private home-like setting instead of a hospital. Palliative care has generally been reserved for those who have a terminal illness
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...
. However, it is now being applied to patients in all kinds of medical situations, including chronic fatigue and other bothersome symptoms.
Role development
The manner in which nurses, physicians, patients, and administrators interact is crucial for the overall efficacy of a healthcare system. From the viewpoint of the patients, healthcare providers can be seen as being in a privileged position, whereby they have the power to alter the patients' quality of life. And yet, there are strict divisions among healthcare providers that can sometimes lead to an overall decline in the quality of patient care. When nurses and physicians are not on the same page with respect to a particular patient, a compromising situation may arise. Effects stemming from a "gender gap" between nurses and doctors are detrimental to the professional environment of a hospital workspace.External links
- Summary of the McCain-Edwards-Kennedy Patients' Bill of Rights
- Understanding Clinical Trials
- Mission Statement of the National Cancer Institute (NCI)
- Guidance for Industry, Investigators, and Reviewers in Exploratory Drug Studies (FDA January 2006)
- Quality Assurance Review Center
- "Palliative Care across the Continuum" (Center to Advance Palliative Care)
- "Hospice Care Center" Centers for Medicare and Medicaid Services (CMS)
- "Universal Declaration of Human Rights (UDHR)" (United Nations)
- Medicare (The Official U.S. Government Site for People with Medicare)
- Historical Background and Development of Social Security; includes information about Medicare