22 Jun Robert Frost (1874 -1963), a
Robert Frost (1874 -1963), an American poet wrote the following lines:
I shall be telling this with a sigh
Somewhere ages and ages hence;
Two roads diverged in a wood, and I
I took the one less traveled by,
And that has made all the difference.
There are two cults (options) within the traditions of ancient Greece – Aesculapius and Hygeia – which dealt with health care delivery. Aesculapius was a strict patient and health care provider model that was aggressively centered around the patient, whereas Hygeia was a public health model that focused on prevention in the context of public interest. It is clear that American medical care is built on the Aesculpapian model. When one considers our concerns regarding the allocation of health care, is it possible that some of our problems are associated with this choice made over 1,000 years ago? Consider how the debate would be altered had we taken the Hygeia model (option) as the standard of health care provision.
In particular, address each of the following:
What would the health care system look like?
What would be its primary legal, ethical, and moral obligations and why?
What would be among the problems facing this different model of health care?
What lessons, from this model, can you take into your own healthcare practice and/or values and why?
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What would the health care system look like?
What would be its primary legal, ethical, and moral obligations and why?
There are a number of preventive health interventions which provide minimal if any benefit to the individual yet provide substantial collective benefit to the public’s health. For example, immunizations provide protection but involve some risk to the individual. However, if a public health program can achieve universal vaccination, the overall public health benefits. If a patient refuses a legally required immunization (e.g., in jurisdictions where immunization is legally mandated), this becomes a legal matter. If not legally mandated, an adequately informed refusal, expressing compelling personal or religious beliefs, may be respected.
Each state has specific statutes that identify specific diseases with public health implications, such as communicable diseases, which require reporting. Beyond this legal requirement lies the question of when it is justified to potentially violate confidentiality to protect the public’s health. It is ethically justified to disclose a diagnosis to public health authorities if the risk to the public has the following features:
– the risk is high in probability
– the risk is serious in magnitude
– the risk relates to an identifiable individual or group
For instance, if a food handling restaurant worker with acute hepatitis asks that his diagnosis be held in confidence, the physician should nevertheless disclose this diagnosis to the dining establishment or public health authorities, since the risk to the public is high, serious, and relates to identifiable persons (e.g., patron of the eating establishment).
Most public health law and regulations reflect a public policy process that involved tradeoffs. There is seldom certainty in the final policy recommendations, which are often the result of compromise positions of divergent advocacy groups. As a result, physicians and other health care workers may find their own positions at odds with regulations or health care laws. Professionals have an obligation to exercise judgment and not follow laws that are grossly unjust or immoral. Most situations are not this extreme, however. Thus, the health care professional should find ways other than outright disobedience to try to influence health care policy with which she disagrees. No health care provider should be forced to provide a service he morally opposes, but he should also not obstruct others who support it. The best and most constructive way to affect health policy is to participate actively in the policy making process.
This is a controversial area in law, and the law varies by state. The ethical justification for treatment of a patient against his will is based on balancing of the risk to the public versus respecting the patient’s personal freedom. If the magnitude of risk to the public is great, many states allow for involuntary treatment. For example, a patient with active pulmonary tuberculosis that is resistant to multiple anti-tuberculosis medications presents a grave risk to the public if her condition is untreated. This arises in part because of the high infectivity of active pulmonary tuberculosis and the relatively small risk to the patient from oral medications for TB treatment. Other conditions for which non-treatment poses little or no threat to the public, such as untreated acute leukemia, can rarely have involuntary treatment justified.
What would be among the problems facing this different model of health care?
There are a number of problems to providing preventive care. These problems can b
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