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Final Exam Phil 331, Sec

Sociology

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Final Exam Phil 331, Sec. 2 Due: 11/17 1. Please design a health care system for the U.S.. Compare it to Biden’s plan and the system of at least one other country that has universal health care coverage. Why is your system preferable to the other systems? (75%) 2. Please provide an analysis of the ethical and legal issues for one of the following (25%): a. Nursing Nurse Travers, now employed by a local community hospital, has been an RN for over 25 years. She is shocked by how routinely physicians and nurses are lately willing to participate in the death of patients. She strongly rejects abortion, withdrawing life-sustaining ventilators, and hastening death through pain medication. Her beliefs are supported by her minister and her religious congregation. Supervisors at the hospital know about her views and frequently make arrangements so that Nurse Travers is not forced to violate her conscience. On a holiday Nurse Travers’ assigned floor was understaffed. Mr. Stoer, a patient with lung cancer and multiple organ failure, was in extreme pain because the cancer had spread near to his spinal column. The pain, which only recently developed, was excruciating. Nurse Travers quietly prayed for him whenever she could. The patient’s wife insisted on stronger pain medication, which a physician ordered. Nurse Travers believed that administration of the medication would lead to his death due to his breathing problems. She refused to comply with the order, claiming it violated her conscience. On the phone, she explained to the physician that she was perfectly willing to give a more routine medication. The doctor aggressively insisted that she give the prescribed dose. Failure to do so, he insisted, would have serious consequences for Nurse Travers. She steadfastly refused. The result was that Mr. Stoer did not get the pain medication for five hours, the time it took to make alternate arrangements. He died soon after administration of the medication. Discuss the ethical and legal significance of the above facts. b. Confidentiality A patient came to his family physician for his yearly physical examination. A routine part of the examination is a blood test. After the examination was completed, the patient mentioned to the physician that he was engaged to be married. The blood test disclosed that the patient had Hepatitis C, a dangerous and highly infectious condition. When the physician communicated the results to the patient, the physician indicated that the patient should not have intimate contact, including unprotected sex, with his fiancé. The patient did not indicate what he would do. The physician became concerned. She believed that the patient’s fiancé was risk. The physician concluded it was her duty to find out from the man whether his fiancée knew about his medical condition, and, if she didn’t, to ascertain her identity and to inform her. Discuss the ethical and legal significance of the above facts. c. Clinical Trials A year ago, officials discovered that the drinking water for a city in Alabama was polluted by lead. Lead can cause serious, permanent neurological problems, especially in children. Dr. Ames strongly encouraged the parents of one of his patients to enroll their child, Sonja, in a clinical trial that was investigating the value of a new treatment for lead in the blood. The treatment was developed by his company, TreatLead. During the trial the research subjects were instructed not to change their habits in any way. The parents enrolled Sonja in the clinical trial, partly because the research subjects were provided financial compensation for participating in the trial. The parents had no medical insurance because they lived in a state that did not expand the Medicaid program and their jobs did not provide insurance. During Phase II of the trial, it was detected that Sonja had a blood disorder that may not have been related to the presence of lead in her blood. Also, during the early stage of the Phase II trial, it was discovered that the research arm in which Sonja was participating showed no medical benefit but that another therapy in a different arm of the trial showed benefit. At the conclusion of the trial 6 months after it began, Sonja began to manifest medical problems. Her parents requested that Sonja receive the treatment that had shown benefit, but their request was denied. Discuss the ethical and legal significance of the above facts. I examined our county's current system, its problems, projected solution measures, and other countries' systems to design my health care plan. In each of these cases, I analyzed the pros, cons, and efficiency of these systems and their effects on the residing residents to create the most proactive approach possible. One of the first systems I analyzed was the United States' current healthcare plan, the Affordable Care Act. As Vice President to President Obama in 2010, Joe Biden was heavily involved in creating the Affordable Care Act. The passing of the Affordable Care Act was revolutionary as, for the first time in the United States, every person had access to affordable health care. No matter their preexisting conditions, social class, or age, everyone was finally allowed to have peace of mind and know that they can now afford quality health care. The passing of this act reduced the percentage of uninsured Americans from 16% to 9.1%. Primary goals of the Affordable Care Act (ACA) 1 1. Make affordable health insurance available to more people 2. Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level 3. Support innovative medical care delivery methods designed to lower the costs of Healthcare. Joe Biden's current Healthcare plan consists of the following main categories:2 1. Give Every American access to affordable Health Insurance 2. Provide the Peace of Mind of Affordable, Quality Health Care and a Less Complex Health Care System 3. Stand Up to Abuse of Power by Prescription Drug Corporations 4. Ensure Health Care is a Right for All, Not a Privilege for Just a Few President-elect Biden plans to build upon Obama Care and make it more accessible and affordable for all. He also plans to provide more significant financial assistance to those in need to ensure access to affordable medical care. Some of the Affordable Care Act issues were that not all states were complying with the expansion of Medicaid, 27 million Americans in 2016 still were not covered, and there were limited locations that accepted the plan as a form of payment. Biden plans to address each of these issues in his new plan. He plans to consider the middle and lower class by increasing tax credits' value to lower premiums and expanding coverage to low income Americans. He is taking on the perspective of the people, and the struggles they are facing. I agree with many of the points presented in Biden's plan and have incorporated many of its key areas in my newly designed health care plan. Similar to Biden, I plan to create a universal health care system accessible to all no matter their background, disband the current trend of drug 1 2 https://www.healthcare.gov/glossary/affordable-care-act/ https://joebiden.com/healthcare/# companies' unreasonable price tags on their products, and establish a much more affordable plan that can accommodate every social class in the United States. Compared to the United States, Switzerland's GDP is 12.2% compared to the US 16.9%. On the grand scale, this may seem slightly high, but as a whole, Switzerland's GDP is still significantly less than the US, and they have much better healthcare outcomes. Switzerland currently has a decentralized universal health care system, funded by various sources such as enrollment premiums, taxes, social insurance contributions, and personal payments. All residents are required to purchase insurance from private nonprofit users. There are 100+ private insurance companies citizens may choose from, which ensures reasonable prices and the prevention of monopolies from forming. The mandatory insurance's essential services include the following: physician visits, hospital care, pharmaceuticals, long-term medical care, and physical therapy, each of which were defined by the government.3 It does not include dental care, and optometry is only covered for children. Citizens may choose to upgrade to voluntary health insurance in which they may have a broader array of medical services choices. Additionally, Switzerland also ensures that all of its citizens can afford this insurance by subsidizing low-income citizens. This is done when the insurance price is more than 10% of their annual income. After reviewing the current US health care policies in place, the new plans, and those of other countries, I have created a program that addresses many if not all of the significant issues we are currently facing. Additionally, I will incorporate proven effective policies other countries are now following. My health care system includes some of the best qualities of ACA, Biden's plan, and Switzerland's health care system. The main goals of my health care system are as follows: all Americans have access to quality, affordable health care; improve the distributions and spending of money within the healthcare system to make it more cost-effective; establish a new emphasis on preventative care, and create a drug production system that is reasonably affordable to all that need it. 1.Universal Health Care4 1. Universal access to health services 2. Health services that are of high quality 3. Receiving health services does not put people at risk of financial harm 3 https://www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-caresystem/?sh=5ecb2a07d743 4 https://axenehp.com/international-healthcare-systems-us-versus-world/ As stated in our Declaration of Independence, "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."5 Healthcare is a human right to LIFE. No government agencies shall be able to deprive anyone of Healthcare. According to the World Health Organization, Universal Health Coverage is "that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship."6 We are all human beings with healthcare needs; therefore, no person shall be ranked above another in receiving this life sustaining treatment. Additionally, race, ethnicity, social class, gender, or preexisting conditions shall not be evaluated in medical insurance distribution. These actions will be taken to close the ever-broadening gap between the services offered to American citizens. This idea is similar to Biden's plan: "health care is a right for all." Wealth should not influence the quality of the treatment one receives. This new plan will establish a new standard in which all will have access to Healthcare to live a "life in the pursuit of happiness." 2. Mandatory Health Insurance (MHI) Similar to Switzerland, all American citizens would be required to purchase a base rate health insurance plan. This mandatory insurance plan will include physician visits, emergency care, physical therapy, and mental health care. Facilities that provide these services will also be located in each county to ensure that all will have access to life-sustaining services. Additionally, suppose the purchase of such a plan would cost more than 10% of a citizen's annual income. In that case, the government will subsidize its purchase to ensure that such a requirement won't have a negative financial impact on the lower-income community. By requiring all to have health insurance, there will no longer be a need to spread the expenses of unpaid bills to paying patients. The MHI will now establish a standard coverage for all citizens. With the current strain on the social security and Medicare system due to the increasing numbers of elderly Americans, an investment into a system such as this may also prove beneficial to our aging population. 3. Voluntary Plan Also, Similar to Switzerland, there will be the option to purchase a Voluntary Plan. This optional upgrade for additional services may include the addition of optometry, dentistry, dermatology, etc. Private employers may also provide the option to purchase such additions as incentives to recruitment. These voluntary insurance policies will be available on the open market, allowing for the innovation that comes from industry competition. 4. Efficient Cost System 5 6 https://www.archives.gov/founding-docs/declaration-transcript http://www.who.int/health_financing/universal_coverage_definition/en/ Currently, the United States spends the most money on its health care system, yet its citizens' health is ranked among some of the lowest on a world scale. It is evident that the funding is there, but the money is not being used efficiently. To address this ineffective use of taxpayer dollars, my healthcare plan will establish a clear budget in which all government-funded healthcare facilities and providers will be required to abide. By selecting a fixed budget, health care providers will be required to be more cautious about how they are spending money, focusing on efficiency and eliminating unnecessary testing and procedures. Additionally, any leftover funding may be used towards the public's education on health-related issues. These may include Public Service Announcements educating the people on the dangers of smoking, vaping, drug use, and more. By educating the public on such matters, self-induced medical conditions may be avoided. 5. Emphasis on Preventative Care Due to the intimidating costs of medical bills, many American citizens avoid going to the doctor as they fear they will never pay off the impending bill. Because of this, many wait until the very last minute to have a physician assess a medical condition they have been experiencing for a long time. Unfortunately, by the time they seek this help, it's too late, and the state has progressed beyond the scope of effective treatment. The time and money spent assessing and treating this terminal diagnosis that should have been detected by early preventative care is a vital supportive factor to the establishment of the Mandatory Health Insurance (MHI). By establishing the MHI, all citizens will have access to annual physicals to maintain their current health and early diagnosis. To ensure that all have access to attend yearly physicals, every county shall have at least one hospital and various clinics in which those with the base insurance plan will cover. With all citizens having yearly physicals, medical facilities will be saving money on last-minute treatment plans. Additionally, the citizens themselves will highly benefit from such a system, as they will have the opportunity to treat illness early and live a longer, more productive life. 6. Fixed Drug Prices Part of the MHI will be establishing a national system to control the costs of prescription drugs. Government funding will be provided to corporations supporting the research and development of new medications with the requirement that they are made available within the established pricing structure. Oversight of this system will ensure that no citizen is faced with the common situation where they cannot purchase necessary prescription medication. This system is preferable to other systems as it has taken into consideration the success and failures of numerous national medical plans currently in place. It provides accessible universal care at an affordable price for all US citizens. This plan introduces cost-saving measures such as preventative care and strict budget guidelines. Additionally, this plan allows for the innovation of free-market competition while controlling costs to protect the most vulnerable in our population. 2. Nursing In today's society, Nurses are the majority of care providers for patients in hospitals. Due to this increased interaction with the patient, the nurses get to know their patients on a much more personal level than the physician and therefore gain greater insight into their wants and needs. In the scenario provided, we hear of Nurse Travers, RN of 25 years, whose personal beliefs may have led to inadequate actions performed or lack thereof towards her patient, Mr. Stoer. As a nurse, Nurse Travers is expected to perform specific duties such as those indicated by the Nurse Association, the National Council of State Boards of Nursing, and their scope of practice. Nurses Association (ANA): "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations." National Council of State Boards of Nursing: "Nursing means a profession focused on the care of individuals, families, and populations to attain, maintain, or recover optimal health and quality of life from the conception of death." Nurse Scope of Practice ? Assessment: ? systematic collection and analysis of data(nature, physiological, psychological, sociocultural, economic, and lifestyle issues) about a patient ? Diagnosis: ? Evaluation of a patient's response to health conditions. Diagnosis considers factors that impact the patient's health, such as anxiety due to family relationships. ? Outcomes/Panning: ? Achievable and measurable goals(nutritional, movement, stress reduction, and pain management) are set based on assessment and diagnosis. ? Implementation: ? As a care plan is implemented, it should be documented in the patient's records based on the above consideration. ? Evaluation: ? The ANA calls for continual evaluation and, when needed, plan modification. After serving as a nurse for 25 years, Nurse Travers certainly has performed the Nurses' scope of practice numerous times and therefore is knowledgeable of all its requirements. Despite her years of experience, this case may be unique to her as supervisors were aware of her beliefs; consequently, they did not assign her cases against her morals. In the case of Mr. Stoer, she believed that the administration of more intense pain medication would be lethal to Mr. Stoer due to his breathing problems. While it may be that her refusal to comply with the physician's order to administer the stronger medication was made according to her experience and the well being of the patient, it could be questioned if this was her motivation or it was her personal beliefs. Since supervisors knew of Nurse Travers' views, it can be assumed that Mr. Stoer's physician knew as well. This may explain why the physician insisted on his orders rather than contemplate Nurse Travers' suggestions of administering a more routine medication instead. With that being said, we may also find fault by the physician in this scenario. We can assume that the physician was not at the hospital when this was taking place as they spoke on the phone. As stated, the patient's pain had only recently developed; therefore, there is a possibility that the physician has not seen the patient in person since the pain began. If this was the case, one might argue that Nurse Travers had better knowledge of the patient's current condition and her suggestion of a change of treatment plan was valid. We do not know if the physician had made this decision before leaving the hospital. Still, since Nurse Travers was there when symptoms started, her re-evaluation should have been considered by the physician before prescribing a strong pain medication, which was out of routine procedures, despite her personal beliefs. The question lies if Mr. Stoer's passing was due to the stress his body experienced from undergoing excruciating pain for over 5 hours or the pain medication that caused him to pass. If it was determined that the lack of care by Nurse Travers in providing adequate medication for the patient's pain was the source of the passing of Mr. Stoner, Nurse Travers could be charged with malpractice. In this scenario, Nurse Travers did not complete her duty as a nurse to properly care for her patient and provide the pain medication that the physician-directed her to do. Additionally, if it was found that the drug indeed negatively altered Mr. Stoer's breathing, both Nurse Travers and the physician can also be charged with malpractice. The physician can be accused of committing both causation and damages. Under his order, the medication was administered, which may have ultimately led to the patient's death. Also, it is unclear as to who administered the pain medication to Mr. Stoner. But if Nurse Travers administered the medication even though she believed it was the wrong action to be performed, she may also be at fault. For Informed Consent to be established, the following must be present: ? Communication ? Understanding ? Reasoning ability ? Appreciation ? Voluntariness ? Disclosure of Information Proxy Decision Making ? Incompetent patient ? Medical condition, age ? Substituted judgment; knowledge of patient's wishes regarding treatment ? Best interest standard; no knowledge of wishes ? Mixed standard; some knowledge of wishes The capacity of the patient to provide valid informed consent is another important in obtaining informed consent. ? Ability to communicate a decision ? Ability to understand medical circumstances ? Ability to reason about medical circumstances ? Ability to appreciate the medical circumstances ? Ability to remember In Mr. Stoer, the extent of proper informed consent being established can also be questioned. In this scenario, we are told that the patient has lung cancer and multiple organ failure. There was no information regarding the patient's mental health and ability to communicate, understand, and reason with proposed treatment plans. We were just told that the patient was experiencing excruciating pain. This pain experience may have altered Mr. Stoer's ability to communicate his decisions, and his proxy may have to take over. Additionally, it is not stated if his wife is his proxy as she was the one requesting the more extreme pain medication. If neither of these is the case for Mr. Stoer, the physician and medical personnel who administered the higher pain medication may be facing malpractice as they did not obtain proper informed consent before the administration of the medicine. Lack of obtaining informed consent is considered a form of negligence: ? Duty- health care professional did not fulfill their DUTY to treat their patient ? Breach - Proof that physician fell below the standard of care ? Causation - Prove mistake caused further problems ? Damages - The patient experienced issues following the medical care of the physician. If Nurse Travers were found guilty of malpractice due to her actions or lack thereof, the hospital in which Nurse Travers was employed would be held indirectly responsible under vicarious as nurses are employees of the hospital. If the medication itself were determined to be the destructive action performed in this scenario, the MD would be held responsible according to the borrowed servant/captain of the ship. Not only did the physician prescribe the medication, but they also "aggressively insisted" Nurse Travers to administer the pain medication to the patient and even threatened consequences if she did not comply with their orders. Additionally, under the doctrine of respondeat superior, the hospital may also be held accountable for Nurse Travers and the physician's actions. They were both contracted employees of the hospital, and the questioned actions were performed on its property. The hospital may have also violated COBRA if found guilty of knowing that these acts of negligence were taking place on its premise. Final Exam Phil 331, Sec. 2 Due: 11/17 Dalia Gazallo 1. Please design a health care system for the U.S.. Compare it to Biden’s plan and the system of at least one other country that has universal health care coverage. Why is your system preferable to the other systems? (75%) When thinking about designing my healthcare system, there were many factors that I considered. My healthcare system will involve an emphasis on prevention, cost-efficient and affordable healthcare for all individuals, accessibility, and high standards of care. To start off, note that our current healthcare system in the United States is one in which spends the most money, around 16.9% of gross domestic product (GDP), on health care, nearly twice as much as the average OECD country. It also has poor health outcomes, with the lowest life expectancy out of 36 OECD member countries with 78.93 years. Our nation also has the highest suicide rates, adults have the highest chronic disease burden, highest rate of obesity, and highest rates of avoidable deaths. While excelling in prevention measures, they also have the highest rates of hospitalizations from preventable causes such as diabetes / hypertension. To start off, the new healthcare system will have affordable and universal healthcare. Criteria for whether an individual qualifies to receive health insurance will be determined by citizenship and location of care. President-elect Joe Biden’s plan is to protect and build on Obama Care. The Patient Protection and Affordable Care Act was established in 2010 by former President Barack Obama. The goal was to have a healthcare where Americans had access to quality, affordable health care while reducing costs. Trump and his Administration have been attempting to repeal it. The Biden plan to protect & build on the affordable care act includes: I. Give Every American Access To Affordable Health Insurance II. Provide The Peace Of Mind Of Affordable, Quality Health Care And A Less Complex Health Care System III. Stand Up To Abuse Of Power By Prescription Drug Corporations IV. Ensure Health Care Is A Right For All, Not A Privilege For Just A Few Like Biden, my healthcare plan will expand the number of Americans who have secure government coverage, as well as changing/expanding eligibility for Medicaid. Additionally, my healthcare plan will involve great cost reductions for patients. One way will be by preventing health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees. An issue may be that Biden's plan could result in dramatically lowered reimbursements for hospitals, as Medicare generally pays significantly less than commercial insurance. My plan would ensure that this isn’t the case, working closely with the Hospital Insurance Trust Fund. To take a look at a different country, Canada’s healthcare system is administered by the provinces with shared funding between the provincial and federal governments. It is decentralized, universal, and publicly funded mainly by the country’s provinces and territories. All citizens and permanent residents of Canada receive medically necessary hospital and physician services free at the point of use. It is a single-payer system that covers the entire population, while the United States provides Medicare for a limited population (60 and older under Biden’s plan). Excluded services in Canada such as outpatient prescription drugs, dental care, and optometry are covered by private spending (private insurance). Each area receives federal funding and most Canadians have supplemental coverage from for-profit insurers. To specify, Canada operates on a public spending, private delivery system model and further controls spending by negotiating drug prices at the federal level. Hospitals are a mix of publicly owned and private not-for-profit organizations and operate under annual global budgets negotiated with the government. Approximately 70% of spend comes from public funding, 14% from out-of-pocket costs (for items such as prescription drugs, dentals, vision, etc.), and 12% from private insurance. About two-thirds of Canadians have private insurance. Their biggest flaw in their system is the lack of coverage for prescription drugs. Besides that, they are able to manage a cost effective system by limiting supply and investing money, but in return, patients unfortunately have longer wait times. As stated before, Medicare in my health care system will not be based on age and income, but rather citizenship. This allows the entire population across the country to have access to affordable healthcare. My healthcare plan, in addition to hospital and physician services, will also include an insurance plan that includes vision/dental care and prescription drugs as needed. We will follow UHC: Universal Health Coverage ensures: 1. Universal access to health services 2. Health services that are of high quality 3. Receiving health services does not put people at risk of financial harm To stay better organized, the outline of my designed healthcare system is below: 1. Universal Health Coverage The U.S. healthcare system depends on a direct-fee system and private health insurance. Because of this, our country has more health problems, higher health-care costs, and higher rates of uninsured people. My healthcare system will follow WHO’s definition of UHC: Universal health coverage means that all people have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) without the risk of financial hardship when paying for them. This requires an efficient health system that provides the entire population with access to good quality services, health workers, medicines and technologies. It also requires a financing system to protect people from financial hardship and impoverishment from health care costs. Access to health services ensures healthier people; while financial risk protection prevents people from being pushed into poverty. Therefore, universal health coverage is a critical component of sustainable development and poverty reduction, and a key element to reducing social inequities. Because healthcare is a HUMAN RIGHT, determination will not include aspects such as economic status, employment, social worth, and merit. Who would be the one to make these decisions? Who benefits? There can be an unfortunate bias that favors one group of individuals over another. A large gap between those receiving insurance and those who aren’t would take our country in the wrong direction, making it worse than it already is. Additionally, cost plays a big role in healthcare, which is why my design will be maintaining a system that is cost-effective. 2. Insurance by corporate employers Insurance to an individual from an employer is a great benefit to both ends. For the employer/companies, there are tax advantages, reduced operating costs, lower insurance cost, and increased productivity. For a worker, the health benefits that come from insurance will increase their productivity, boost morale, and help create a better environment for the company. Coverage will include mental health resources and consistent check-ups. Additionally, companies will become more attractive and competitive. Coverage will include, to an extent, vision/dental/prescription drugs. 3. Insurance regardless of economic status By providing insurance to individuals based on income/economic status, millions of people are left uninsured and unable to have access to affordable healthcare. Unfortunately, lack of insurance is one of the highest causes of death for ages 55 to 64. In the United States, when comparing uninsured people to insured, insured people have a lower prevalence of chronic disease, lower physical morbidity, and lower mortality rates. Uninsured individuals are barely able to focus on maintaining a “healthy” lifestyle let alone work on prevention because they are too focused on surviving. Instead of doing constant check-ups and physicals, most only attend the doctors when ill or in an urgent situation. Many preventable complications no longer become preventable. My plan will make sure that economic status does not play a role in insurance, like Canada, so that citizens do not have to choose between finances and health. 4. Cost-efficient system Like Canada, hospitals will be publicly funded but will be required to operate under a fixed budget. This system will allow the United States to control its spending, lowering costs and raising quality of care. A current issue in the U.S. is the use of expensive technologies and specialized procedures more often than other countries. It is a tendency to order tests such as an MRI or CT Scan by physicians when highly unnecessary. This is quite costly. It can be agreed that our country is very profit-motivated, yet the budgeting is horrible. Costs for insurance (Medicare) will drop, large pharmaceutical corporations will no longer be able to swim in an economic uprise at the expense of people’s health, and drugs will become affordable. 5. Healthcare coverage includes hospital and physician services; vision/dental/prescription drugs can be covered with an additional insurance that will require higher payment, yet still very affordable The healthcare coverage will include doctors' services, inpatient / outpatient hospital care, pregnancy and childbirth, and mental health services. This effective care is important to have across all populations . Additional insurance can be acquired for vision / dental / prescription drugs, but it will be VERY affordable and through employers if applicable. In terms of employers, the “extras” will be covered to a limited extent. 6. A focus on prevention Preventative healthcare, I think, is one of the most important measures for long-term health. It involves decreasing risk factors and lowering disease/illness complications. Screening tests will be given as needed without too many unnecessary ones. Increasing advocating for lifestyle changes and vaccinations are one way this will occur. It will help reduce medical expenses and reduce chances of illness and premature death. Patients need to be educated on the importance of prevention. Prevention means less medication. Another emphasis will be family history and weight loss. Additionally, more free classes will be implemented to focus on prevention. 7. Similar to Biden’s plan, drug prices will be negotiable with corporations and states A big issue is millions of patients being unable to afford their needed prescription drugs due to high pricing. Corporations are taking advantage of the sick, but with my healthcare system Medicare will be able to negotiate pricing on drugs. Inflation rates will be controlled, and by doing this, pricing will be controlled. Also like Biden, consumers will be allowed to purchase medications and drugs from other countries as long as they are approved by the U.S. Department of Health and Human Services. 8. Insurance companies cannot discriminate because of pre-existing conditions Health insurers are known to deny individuals due to having pre-existing conditions. The reason this occurs is because companies think that individuals with pre-existing conditions are more likely to utilize the benefits of insurers. Morally and ethically, this is completely wrong because it leads to more people being uninsured. Pre-existing conditions such as diabetes, cancer, and asthma can lead to the worsening of those conditions and possible death. This is why caring for those patients and offering them equal insurance is important for their health and our society. 9. Equity & Equality in healthcare There will be absolutely NO discrimination based on race, ethnicity, gender, sexuality, and gender identity. All individuals will be protected in the healthcare system at all times. Premiums will absolutely not be adjusted depending on any of the above because that would be a violation of the 14th Amendment. Health statuses such as past abortions or cases of HIV will not be used against an individual to increase cost or prevent access to care. Reducing health inequities will be one of many primary goals of the healthcare system. My healthcare system is preferable to others because it is cost-effective, applicable to populations anywhere and everywhere, and provides quality healthcare. While it may not be perfect, this system fits best for the United States. Just by providing universal health care access, it is already greater than the current system. It is highly equitable and is in the best interest of its people. There is no such thing as the “perfect” healthcare system. While a country should look out for its citizens by providing the best healthcare possible, it will always have the economy in mind. But my plan allows the economy to thrive while also providing improved healthcare. 2. Please provide an analysis of the ethical and legal issues for one of the following (25%): Evaluating Nurse Travers Before getting into the specifics of the scenario, it would be best to view the overall scope of practice of a nurse, which includes: Assessment ? Systematic collection and analysis of data about a patient Diagnosis ? Based on an evaluation of a patient’s response to health conditions ? How the patient is doing as a person, not just the condition Outcomes / Planning ? Goals may be related to nutrition, movement, stress reduction, and pain management Implementation ? Document in record Evaluation ? Continual evaluation and plan modification ? Make nursing judgments As a nurse, they must use their knowledge through the application of critical thinking, judgment, and skill in order to make ethical decisions. The situation of the patient and their condition needs to be assessed by looking at both the risk of their decision and how the patient will benefit. There are many sides to this situation that need to be considered, and all of them will be evaluated. Malpractice / Standards of Care Malpractice is a specific form of negligence, failure to act toward others with the care a prudent or reasonable person would use in the circumstances, additionally involving actions taken without proper care. In malpractice situation and in court, negligence includes: - Duty: health-care professional had a duty of care to treat him or her Breach: duty of care was breached. Care must be shown to be below the applicable standard of care Causation: Misconduct caused injury to the complainant Damages: Injury caused by the misconduct resulted in harm. That is, there must be a “harmful effect” from the “causation” After initial evaluation of the scenario, one indication that came to mind immediately was that Nurse Travers committed malpractice. Because of Nurse Traver’s refusal of stronger pain medication, Mr. Stoer did not get the pain medication for five hours, the time it took to make alternate arrangements and died soon after administration of the medication. If the cause of death was deemed to be the medication apparently administered by Nurse Travers, even after the physician’s aggressive insistence on giving the prescribed dose, then Nurse Travers has committed malpractice. We are not aware of the alternative outcome, which is what would happen if Nurse Travers listened to the desires of the wife and orders of the physician by giving the prescribed medication. While a physician may seem to have greater authority over a nurse in the healthcare setting, nurses do not work under physicians. It may be difficult to determine what is considered “best care possible”, so it can possibly be said that the standards of care were violated through a breach. The standard of care is based on what a reasonably competent healthcare professional would have done in the same situation This involves determining: - Whether a reasonably competent healthcare professional would have been able to predict the risk of harm; Whether the risk was significant; and Whether a reasonably competent healthcare professional would have taken precautions against the risk. On one hand, it is unclear whether Nurse Traver’s actions were the main causes ultimately leading to the death of Mr. Stoer. What is known is the condition of Mr. Stoer by the nurse, and a nurse with twenty five years would be able to evaluate how the medication could affect the patient while looking at the charts and conditions. Informed Consent Another topic of consideration is informed consent. Legally, this requires that the patient is informed of the risks, benefits, and alternatives to a treatment. A signature on the consent form provides legal documentation of consent. Ethically, consent is about patient autonomy, meaning the patient understands and freely agrees to the treatment. It is difficult to determine the legal and ethical aspects of informed consent due to limitations of information provided in the situation. The only information that could help in determining the relativity of informed consent is the fact that the patient’s wife insisted on stronger medication, but otherwise, further information is needed. It also was not made clear whether or not the wife was her husband's designated proxy. Again, the physician was not physically with the patient, and if the physician knew that the nurse’s decision was based on personal belief, this could have affected his aggressive insistence as well. Capacity of a patient to provide valid informed consent includes: -Ability to communicate a decision -Ability to understand medical circumstances -Ability to reason about medical circumstances -Ability to appreciate the medical circumstances -Ability to remember Hospital Liability Nurses usually are employees of hospitals, which means that the hospital can be held indirectly liable for their actions if they were acting in the scope of the employment relationship. Whether malpractice was deemed to be at the hand of Nurse Travers or the physician who aggressively insisted on the medication and reminded the nurse of the consequences of not following, the hospital would additionally be liable according to the doctrine of respondeat superior, which holds an employer or principal legally responsible for the wrongful acts of an employee or agent, if such acts occur within the scope of the employment or agency. Also, the physician who aggressively insisted that she give the prescribed dose and insisted that failure to do so would have serious consequences for Nurse Travers could be held responsible under borrowed servant/captain of the ship. In the Hansen case, a physician’s testimony was more heavily weighted than the nurse. In the case of Nurse Travers, she would face the consequences of malpractice and not the physician because nurses are have stricter regulations than physicians. Also, the hospital could also be liable under COBRA, a law designed to prevent hospitals from continuing poor practice. Under COBRA, hospitals found guilty of knowing or negligent violations may be suspended or terminated from receiving all Medicare reimbursement. Position to Evaluate Nurse Travers is an experienced nurse, so before diving into her beliefs, note that while Nurse Travers was at the hospital with the patient Mr. Stoer, the physician involved was not. She, based on her judgment and evaluation of Mr. Stoer, believed that the administration of the medication would lead to his death due to his breathing problems. She saw his condition in person and how he was handling it at the hospital. The physician ordered stronger pain medication based on the wife’s insistence, but it is unclear how much background the physician had on Mr. Stoer. Mr. Stoer was also in an extreme pain that recently developed, and most likely needed immediate care. Factoring in that the physician did not have as strong as an evaluation of the patient at the scene as Nurse Travers, it could be argued that Nurse Travers was in the better position to re-evaluate Mr. Stoer’s treatment plan. The utilitarian perspective discusses determining right from wrong by focusing on outcomes. It explains that the most ethical choice is the one that will produce the greatest good for the greatest number. It could be that when viewing the situation from a utilitarian perspective, it may have been best for Nurse Travers to provide her special health services. What also must be looked into is whether Nurse Travers failed to fulfill her duty as a Nurse. Nursing practice is directed towards the goal of assisting clients to achieve and maintain optimal health in order to maximize quality of life across the lifespan. Did Nurse Travers do as such? Did she do everything she could to maximize Mr. Stoer’s quality of life or did she instead prioritize her beliefs in the workforce? Well, she could argue that in her vision, she was attempting to maximize the patients quality of life. In this case, she would not be violating her conscience nor would be minimizing the quality of life, but who is the final determinate of said “quality of life”? Additionally, according to the ARNNL, the decision-making process of a nurse has a new framework that recognizes: - ARNNL’s responsibility to set the parameters for scope of practice decision making to promote safe, competent and ethical nursing practice Registered Nurses’ professional accountability for their own practice Agencies/health authorities responsibility to provide quality health care services in response to client needs, available resources, and internal quality initiatives Another question that could be asked is if the hospital supervisors and staff knew about Nurse Traver’s beliefs and made arrangements so she is not forced to violate her conscience, rearrangements could have also been made so that Nurse Traver’s does not have to choose between her beliefs and what may truly be best for Mr. Stoer. Again, because Nurse Travers was physically present and might have believed her revaluation was the best treatment plan for Mr. Stoer, this could have been the best decision at the time. A combination of those client needs and internal quality initiatives could be enough to side with Nurse Travers. In the Tuma case, a nurse got her license suspended for six months by interfering with the physician-patient relationship and thereby constituting unprofessional conduct. It was done through the means of talking in private to a patient and thereby allegedly suggesting alternative treatment. This is a situation very similar to that of Nurse Travers ANSWERS Nursing Nurse Travers has been working at the hospital for 25 years, so she must have seen the worst and best scenarios of daily patients. It is interesting that the hospital has been okay with her working there despite her religious views. However, according to the NCSBN and ANA, the definition of nursing is very inclusive and vague, and focuses more on the ability of nurses to care for the patients than the nurses themselves. For example, none of the definitions of nursing discuss the circumstances in which improving the “quality of life” contradicts conscience. So, it leaves the question, did nurse Travers not fulfill her duty as a nurse because she had the ability to improve the quality of life of the patient? Some would argue that she did fulfill her duty as a nurse because even though she is not a physician, she has 25 years of experience and Nurse Travers has seen a lot of patients with varying conditions. So, when deciding that she shouldn’t administer the medication to the patient, she may have had a point because she noted that the patient had breathing problems. It is unclear to say that the physician was there at that exact moment, but one can argue that the nurse had a better perspective of the patient at that moment of severe pain. Also, nurses have an independent legal duty to the patient, so it is unclear that Nurse Travers had the knowledge on whether or not the physician got informed consent from the patient on whether the patient should be treated or not. Additionally, the concept of malpractice can be an issue here because malpractice constitutes duty, breach, causation, and damages. Since nurses are independent of physicians, one can argue that giving the patient the medication could be considered breach because she knew that the patient has breathing problems and still administered the medication. In regard to causation and damage, it is unclear if the nurse’s actions are the cause of the suffering which resulted in the death of the patient. However, if the concept of malpractice is threatened upon the nurse, it questions who is responsible, the hospital under the vicarious liability or the physician under the borrowed servant/captain of the ship? Furthermore, nurses are said to have stricter regulations than physicians. This is seen in the Hansen case where it was proved that a physician’s testimony held heavier weight than a nurse. However, as seen in the Tuma case where a nurse was in a similar situation as Nurse Travers, the nurse was found guilty for unprofessional conduct and interfering with the physician/patient relationship for suggesting and acting on the idea that the patient could have another alternative instead of chemo. In regard to the Lundsfords case, where the nurse lost their license for failing to assess the patient and still transporting them, it is unclear if Nurse Travers assessed the patient, but Nurse Travers did say that the patient had breathing problems. In relation to this case, if Nurse Travers had given the medication and the patient died then and there, Nurse Travers could be sued for unprofessional conduct. Clinical trial Clinical trials have been an ongoing case for many years now. Statistics show that there are 40k clinical trials per year and is still increasing by 10% every year. This can be seen as a good or bad thing. Good because the human race is being more innovative but bad because it can be seen as taking advantage of humans. In this scenario, one can argue that Dr. Ames is taking advantage of the situation in Alabama where there are traces of lead in the water. Interestingly, it just so happens that Dr. Ames has a company called TreatLead where the mission was to investigate the value of a new treatment for lead in blood. This can be seen in two perspectives: Dr. Ames is genuinely concerned about the well-being of humans OR Dr. Ames is attempting to market his new company and taking advantage of the less fortunate. The Tuskegee study showed that unhealthy people are more desperate for treatment than those that are healthy. Being that officials are saying there is lead in the waters of Alabama, will cause problems in the community and many will look for help. In this case, Dr. Ames perfectly timed his clinical trials. However, it is unclear on what Dr. Ames true intentions were but anyone and everyone has a “right to try”. In regard to the Nuremberg code that originated from the trials held in Germany and the Belmont report which emphasized that research subjects deserve respect, safety, and informed consent, along with beneficence and justice, it also emphasized that subjects must volunteer, and suffering should be minimized. Again, Dr. Ames’s true intention is unknown but saying that he strongly encouraged the parents of Sonja seems to be suspicious as opposed to them volunteering. The parents also do not have medical insurance, which makes them more inclined to try this clinical trial hoping it will be useful. Also, the clinical trial provided “financial compensation” so even though the parents may have volunteered, it is unclear if they volunteered because they were worried about the issue or if they didn’t want to pass up the deal. There are several types of clinical trials separated into phases. Phase I deals with safety and dosage use, Phase II deals with effectiveness with a small number of participants, and Phase III (if Phase II is successful) deals with a larger number of participants. According to the scenario, Sonja has been informed that she has a blood disorder. It is unclear whether or not Sonja obtained the blood disorder from the clinical trial or from biological imbalance. Regardless, Phase III should not have proceeded due to the incident that Sonja developed, but it is unclear whether or not Dr. Ames proceeded to move on from Phase III. In regard to ethical issues, the conflict of interest still remains unclear with Dr. Ames. As a physician Dr. Ames may have interest in research which is explained by the ownership of the drug company however, that is not stated. If he does not have any interest, and Dr. Ames strongly encouraged the parents, it would be considered unethical. Sonja found out that the research arm that was given to her showed no medical benefit. This questions whether or not it was ethical to give her a placebo knowing she was sick. Furthermore, it is unclear on whether or not Dr. Ames signed a consent form regarding continued treatment. The Abney case showed that if the company did not sign the consent form then there is no obligation to continue to administer the drug to the patient. Lastly, in regard to the Grimes V Kennedy Kreiger institute, they found that research of a child must be beneficial to them, if not then you cannot sign your child up for nontherapeutic studies. However, in this scenario the research is considered to be therapeutic so it is acceptable. Confidentiality A physician has the obligation of competent treatment, informed consent, and maintain confidentiality. The doctor had demonstrated competent treatment and informed consent. It is unclear that the doctor received informed consent, however, it is a family doctor and it was a yearly examination, so the patient must have had to make the appointment and know what he was going in for. However, the physician did breach confidentiality. A physician may not disclose any information regarding a patient to anyone besides the patient. In a Utilitarian sense, it makes sense to keep confidentiality to maintain patient/physician relationship. If this was violated, then patients would not see doctors and doctors could not practice medicine. In a Deontological sense it is important to maintain confidentiality out of respect of the patient. There are two types of privacy, conduct privacy and information privacy. Conduct privacy is associated with cases such as Roe v Wade, Griswold, and Quinlan case, where the right to make their own decisions about contraception and pulling the plug was crucial. Information privacy is associated the right to control how information is disseminated. This scenario and the Whalen v Roe case are examples of this. One can argue that the relationship of the patient and fiancé is fairly strong, however, the chances of them ending up being married may be high or low, it is unclear. Being so, the physician shouldn’t have thought about informing the fiancé. According to HIPPA, your medical information is your property, but the records belong to the individual whom made the medical record. However, this is different in every state and it is unclear what state the patient is in. Exceptions to confidentiality include waivers, court applied psychotherapist, public interest, and a report of violence wounds/ abuse. It is unclear if the patient signed a waiver for the information to be disclosed but for this situation, it is assumed it was not signed, so the physician shouldn’t disclose the info. Additionally, one can argue that a physician has a duty to warn. This is represented by the Tarasoff v UC case, where a school failed to warn an individual that they were in threat and ended up dying. The school lost the case because in a threat of violence, they have the right to disclose the info. However, in this case, it is unclear if the patient was threatening the fiancé for unprotected sex or any threat for that matter. Additionally, since Hep C is a very infectious disease, it is an endangerment to the community if one has it and does not disclose. The patient here has a fiancé so there is a risk of transferring the disease. In the Reisner v UC, a girl acquired HIV via blood transfusion and gave it to her BF and both died of AIDS. The physicians had a duty to the boyfriend to tell the girl and her parents that she had HIV. However, the girl did not know she had acquired the disease. In this case, the patient knows that he has Hep C, so it is possible that he could have unprotected sex and pass on theHep C the his fiance, therefore the physician has a duty to warn.