Question

1. Should there be a right to healthcare? If so, how much should be provided? In your answer, you must discuss the concepts of negative and positive rights and you must explain which bioethical principles you are using to justify your position.

2. It is generally accepted that autonomy should be followed when end of life care decisions are made; however, some bioethicists have challenged this, stating that there are some situations when the patient's autonomy should be overruled. Discuss these situations and argue for (or against) each situation from an ethical standpoint.

Answer 1

1- Health is a fundamental good necessary for human flourishing and health care is a fundamental human right. Because health care, at its best, promotes and sustains human health, society is obligated to provide access to basic quality health care for all its members.”

Understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information

Article 25 “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”

The place of principles in bioethics

Ethical choices, both minor and major, confront us everyday in the provision of health care for persons with diverse values living in a pluralistic and multicultural society. In the face of such diversity, where can we find moral action guides when there is confusion or conflict about what ought to be done? Such guidelines would need to be broadly acceptable among the religious and the nonreligious and for persons across many different cultures. Due to the many variables that exist in the context of clinical cases as well as the fact that in health care there are several ethical principles that seem to be applicable in many situations these principles are not considered absolutes, but serve as powerful action guides in clinical medicine. Some of the principles of medical ethics have been in use for centuries. For example, in the 4th century BCE, Hippocrates, a physician-philosopher, directed physicians “to help and do no harm” (Epidemics, 1780). Similarly, considerations of respect for persons and for justice have been present in the development of societies from the earliest times. However, specifically in regard to ethical decisions in medicine, in 1979 Tom Beauchamp and James Childress published the first edition of Principles of Biomedical Ethics, popularizing the use of principlism in efforts to resolve ethical issues in clinical medicine. In that same year, three principles of respect for persons, beneficence, and justice were identified as guidelines for responsible research using human subjects in the Belmont Report (1979). Thus, in both clinical medicine and in scientific research it is generally held that these principles can be applied, even in unique circumstances, to provide guidance in discovering our moral duties within that situation.

Four commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress (2008), include the:

1. Principle of respect for autonomy,
2. Principle of nonmaleficence,
3. Principle of beneficence, and
4. Principle of justice.

Positive rights, by contrast, obligate you either to provide goods to others, or pay taxes that are used for redistributive purposes. Health care falls into the category of positive rights since its provision by the government requires taxation and therefore redistribution.

1. Respect for Autonomy
Any notion of moral decision-making assumes that rational agents are involved in making informed and voluntary decisions. In health care decisions, our respect for the autonomy of the patient would, in common parlance, imply that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act. This principle is the basis for the practice of "informed consent" in the physician/patient transaction regarding health care. (See also Informed Consent.)

2-
These issues include patients' decision-making capacity and right to refuse treatment; withholding and withdrawing life-sustaining treatment, including nutrition and hydration; "no code" decisions; medical futility; and assisted suicide.

While one does not take precedence over another, the concept of autonomy or self-rule has become the basis of patient decision making. Respecting autonomy allows patients to make decisions that are in their best interests, as they are usually the best judges of those interests.

The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients' Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex.

When harm to others is sufficiently grave, it overrides the principle of autonomy. In some cases, the team may not be able to fully respect autonomous decisions. Furthermore, autonomy is limited when its exercise violates the physician's/healthcare team's medical conscience.

Autonomy is partly protected in medical law through the concept of informed consent. Before any treatment is given or procedure performed on a patient, she must, if competent, give consent.

Competent patients have a right to refuse treatment. This concept is supported not only by the ethical principle of autonomy but also by U.S. statutes, regulations and case law. Competent adults can refuse care even if the care would likely save or prolong the patient's life.

Altered mental status: Patients may not have the right to refuse treatment if they have an altered mental status due to alcohol and drugs, brain injury, or psychiatric illness. 6 Children: A parent or guardian cannot refuse life-sustaining treatment or deny medical care from a child.

5 Common Ethical Issues in the Workplace

• Unethical Leadership. Having a personal issue with your boss is one thing, but reporting to a person who is behaving unethically is another. ...
• Toxic Workplace Culture. ...
• Discrimination and Harassment. ...
• Unrealistic and Conflicting Goals. ...
• Questionable Use of Company Technology.

Ethical dilemmas are situations in which there is a difficult choice to be made between two or more options, neither of which resolves the situation in a manner that is consistent with accepted ethical guidelines. ... Explore ethical dilemma examples to see how you might handle these difficult situations.

Dealing with unethical behavior in the workplace

1. Do your research. It's important to determine if your colleague is breaking your employer's policy. ...
2. Document the unethical behavior. It's important to document what your colleague did and when. ...
3. Approach your colleague. It's important to approach your coworker in a calm manner. ...
4. Speak to management.