(Student’s Full Name)
Introduction
“meeting the health needs of all persons, viewed as free and equal citizens, is of comparable and special moral importance” –Justice and Access to Health Care, Norman Daniels
The above statement expresses the sentiments of persons who concur with the idea that there should be universal access to healthcare. The concept of distributive healthcare prevents this from taking place since it subjects persons to a screening process to determine their eligibility for certain types of healthcare. Additionally, distributive healthcare also promotes discrimination of persons, even substance abusers, in need of dire care at hospitals and health centers. Indeed it can be argued that although twenty-five cents of every healthcare dollar goes towards treating lifestyle diseases, while individuals engaged in unhealthy habits, such as substance abusers, contribute a fraction of the cost of treatment, distributive justice should not be used in the treatment of American substance abusers because genetics, ethnicity, and socio-economic background are significant considerations when treating persons with substance abuse, and one cannot hold someone responsible for genetic predispositions, and subject such a person to discrimination.
Definition of Distributive Justice in Healthcare and Issues Concerning Distributive Justice in the American Healthcare System
According to Drs. Beauchamp and Childress, who developed the four principles of Biomedical Ethics, distributive justice in healthcare refers to the just or fair distribution of healthcare benefits in a society (330). Beauchamp and Childress explain that societies use a variety of factors as criteria for practicing distributive justice, as indicated by the following: to each person an equal share; to each person according to need; to each person according to effort; to each person according to contribution; to each person according to merit and to each person according to free market exchanges.
Dr. Merrill A. Cohen argues that when the question of distributive justice arises then the scarcity of resources becomes an issue (par. 14). Cohen posits that when the cost is contained by the rationing of resources then some persons are denied potential healthcare benefits against their wishes (par. 14). She explains that this is an abuse of power. However, in the case of the American healthcare system, it has not been verified that there is yet a need for the rationing of healthcare services (Cohen par. 14).
Claire Andre, Manuel Velasquez, and Tim Mazur reveal that alcohol abuse costs the American healthcare system $85.8 billion in 1988 (par. 1). Cigarette smoking costs the American taxpayer $65 billion each year (par. 1). Andre, Velasquez, and Mazur mention that critics of the U.S. healthcare system argue that most of the healthcare costs are used to treat diseases or conditions that could be avoided through a change of behavior or lifestyle (par. 2). The opponents of the American healthcare system argue that most of these costs are borne by persons who do not have diseases that are affected by a lifestyle change (Andre, Velasquez & Mazur par. 3). They are paid for in the form of insurance premiums, disability benefits, and government expenditures for healthcare (Andre, Velasquez & Mazur par. 3). Consequently, lawmakers, insurers, and employers are advocating for policies that would lead to the redistribution of expenses to persons who choose to engage in behaviors and lifestyles that endanger their health, such as drug abusers (Andre, Velasquez & Mazur par. 3). Therefore, it can be argued, in respect of the American healthcare system, that (according to the critics of the U.S. healthcare system) the rationing of services should occur when persons who engage in behaviors that adversely affect their health. In addition, critics of the American healthcare system contend that such persons should be denied certain benefits when they are unable to sufficiently cover the cost to do so.
Nevertheless, proponents of the American healthcare system argue that if the critics of the U.S. healthcare system were to have their way then this would potentially place ethnic minorities and those from a lower socio-economic bracket at a disadvantage. This is significant point which should be recognized considering the fact that an estimated “43 million Americans” lack healthcare coverage (Putsch & Pololi 46). Therefore, this means that persons living at and below the poverty line lack the financial resources to cover their health expenses. In addition, out of all the 29 OECD countries, only the United States, Mexico, and Turkey have not implemented policies to facilitate universal health coverage (Putsch & Pololi 46).
Furthermore, there are other issues which should be considered when treating persons dealing with substance abuse, for instance. One of these issues includes genetic predispositions, and studies have confirmed that persons who have a family history of substance abuse will become an abuser themselves.
Racial/Ethnic Discrimination and Substance Abuse Treatment in America
According to Alexandra Shields in her article, “Ethical Concerns Related to Developing Pharmacogenomic Treatment Strategies for Addiction,” although the United States government intends to implement strategies for the elimination of health disparities, the field of substance abuse treatment has been more successful in documenting disparities in treatment rather than eliminating them (32).
Moreover, a study conducted by Laura Schmidt and Nina Mulia confirmed that minorities in the United States experience discrimination when receiving treatment for substance abuse (par. 3). The treatment that they receive is inferior to that received by Caucasians (par. 3). These researchers argue that minorities have more “complex treatment needs” compared to their Caucasian counterparts (Schmidt & Mulia par. 12). Schmidt and Mulia explain that these “complex treatment needs” are connected to the stress of racial discrimination, to the difference in behaviors of persons who have substance abuse issues and are minorities, and the “effects of acculturation” (Schmidt & Mulia par. 12). These researchers also confirm that even public authority figures are more readily responsive to persons who have substance abuse issues and are minorities than to those who are of a Caucasian background.
Furthermore, findings of research conducted by Wells, Klap, Koike and Sherbourne demonstrated that there was less access to care, poor quality of care, and greater unmet need for substance abuse treatment for Hispanics and African Americans in comparison to Caucasians (2030). The researchers observe that the percentage of those with unmet need for treatment for substance abuse was twice as high for African Americans as for whites (Wells, Klap, Koike & Sherbourne 2030). Moreover, Wells, Klap, Koike and Sherbourne demonstrate in their empirical study that the percentage of those in need who were recipients of on-going treatment for substance abuse was nearly “50% less for Hispanics than for whites” (2030).
In a research study conducted by Acevedo et al., revealed that Hispanics reported lower satisfaction with care for “substance use disorders” compared to Whites (2). Additionally, it was acknowledged that there was lower satisfaction with treatment for persons suffering with alcoholism by Hispanics and African Americans compared to Caucasians in a “randomized clinical trial” (Acevedo et al. 2). Furthermore, it was noted that ethnic minorities tend to have lower treatment retention rates compared to the White counterparts (Acevedo et al. 2). This point is significant to note because it illustrates the quality of care that is being provided to the patient since treatment retention and retention rates are linked to “better treatment outcomes” (Acevedo et al. 2).
The principal findings of a study conducted by Erick Guerro, Jeanne Marsh, Lei Duan, Christian Oh, Brian Perron and Benedict Lee verify that African Americans and Latinos were less likely to complete treatment compared with Whites (1450). The study also arrived at the conclusion that “service factors” were instrumental in enabling Hispanics and African Americans in completing treatment programs (Guerro, Marsh, Duan, Oh, Perron & Lee 1450). The term “service factors” refers to referral from the criminal justice system or a social worker (Guerro, Marsh, Duan, Oh, Perron & Lee 1450).
The Role Socioeconomic Background Plays in the Distribution of Healthcare when Treating Substance Abusers in America
According to P.J. Veugelers and A.M. Yip, poor lifestyle habits are usually documented amongst those who are a part of a low socio-economic bracket (424). On the contrary, those who a part of the higher socio-economic groups are more likely to take advantage of preventative health services, such as regular medical check-ups (424). Furthermore, it was noted by the researchers that financial barriers to health services may perpetuate “existing socioeconomic disparities” in the healthcare system (Veugelers & Yip 424). Veugelers and Yip explain that persons who are of a lower socio-economic background are not in the position to pay for costly medical insurance and health services.
A significant point to note is that in America there is no access to universal health care; and, consequently, impoverished persons in the US rely on safety net programs offered by the State to cover their health costs. Hence, it is important to note the impact of the Patient Protection and Affordable Care Act (PPAC), which is popularly known as Obama Care, of allowing American citizens to gain access to affordable, quality health insurance. This Act was signed into law by President Obama on March 23, 2010, and upheld by the Supreme Court on June 28, 2012 (obamacarefacts.com par. 4). Consequently, millions of persons who were unable to access quality medical insurance are now able to do so with the passing of PPAC or Obama Care. This means that individuals who are coping with substance abuse disorders are now able to pay for required medical services if they opt to take advantage of the benefits provided by the Act.
On the other hand, it should be noted that in the U.S. patient physician care relations are significantly affected if an individual comes from a lower socio-economic bracket. According to a report done by R. Osborn, C. Schoen, P.T. Huynh and A. Holmgren, a person who earns a low income has unsatisfactory experience with his physician compared to a patient who earns a high income (par. 7). This makes the situation in America concerning patient-physician relationship unique when compared to other developed countries, such as New Zealand, Australia, Canada and the United Kingdom (Osborn, Schoen, Huynh & Holmgren par. 7). The report also revealed that compared to findings from other developed countries, low income adults from the United States were most likely to have difficulty receiving treatment on weekends or holidays without going to the emergency room (Osborn, Schoen, Huynh & Holmgren par. 12). The study noted that persons earning a low-income were more likely to go without treatment because of costs compared to individuals from a similar socio-economic background in selected developed countries (Osborn, Schoen, Huynh & Holmgren par. 13). Osborn, Schoen, Huynh and Holmgren noted that low-income adults in America were more likely to report duplication of medical tests when compared to adults in similar economic circumstances in the United Kingdom, Canada, Australia and New Zealand (par. 14). The report mentioned the fact that persons of a lower socio-economic background in the United States were more likely to rating their physician’s performance as being fair or poor compared to low-income adults living in New Zealand, Australia, Canada and the United Kingdom (par. 15). It is also significant to note that the researchers observed that the United States was distinguished for “pervasive disparities” by income (Osborn, Schoen, Huynh & Holmgren par. 17). The study noted “wide gaps” between the experiences of individuals in the U.S. from a higher socio-economic background at health facilities compared to individuals from a lower socio-economic background (Osborn, Schoen, Huynh & Holmgren par. 17). The low-income adults, most often than not, reported negative experiences when compared to high-income adults in the United States (Osborn, Schoen, Huynh & Holmgren par. 17). However, it should be noted that the U.S. led the other countries in the use and implementation of preventative health measures. Nevertheless, as mentioned previously, persons from a high socioeconomic group are able to access these services they are usually costly.
The above information has serious implications as it pertains to the issue of distributive justice in healthcare for American substance abusers. It indicates that social discrimination in the healthcare system is a serious impediment for American substance abusers who are in need of adequate care and treatment. Shields notes in her study poor substance abusers are among the “most stigmatized” individuals in society (33). This stigmatization and discrimination may pose a psychological hurdle for those persons who desire to seek treatment for substance abuse disorders. The studies mentioned imply that healthcare resources will not be fairly or justly allocated to substance abusers who are of a low socioeconomic background. Hence, this goes against the four principles of Biomedical Ethics, which were advocated by Beauchamp and Childress. Therefore, the American healthcare is operating with a serious flaw which prevents it from providing high quality healthcare to its citizens in stark contrast to other developed nations.
Genetics and Treatment of Substance Abuse Disorders in the United States
Shield indicates in her study that “genetically guided treatment” has been incorporated into routine medical practice in specialized fields, such as oncology (34). She argues that “genetically guided treatment” can prove to be effective in treating persons who have problems with nicotine dependence and addictions to alcohol and drugs, such as cocaine (34). The researcher explains that research in pharmocogenomics reveal that gene variants which have been implicated in nicotine dependence have been connected with increased risk of being addicted to alcohol and cocaine (34).
Shield contends that pharmocogenomics treatments be used to treat substance abuse disorders for so-called undeserving populations, such as minorities and the poor (34). She argues that pharmocogenomics research can allow a physician to match a substance abuser to the “optimal choice of medication” (34). She posits that persons who have been “‘systematically disadvantaged’” by the American healthcare system be given the equitable access to the opportunity of being treated with pharmocogenomics treatments (34).
Reasons Indicating Why Persons who are Systematically Disadvantaged Should Enjoy Equitable Access to High Quality Health Care
Andre, Velasquez, and Mazur posit that socioeconomic factors often influence the behaviors of low income persons (par. 7). These factors can include inadequate income or lack of education (Andre, Velasquez, & Mazur par. 7). They argue that persons may choose to abuse substance in order to deal with the stress of being poor (par. 7). They posit that advertising and peer pressure when lead one to have substance abuse disorders. When that individual becomes addicted to a substance, such as cocaine, it would be difficult from them to stop abusing the drug (Andre, Velasquez, & Mazur par. 7). This is because the person’s capacity to stop abusing a substance becomes hampered by the neurological, physiological, and psychological factors connected with addiction (Andre, Velasquez, & Mazur par. 7). In addition, studies have verified the fact that most individuals have a genetic predisposition to drug abuse. Therefore, to penalize an individual financially or otherwise for having a substance abuse disorder, in essence, is blaming the person for the addiction without having a complete understanding of the causes of substance abuse.
Conclusion
In conclusion, distributive justice in health care for substance abusers living in America is not practiced because of factors related to racial and social discrimination. In addition, poor policy-making on the part of U.S. Government officials is also a contributing factor because to date a universal healthcare system has not been implemented by the American government. This is in stark contrast to most developed countries in the world. Furthermore, there is a necessity for American citizens, who suffer from drug addiction, to receive equitable access to treatment. Critics of the present healthcare system need to be made aware of the causes of substance abuse and the best methods of treating substance abuse disorders. Proper education and awareness of the issues related to substance abuse will ensure that addicts will not face discrimination and receive equitable access to high quality healthcare.
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