Final Case: Health Care Ethics
Reason for the Case
The primary question regarding the case is to justify whether or not it is fair to deny anatomical gifts to someone who abstains from donating his or her own organ or tissue.
Summary of the Case
One of the representatives of the state of California prosed a law that aims to increase the organ and tissue donors in the state. This is due to thousands of patients who are waiting for organs, but the actual citizens who are willing to donate may not be sufficient to address the needs for tissue and organ transplantation. According to the draft bill, an organ procurement program will be enacted giving the chance to many patients to receive the needed organs or tissues. By doing so, all citizens who will participate in the said program, by making themselves donors, will also have the chance to receive the organ donations in the future if they will be in a life-threatening situation. The proposed law presumes that all citizens of California are donors, as it is looking forward to promoting a common good across the people of state.
On the other hand, citizens who will be participating in this program will not have the chance or will not be allowed to receive organ donation if they will be needing it in the future. This is bureaucratic mechanism may force many people to become organ donors, otherwise they might suffer from not becoming a donor recipient if they might need it in the future. Generally, the proposed law aims to increase the people citizenry by helping each other out survive through becoming an organ donor for others’ survival.
The proposed bill was opposed by the second state representative due to the exclusion of citizens, who opt not to become donors themselves, to receive organ tissue donation in the future. The opposing argument states that every person should have the equal access to organs and tissues and the law should not put barriers on this claim. Perhaps, the second representative believes that creating a law that will not allow them to receive organs and tissues in the future violates the equal access to health care services. Thus, these people who opt not to donate their organs may change their minds in the future.
Furthermore, the proposed bill was also opposed by another representative, saying that the draft bill provides limitation that only the documented visitors of California and the state citizens are covered by the program. The representative stated that there is no provision stated in the bill that will benefit the people who have issues with their insurance policies. Additionally, it could promote sexism and racism due to such limitation. With these opposing arguments by the two representatives, it is quite impossible for the bill to be enacted. That is why, ethicists must provide recommendations in relation to the draft bill’s (a) the opt-out clause, (b) the exclusion clause, and (c) allocation.
Relevant Ethical Principles and Theories
Autonomy is one of the relevant ethical principles of the case. By definition, autonomy refers to the people’s capacity to determine their own rules and laws (Devettere, 485). Autonomy also respects every person’s social uniqueness. Thus, there should be a freewill in connection to the person’s choices. The term patient autonomy means that any health care professional must not provide treatment the patients without obtaining the patient’s consent. The principle of autonomy is also relevant to the case in terms of the exclusion clause of the proposed bill. Autonomy, as it relates to the health care ethics, aims to enable the person or patient’s choice when it comes to deciding for himself. After all the necessary information has been provided, the health care professional’s next action must be based on the patient’s decision.
The informed consent principle defines an idea that represents the patient’s right to accept or decline any medical procedures. In this case, an informed consent is an essential and relevant ethical principle due as it holds characteristics that can be used for the case analysis.
Justice is another ethics principle that is relevant to the case. This principle is defined as the health care professionals practice to be as fair as possible across all of the patients. This is in terms of offering effective treatments as well as allocating limited medical resources. Based on the definition of this ethical principle, the health care professionals must provide equal allocation of resources across all patients. Therefore, this principle is also relevant to the case due to its characteristics. Exclusion, according to the case, will disable other person’s access to the treatment that others could get. The justice principle can also be used to analyze the case’s issue in relation to the non-availability of treatment of other people. The idea of justice as an ethic principle is also relevant to the case. In addition to the previous definitions of Justice, the health care professionals must also be able to justify the actions that took place in relation to the provision of treatment option for all people. There should always be fairness between the provider and receiver of heath care, such as the donor and receiver of organs and tissues.
Beneficence is a concept in health care ethics that aims to provide only good actions towards the patients. It emphasizes the idea that health care professionals must always practice beneficence. This principle holds various elements, such as prevention of harm or evil, one must remove evil in every action, and to always practice “good”. In this case, excluding the abstaining citizens from becoming organ recipients opposes the idea of this principle.
Analysis
The relevance of the autonomy on the case is based on the draft bill’s provision about the opt-out mechanism. Based on the case, there will be a bureaucratic approach that will be used to individuals who will not join the Universal Anatomical Gift Procurement. In this case, the government may seem to be controlling the decisions of the people. It somehow violates the people’s freewill as to whether or not to become a donor. The relevance of the principle is that the people’s freedom to choose whether or not they will abstain from being an organ donor will directly affect their future access to health care, specifically if they will need a donor for themselves. Although they are free not to become a donor, there is a potential adverse effect in the event if they will need an organ or tissue donor in the future.
Informed consent plays a role in this case, although the deceased person is aware that his organ will be donated after his death, the persons on his behalf should also be informed about the impending organ transplantation. It is possible that the organ transplant may proceed without any violation of the law (given that the draft bill has been enacted) especially if the deceased person participated in the organ procurement program and signed up for this government program. However, the procedure could be more ethically acceptable if the family or persons on behalf will be informed prior to proceeding with the organ transplantation.
The relevance of justice in the case is that there should be a fair treatment across all patients. Although the opt-out mechanism clause recognizes the cultural sensitivity of the society, such as the religious groups, and individual preferences, it could violate the principle of justice as it does not recognize the other people’s choice. Therefore, it only highlights the benefit of the opt-out mechanism for those who will not abstain from being a donor. In definition, Justice tells the notion of providing equal allocation of scarce resources across all patients. Thus, the case shows that if passed, the bill will only allow the non-abstaining persons to receive the anatomical gifts, which violates the idea of Justice. On the other hand, this principle’s idea can be obtained by allowing all citizens to receive such gift especially during the time of life and death situation, regardless whether they are participating with the Universal Anatomical Gift Procurement or not. On the other hand, citizens will be allowed to reverse their previous decision of abstaining from being a donor by submitting the 52E form, which somehow follow the rule of justice principle. The only relevant ethic principle that can be used to analyze the case based on the allocation clause of the bill is the principle of justice. According to the case, there have been some forms of injustice that the bill proposes. One good example is the lack of proper funding for persons who are uninsured, under-insured, and insufficiently insured as well as the bill’s limitation to documented visitors and California citizens only.
The relevance of beneficence according to the proposed bill is that citizens who opt not to donate their organs will not be entitled to receive the anatomical gift. This could be a practical idea to increase organ donors, but it violates the core principle of beneficence, which is to always remove evil in every action and to always practice only the good ones. If an abstaining citizen would be in a critical stage that needs to have an organ transplantation and was not given the chance to have it, then the process is not good at all.
Recommendation
A bureaucratic approach can be applied to the drafting of the bill, but Representative Smith must consider the autonomous decision-making of the people if they want to be a donor or not. This will give them the choice without being forced by the government.
Although the deceased person opt to donate his organ when he still alive, the health care professional must still seek consent from the person’s family or representative. This will allow the health professionals to exercise ethical behavior when it comes to their practice and prior to harvesting an organ or tissue. The people’s choice as to whether or not they will receive an organ in the future should not be based on the decision not to participate in the donor procurement. The proposed bill must respect their decision and should not provide any unwanted effects such being excluded from being an organ recipient.
Generally, it is recommended to have a public consultation apart from seeking advice from an ethicists in order to hear the public’s opinion about the proposed bill. Relatively, citizens must not be excluded from being an organ recipient as it violates the principle of justice. It is recommended that abstaining citizens must be able to change her mind without submitting Form 52E. There must be an equality in every clause of the bill. Proper funding must be planned accordingly in order to serve other citizens who are uninsured, under-insured, and insufficiently-insured. In order to achieve this, Representatives may consider allowing non-California citizens to receive an organ donation for a fee. In that case, it will cover the allocated funds that will benefit the citizens who lack insurance to avail the organ procurement program.
It is recommended that the proposed bill should include conditions that allow the abstaining citizens to receive organ donations even on the last minute, especially if it is a life and death situation. The bill should not be very strict when it comes to limiting the opportunities of citizens to receive organs even if they do not participate to the proposed organ procurement program. This is to endure that health care professionals do not violate one of the major ethical principles in health care.
Works Cited
Devettere, Raymond J. Practical Decision Making in Health Care Ethics: Cases and Concepts. Washington: Georgetown UP, 2010. Print.
