SU Biomedical Ethics Healthcare System Curative Services & Chronic Illnesses Essay
I’m working on a philosophy multi-part question and need a sample draft to help me understand better.
- 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%)
- Please provide an analysis of the ethical and legal issues for one of the following (25%):
The instructions plus examples of well written essays for the class are attached.
I posted the PDF with the instructions to the essay. I also added two examples of essays that scored well if you wanted to use that as reference or reword. I also attached the answers to question number two that you can also look at and reword. There are not any specific page numbers or format specified. It will be good as long as it has all the information necessary with good info.
Question 1 has multiple parts to it. If you are ever in need of a good example of what our teacher is expecting in terms of content, please look at the examples of finished essays for reference. Again, thank you so much and keep me updated :).
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
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.
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
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.
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.
