Philosophy of healthcare
The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component of human social structures. That is, the societal institution of healthcare can be seen as a necessary phenomenon of human civilization whereby an individual continually seeks to improve, mend, and alter the overall nature and quality of their life. This perennial concern is especially prominent in modern political liberalism, wherein health has been understood as the foundational good necessary for public life.
The philosophy of healthcare is primarily concerned with the following elemental questions:
- Who requires and/or deserves healthcare? Is healthcare a fundamental right of all people?
- What should be the basis for calculating the cost of treatments, hospital stays, drugs, etc.?
- How can healthcare best be administered to the greatest number of people?
- What are the necessary parameters for clinical trials and quality assurance?
- Who, if anybody, can decide when a patient is in need of "comfort measures" ?
Ultimately, the purpose, objective and meaning of healthcare philosophy is to consolidate the abundance of information regarding the ever-changing fields of biotechnology, medicine, and nursing. And seeing that healthcare typically ranks as one of the largest spending areas of governmental budgets, it becomes important to gain a greater understanding of healthcare as not only a social institution, but also as a political one. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems; be it nurses, doctors, allied health professionals, hospital administrators, health insurance companies, the government, and lastly, the patients themselves.
Image:Lyndon_Johnson_signing_Medicare_bill,_with_Harry_Truman,_July_30,_1965.jpg|thumb|300px|President Johnson signing the U.S. Medicare bill. Harry Truman and his wife, Bess, are on the far right.
Ethics of healthcare
The ethical and/or moral premises of healthcare are complex and intricate. To consolidate such a large segment of moral philosophy, it becomes important to focus on what separates healthcare ethics from other forms of morality. And on the whole, it can be said that healthcare itself is a "special" institution within society. With that said, healthcare ought to "be treated differently from other social goods" in a society. It is an institution of which we are all a part whether we like it or not. At some point in every person's life, a decision has to be made regarding one's healthcare. Can they afford it? Do they deserve it? Do they need it? Where should they go to get it? Do they even want it? And it is this last question which poses the biggest dilemma facing a person. After weighing all of the costs and benefits of her healthcare situation, the person has to decide if the costs of healthcare outweigh the benefits. More than basic economic issues are at stake in this conundrum. In fact, a person must decide whether or not their life is ending or if it is worth salvaging. Of course, in instances where the patient is unable to decide due to medical complications, like a coma, then the decision must come from elsewhere. And defining that "elsewhere" has proven to be a very difficult endeavor in healthcare philosophy.Medical ethics
Whereas bioethics tends to deal with more broadly based issues like the consecrated nature of the human body and the roles of science and technology in healthcare, medical ethics is specifically focused on applying ethical principles to the field of medicine. Medical ethics has its roots in the writings of Hippocrates, and the practice of medicine was often used as an example in ethical discussions by Plato and Aristotle. As a systematic field, however, it is a large and relatively new area of study in ethics. One of the major premises of medical ethics surrounds "the development of valuational measures of outcomes of health care treatments and programs; these outcome measures are designed to guide health policy and so must be able to be applied to substantial numbers of people, including across or even between whole societies." Terms like beneficence and non-maleficence are vital to the overall understanding of medical ethics. Therefore, it becomes important to acquire a basic grasp of the varying dynamics that go into a doctor-patient relationship.Nursing ethics
Like medical ethics, nursing ethics is very narrow in its focus, especially when compared to the expansive field of bioethics. For the most part, "nursing ethics can be defined as having a two-pronged meaning," whereby it is "the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice." This definition, although quite vague, centers on the practical and theoretical approaches to nursing. The American Nurses Association endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession. The importance of values is being increasingly recognized in all aspects of healthcare and health research. And since moral issues are extremely prevalent throughout nursing, it is important to be able to recognize and critically respond to situations that warrant and/or necessitate an ethical decision. A nurse promotes for and strives to protect the rights, safety, and health of all patients. Although these are clear nursing roles, all health care professionals must work together and collaborate to observe the patient's needs and rights.Business ethics
Balancing the cost of care with the quality of care is a major issue in healthcare philosophy. In Canada and some parts of Europe, democratic governments play a major role in determining how much public money from taxation should be directed towards the healthcare process. In the United States and other parts of Europe, private health insurance corporations as well as government agencies are the agents in this precarious life-and-death balancing act. According to medical ethicist Leonard J. Weber, "Good-quality healthcare means cost-effective healthcare," but "more expensive healthcare does not mean higher-quality healthcare" and "certain minimum standards of quality must be met for all patients" regardless of health insurance status. This statement undoubtedly reflects the varying thought processes going into the bigger picture of a healthcare cost-benefit analysis. In order to streamline this tedious process, health maintenance organizations employ large numbers of actuaries to ascertain the appropriate balance between cost, quality, and necessity in a patient's healthcare plan. A general rule in the health insurance industry is as follows: This generalized rule for healthcare institutions "is perhaps one of the best expressions of the practical meaning of stewardship of resources," especially since "the burden of proof is on justifying the more expensive intervention, not the less expensive one, when different acceptable treatment options exist."Religious Ethics
Various forms of religiosity are often tied together with health care, as some practitioners feel an obligation of the divine sort to try and care for others. In ancient Greece, a lack of institutionalized health care made it difficult for society to care for "beggars or mendicants", known as πτωχός. Following the genesis of Judaism and later, Christianity, religious texts supported "special dispensations for economic and political care" for those who were perceived as helpless in largely patriarchal societies. The role of the patriarch at the center of both society at large and the family unit meant that orphans and widows were necessarily among the helpless, and this sentiment was echoed by the Old Testament's conception of the poor, which also included individuals who were lame, blind, and/or prisoners. The mythologizing of Asclepius in Greek and Roman tradition is reflective of the historical transformation of places of worship into sites of health care delivery.A concept that is fundamental to health care development, grounded in the sacred texts of both the Western and Eastern worlds, is the sanctity of life. From this notion, we are commanded to treat life of all sorts with considerable dignity before we may interfere with it, "giving at least some attention to its nature and purpose." In Western health care, dignity regarding human life can be traced back to imago dei, meaning "image of God", which asserts that human beings are created by God in a manner of resemblance to his own existence. This is to say that health care practitioners shouldn't merely perceive patients/clients to be fellow humans undergoing suffering, but also as unique likenesses of God.
Following the Industrial Revolution, and the advent of the 20th Century, the face of modern medicine has evolved. However, the tensions between health care and religious practices have also grown in recent decades, and has led to some inequalities between the "rights" of the recipients and providers of health care. Legislative action has taken place in order to help solidify the rights of health care providers with respect to their religious beliefs. An example of this would be a conscience clause, which attempts to makes concessions to one's conscience when impacted by a law. In other words, there are laws in place that are intended to protect health care providers who refrain, for moral and/or religious reasons, from engaging in some forms of health care.
The rights of religious individuals and organizations are not just a matter of personal preference, but also of international jurisprudential value. The ethical implications of Supreme Court cases, such as that of Burwell v. Hobby Lobby, have the potential to shift personal and governmental attitudes regarding religiosity as it relates to health care. In pursuit of upholding their constitutional right to the free expression of religion, religious entities have had to legally defend their refusal to comply with government mandates, such as "to provide employee insurance plans that cover contraceptive costs", which is of moral violation when viewed with a particular interpretation of some religious texts. The willingness of a governmental body to bring these sorts of cases to the highest legal authority may be thought of as a form of intolerance, and perhaps, additionally, as a precursor to social and legal changes surrounding the "rights" of health care providers and recipients.