Navigating Ethical Dilemmas in Access to Healthcare

Navigating Ethical Dilemmas in Access to Healthcare

Author: Aney Verma, Symbiosis Law School, Noida.

Abstract

Access to healthcare for everyone should be free and fair. Access to healthcare raises some fundamental concerns like finance, medical structure, ethical dilemmas, and politics. Generally, people presume healthcare means medical treatment provided by a trained professional. The issue of access to healthcare only arises for the middle class or poor class because the rich class has all the resources and money to get the best healthcare that is available, but this situation changed during COVID-19. During COVID-19, every section of society faced the issue of access to healthcare, and several ethical dilemmas occurred during COVID-19. Society always talks about access to healthcare every day but never takes the step to achieve it. The national government never focused on the need to improve and increase the infrastructure of healthcare. Access to healthcare has two faces: one that helps society and the poor maintain their health, and the other is its cost, impact on business, unemployment, etc.

A few questions arise when an individual hears the concept of access to healthcare. These questions are:

Why is access to healthcare important? Access to healthcare affects a person’s, community’s, or class’s well-being. Regular and reliable access to healthcare will reduce the spread of the virus and help detect and treat the disease early. What is access to healthcare? Access to healthcare means any person could enjoy the benefits of the healthcare system without facing any type of hindrance. What is the hindrance to access to healthcare? There are several, but a financial hindrance and a lack of medical personnel are the main hindrances. Is it possible for him to gain access to healthcare? On one look, this concept looks achievable, but when you deep dive into it, you realise this concept is a full hindrance and an ethical dilemma.

Access to health care 

As we mentioned, easy and free healthcare is the true meaning of access to healthcare. Different countries face different problems while implementing access to healthcare.

• India follows the public healthcare system, in which the government sets up hospitals that provide free health support. We have the largest number of medical colleges in the world, and almost 15,000 doctors qualify every year. The present government advocates the health model of the US. The expenditure of India in healthcare is around 1.2% of its GDP. Most of India’s population lives in rural areas, and providing healthcare to them is difficult. The Ayushman Bharat programme was launched in 2018 to cover the working population of the unorganised sector.

• USA: The USA follows the individual model of healthcare, in which an individual is responsible for his or her life. The US provides subsidies for the poor and elderly because of the high price of medicine. The USA doesn’t follow universal healthcare, which means they don’t pay for the medical expenses of their citizens and tourists. To avoid paying a lot of money, the citizens adopt health insurance. The USA spends 18% of its GDP on healthcare.

• EUROPE: The European model of healthcare focuses on the principle of collective responsibility. The government develops policies to ensure every individual’s inherent right to health. They develop a state-regulated facility that guarantees all individuals equal access to healthcare services.

Ethical dilemma

An ethical dilemma is a moral situation in which an individual has to choose between two or more conflicting values. An individual will face a situation in which he or she will have to choose and compromise his or her morality. The problem with ethical dilemmas is that there is no 100% correct answer. In morality, nothing is black or white; everything is grey. An individual has to choose according to his moral values.

The ethical dilemmas in access to healthcare and healthcare are as follows:

• COVID-19: During the phase of COVID-19, the doctors were put in a position where they had to decide whom to provide medical care and whom not. The first wave of COVID-19 wasn’t as horrible as the second wave of COVID-19. Lack of medical infrastructure and poor medical management make things worse. The shortage of beds in the ICU and the low quantity of oxygen, plus the high number of COVID-19 patients in the hospital, put medical professionals in the ethical dilemma of whom to save. Is choosing one person rather than another right? Whose life matters most? Such ethical dilemmas were arising during the high time of COVID. The doctors require PPE kits to work, and the PPE kits were in short supply. Is it ethical for a doctor to work without proper kits, to just sit and wait for the arrival of PPE kits while the patient suffers, or to risk his or her own life to save others? Is it ethical to remove an elderly patient’s oxygen supply for an adult’s life?

• Testing and vaccines: with the spread of COVID-19, the world was anxious to see the effectiveness and availability of vaccines. Once the vaccine starts mass-producing, several ethical questions start arriving. Many researchers continue to study the long-term effects of a vaccine. This process stops the early use of vaccines, which could save someone’s life. Is it ethical to conduct trials on vaccines at the cost of depriving people of their benefits? To confirm that you are COVID-19 positive or not, you have to get a medical test. If a doctor is showing COVID-19 symptoms and did the COVID test, should he or she still work in the COVID ICU or wait a few days to get the report?

• Alone: When the COVID-19 patients start flooding the hospital, in order to protect the patient’s family and reduce the spread of COVID-19, the hospital bans visitors. They didn’t even allow the support person during childbirth. The severally ill patients died alone, without the presence of their loved ones. Is it ethical to not allow the patient’s family members to meet the dying patient? Is it ethical to let someone die alone? Is it ethical to not allow a support person?

• Access to healthcare: some countries also get access to healthcare, i.e., vaccines, PPE kits, ventilators, etc. In a narrow sense, citizens of European countries have better access to everything as compared to citizens of any African country. Some people will always get more priority than others; it doesn’t matter if the late person is backward or not. Is it ethical to give priority to some people? Access to free healthcare will lead to the loss of private hospitals and profit-making companies. This will also cause unemployment in the medical field. Is it ethical for a doctor to lose his or her job for the benefit of others? During the COVID-19 phase, the vaccine manufacturer is charging money for vaccine shots. Is it ethical to charge money for COVID vaccines?

Conclusion and Analysis

Each and every individual in his or her life has to face some ethical dilemmas. The individual has to choose between those ethical dilemmas. As it is mentioned in ethics, there is no correct answer to an ethical dilemma.

The COVID-19 pandemic shows the true colour of healthcare, but the key issue is the shortage of medical equipment, etc., which caused the scenario in which ethical dilemmas occurred. Countering the present scenario, which leads to questions about ethical dilemmas in the future, is easier than facing the ethical dilemmas.

• During COVID-19, the doctors face ethical dilemmas like: whom to save? Whose life matters more? etc. Every person will answer differently, but according to me, the person with whom others depend should be given more preference because his or her death will affect the dependent members, and the person who is young should have a better chance of living.
• The issue of a long trial of the vaccine According to me, there is a slight chance that a vaccine that is not used for a long period of time will save a dying person. I would prefer to give the vaccine shot to him or her.
• The issue of dying alone in a hospital No one should die alone in the hospital, at least not in natural times. If there is an on-going pandemic and family members are allowed to meet the patient out of fear of spreading the virus and risking other people’s lives, in this situation, I will not allow the family to meet with the patient.
• The issue of inequality Everyone should be treated equally, and if one person is not equal by birth, socially, economically, etc., that person should be given preference.

An individual will have to choose between two or more ethical dilemmas and face the benefits and consequences of his choice.

Bibliography 

Charlene A. Galarneau, The Ethics of Access to Health Care, JSTOR (Nov. 1, 2021, 10:00 AM), https://www.jstor.org/stable/23561093?Search=yes&result ItemClick=true&search Text=The% 20Ethics%20of% 20Access%20to% 20Health% 20Care&search Uri=% 2Faction% 2FdoBasicSearch% 3FQuery%3DThe% 2BEthics%2Bof% 2BAccess%2Bto%2BHealth% 2BCare%26so% 3D rel&ab_segments=0% 2Fbasic_search_gsv2% 2Fcontrol&refreqid=fastly-default%3A76452c41e09788053ded2c0b9231d67b. 

Hassan Chamsi-Pasha, Majed Chamsi-Pasha, Mohammad A Albar, Ethical dilemmas in the era of COVID-19, GEORG THIEME VERLAG KG (Nov. 1, 2021, 11:00 AM), https://www.thieme-connect.de/products/ejournals/html/10.4103/AJM.AJM_119_20.