Healthcare Philosophy - Option Matrix

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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

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Contents

	Overview
	Healthcare Systems
	Ethics in healthcare
	Research and Scholarship
	Role Development

Overview

The philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. (Although veterinary concerns are worthy to note, the body of thought regarding their methodologies and practices is not dealt with in this article.) 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 phenomena of human civilization whereby man continually seeks to improve, mend, and alter the overall nature and quality of his 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" (euthanasia)?

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 as healthcare typically ranks as one of the largest spending areas of any government's budget, it becomes rather important to gain a greater understanding of healthcare as not only a social institution, but also as a human phenomena. In addition, healthcare philosophy attempts to highlight the primary movers of healthcare systems; be it nurses, doctors, hospital administrators, health insurance companies (HMOs and PPOs), the government (Medicare and Medicaid), and lastly, the patients themselves.

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Healthcare Systems

The goals for health systems, according to the WHO are good health, responsiveness to the expectations of the population, and fair financial contribution. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.

Financing

There are generally five primary methods of funding health care systems:

1. direct or out-of-pocket payments,
2. general taxation,
3. social health insurance,
4. voluntary or private health insurance, and
5. Donations or community health insurance.

One recent study published by the National Bureau of Economic Research found no systematic relationship between the cost efficiency of health care systems and the type of financing used. The author concluded "that almost all financing choices are compatible with efficiency in the delivery of health care."

Health care has the following characteristics:

The provision of critical health care treatment is often regarded as a basic human right, regardless of whether the individual has the means to pay-some treatments cost more than a typical family's life savings.

Health care professionals are bound by law and their oaths of service to provide lifesaving treatment.

Asymmetric information

High risk level

There is a debate whether these characteristics necessitate public ownership or increased government regulation of the health care industry.

Health care systems models

Health care systems are comparatively rare. Where they exist, it is usually for a comparatively well-off subpopulation in a poorer country with a poorer standard of health care-for instance, private clinics for a small, wealthy expatriate population in an otherwise poor country. But there are countries with a majority-private health care system with residual public service.

The other major models are public insurance systems:

Social security health care model, where workers and their families are insured by the State.

Publicly funded health care model, where the residents of the country are insured by the State.

Social health insurance, where the whole population or most of the population is a member of a sickness insurance company.

In almost every country with a government health care system a parallel private system is allowed to operate. This is sometimes referred to as two-tier health care. The scale, extent, and funding of these private systems is very variable.

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Ethics in Healthcare

The ethical and moral premises of healthcare are convoluted and numerous. In order to consolidate such an enormous field of ethical thought, it becomes necessary to focus on what makes healthcare ethics truly different 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 a every person's life, a decision has to be made regarding his healthcare. Can he afford it? Does he deserve it? Does he need it? Where should he go to get it? Does he 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 his healthcare situation, the person has to decide if it is even worth it. It is not simply economic issues that are at stake in this conundrum. In fact, a person must decide whether or not his life is at its end or if it is worth salvaging. Of course, in instances where the patient himself 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.

Bioethics

According to French philosopher Luc Ferry, the field of bioethics represents a "sacralization of the human body," whereby the body effectively "becomes a temple." This viewpoint of bioethics is rather interesting for it makes an intrinsic connection between the integrity of the human body and spirituality. Even so, this perspective on bioethics contains a hint of what Ferry refers to as "transcendental humanism," in which reason has succeeded in subverting religion insofar as traditional morality is concerned.In a classically French existentialist manner, Ferry proceeds to assert:

Never before, without a doubt, has the progress of science and technology given rise to questions with such broad moral and, let us dare to use the word, metaphysical implications. It is as though the sense of the sacred remains, in spite of the "death of God," but without our being given the spirituality or wisdom that should correspond to it.

This assertion can essentially be seen as an effective summary of the philosophical issues raised in bioethics.

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 principals to the field of medicine. It is a large and relatively new area of study in ethics. And 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 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 (ANA) endorses an ethical code that emphasizes "values" and "evaluative judgments" in all areas of the nursing profession.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.

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 (HMOs) like BlueCross BlueShield employ large numbers of actuaries (colloquially known as "insurance adjusters") to ascertain the appropriate balance between cost, quality, and necessity of care for a patient. Another general rule in the health insurance industry is as follows:

The least costly treatment should be provided unless there is substantial evidence that a more costly intervention is likely to yield a superior outcome.

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."

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Research and scholarship

Considering the rapid pace at which the fields of medicine and health science are developing, it becomes important to investigate the most proper and/or efficient methodologies for conducting research. On the whole, "the primary concern of the researcher must always be the phenomenon, from which th research question is derived, and only subsequent to this can decisions be made as to the most appropriate research methodology, design, and methods to fulfill the purposes of the research."This statement on research methodology places the researcher at the forefront of his findings. That is, the researcher becomes the person who makes or breaks his scientific inquires rather than the research itself. Even so, "interpretive research and scholarship are creative processes, and methods and methodology are not always singular, a priori, fixed and unchanging."Therefore, viewpoints on scientific inquiries into healthcare matters "will continue to grow and develop with the creativity and insight of interpretive researchers, as they consider emerging ways of investigating the complex social world."

Clinical trials

Clinical trials are a means through which the healthcare industry tests a new drug, treatment, or medical device. The traditional methodology behind clinical trials consists of various phases in which the emerging product undergoes a series of intense tests, most of which tend to occur on interested and/or compliant patients. The U.S. government has an established network for tackling the emergence of new products in the healthcare industry. The Food and Drug Administration (FDA) typically conducts appropriate trials on new drugs coming from pharmaceutical companies. Along with the FDA, the National Institutes of Health sets the guidelines for all kinds of clinical trials relating to infectious diseases. For cancer, the National Cancer Institute (NCI) sponsors a series or cooperative groups like CALGB and COG in order to standardize protocols for cancer treatment.

Quality assurance

The primary purpose of quality assurance (QA) in healthcare is to ensure that the quality of patient care is in accordance with established guidelines. The government usually plays a significant role in providing structured guidance for treating a particular disease or ailment. However, protocols for treatment can also be worked out at individual healthcare institutions like hospitals and HMOs. In some cases, quality assurance is seen as a superfluous endeavor, as many healthcare-based QA organizations, like QARC, are publicly funded at the hands of taxpayers. However, many people would agree that healthcare quality assurance, particularly in the areas cancer treatment and disease control are necessary components to the vitality of any legitimate healthcare system. With respect to quality assurance in cancer treatment scenarios, the Quality Assurance Review Center (QARC) is just one example of a QA facility that seeks "to improve the standards of care" for patients "by improving the quality of clinical trials medicine."

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Role development

The manner in which nurses, physicians, patients, and administrators interact is crucial for the overall efficacy of a healthcare system. From the viewpoint of the patients, healthcare providers can be seen as being in a privileged position, whereby they have the power to alter the patients' quality of life. And yet, there are strict divisions among healthcare providers that can sometimes lead to an overall decline in the quality of patient care. When nurses and physicians are not on the same page with respect to a particular patient, a compromising situation may arise. Effects stemming from a "gender gap" between nurses and doctors are detrimental to the professional environment of a hospital workspace.

Aside from role development, another area in healthcare philosophy that necessitates discussion is palliative care. Otherwise known as hospice care, this area of healthcare philosophy is becoming increasingly important as more patients are preferring to receive healthcare services in their homes. Even though the terms "palliative" and "hospice" are typically used in an interchangeable fashion, they are actually quite different. And the major difference resides in the fact that hospice care is a benefit associated with Medicare while palliative care is not. As a patient nears the end of his life, it is more comforting to be in a private home-like setting instead of a hospital. Palliative care has generally been reserved for those who have a terminal illness. However, it is now being applied to patients in all kinds of medical situations, including chronic fatigue and other bothersome symptoms.

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