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Introduction
Throughout history, people have been using their reasoning to determine what is right or wrong in different circumstances and in justifying why it is so. This criterion is the basic foundation of normative ethics. In most cases, health care professionals encounter highly complex issues while dealing with their patients or the health care system at large. Handling such issues requires a strong foundation based on knowledge and skills that can be applied so as to generate solutions that benefit both the patient (in terms of quality treatment) and the organization as regarding to the management of risks and preservation of life (Ashcroft, Dawson & Draper, 2007). Arguably, for one to be recognized as a professional, he/she must understand the foundation of the field of practice. In other words, a health care professional is expected to fully understand the nuts and bolts that hold the health care system together. The same case applies in ethical studies.
Ethics in the healthcare business is not simply doing what we consider to be right. As mentioned earlier, issues encountered in this sector are often exceedingly complex and assuming that there is a one-shoe-fits-all approach to dealing with these issues is an outrageous fallacy. To make matters worse, the society and other health care professions also have their inflexible ethical expectations. To this end, it is not only logical, but also wise for a healthcare practitioner to have a strong foundation and a deeper insight in the theories and principles of ethics if they are to act professionally in regard to decision-making processes (Ashcroft, Dawson & Draper, 2007). This paper shall set out highlight various ethical theories and principles that are used in the health care sector. This shall aim at elaborating how these theories and principles can be applied to solve issues in this sector.
Ethics and Health Care: A Brief Overview
There are various documented theories that can be applied in solving ethical issues in the health care sector. You may be questioning the importance of knowing such theories and principles. Well, the answer is that a lack of a solid ethical foundation leaves an individual with no other choice but to make decisions that lack a solid structure to support those decisions (Morrison & Monagle, 2009). A practitioner would therefore lack the ability to defend his/her actions whenever the need arises. In addition, you would not be adequately equipped to deal with the issues that are inherent in todays health care sector. As such, understanding the ethical theories that apply in health care delivery is not only pivotal, but also a necessity in todays dynamic, and aggressive working environment.
Important of Ethical Theories in Health Care
Morrison and Monagle (2009) contend that we live in an era whereby technological advancements in the medical and scientific arenas are constantly presenting people with challenges that demand similar thought processes. Resource allocation is slowly becoming global, new diseases are cropping up globally, nature is taking its toll on our lives and people all over the world are finding it more difficult to cope as poverty and diseases become a common place to the global population. Understanding ethics presents people with an avenue through which solutions for these vexing situations can be found.
In addition, equipping ourselves with adequate ethical knowledge enables us to work with others (colleagues, patients, policy-makers and stakeholders). This means that ethical understanding enables practitioners to understand alternative views thereby fostering cultural competence on a global scale (Brannigan & Boss, 2000). Ashcroft, Dawson and Draper (2007) define normative ethics as the study of what is considered as right or wrong. As such, normative ethics sets out to examine the formulated theories of ethics and how they apply in various fields such as health care. With this in mind, you may be tempted to think that normative ethics offer conclusive outcomes since they set out to determine the right course of action that can be taken to solve a particular issue, and explain why it is the right move. However, there are many disagreements in various fields such as health care, engineering and even business on how the results are interpreted.
There are various types of ethical theories that are often used in healthcare situations. Some of these theories shall be defined, elaborated and applied in health care.
Authority-Based Theories
In this category, the theories are often based on religious faith such as Christianity, Buddhist or Muslim ethics. Marlin (2002) asserts that in some cases, theories in this category are based on ideologies. For example, Karl Marx writings, and theories that try to explain capitalism. These theories are based on what an authority considers to be right. As such, the ethicist in this case tries to determine the ruling that the authority would pass in regard to the given problem. Marlin (2002) states that in most cases, ethical teachings often avoid religion-based ethical theories despite the constant protest from those who hold deep religious beliefs. In health care, religious-based theories should never be used to solve issues or make decisions. Geirson and Holmgren (2010) attribute this to the fact that there is a worldwide disagreement on which authority reigns over the rest. This is tricky since there is no prescribed way of knowing which authority or ideology is correct. Most of the theories in this category are normative relative to whoever uses them. As such, they often lead to conflicts and there is no method to sort them out that is agreed upon.
Despite these limitations, there are some benefits that can be accrued from understanding this category of theories. For example, all religions have their own beliefs regarding the source and solutions for ailments and suffering. In most cases, patients often have their religious beliefs and attitudes that help them make sense and find comfort in their circumstances. On the plus side, understanding authority-based theories enable practitioners to deliver a more patient-focused treatment or solution. However, an ethical dilemma may arise whenever a patient feels as though his/her religious beliefs have been violated or disrespected by the practitioner.
In regard to the influence of authority-based theories in the formulation of health care policies, Hester (2001) argues that acknowledging and understanding the religious philosophies behind these theories may enable a practitioner to steer away from contentious issues (such as abortion, euthanasia and resource allocation among others) that may offend or undermine the religious beliefs held by the people responsible for making the policies. For example, when dealing on an international perspective, a healthcare practitioner who understands the alternative views held by different parties can find a common morality that is readily acceptable by all members, thereby ensuring that the policies made are readily acceptable to all.
Similarly, it should be noted that religion plays a pivotal role in helping people determine what is right or wrong. This can be attributed to the fact that all religion provides answers regarding the nature of the world and how we should exist in it. In addition, religions help people understand themselves, their purpose and how they should co-exist with each other in this earthly realm. In short, religion explains the world and how each individual fits in it. Conclusively, it is not advisable for a health care practitioner to apply this category of theories in the field. However, they can be used as a tool to provide quality treatment to patients, or to negotiate agreeable terms where health care policies are concerned. On a personal note, having an understanding of authority-based theories enable an individual to better understand his/her religious stand thereby acting as a guideline that prevents the practitioner from imposing his/her religious views on the patient and vise versa.
Virtue Ethics Theory
This theory as defined by Melia (2004) argues that we should find a solution for humanity and then work towards achieving that solution. It focuses on finding perfection and excellence in all we do. It therefore proposes that as human beings, we should work towards developing ourselves to excellence by using the best of our ability. The questions in this theory include: What kind of an individual should I become? Or how can we live together in harmony? Devettere (2009) contends that this theory is very influential in formulating professional code of ethics in the health care sector. Virtues are described as desirable moral qualities. According to Melia (2004), this theory was founded on the tenets that everyone is innately virtuous but there is need for development and nurturing before a person can exhibit a virtuous character. This sentiment is further supported by Loewy and Springer (2004), who defines elitism as a state in which a person who has been nurturing virtues becomes virtuous after long practice.
As mentioned earlier, the virtue ethics is all about exhibiting the highest good we possibly can. This theory is very important since it helps practitioners maintain professional conduct. Understanding this theory enables practitioners to better their character and that of their patients. In addition, Greenhalgh (2007), states that virtue ethics enable practitioners to balance their obligations more efficiently. For example, there are some treatments such as chemotherapy, which are harmful to the patients but beneficial in the long-run. A professional practitioner equipped with the knowledge of virtue ethics can effectively communicate the harms as well as the benefits of such treatments to the patient and get consent to administer the treatment.
In addition, if the patient views the practitioner as a virtuous person, their confidence in the services provided increases. Also, caregivers who have practical wisdom (a virtue) are able to find viable solutions and work towards attaining them. As such, people who have practical wisdom can consult each other and come up with appropriate remedies to different issues. Over the years, healthcare organizations have used such people to form ethics committees which help in determining ethical courses of actions and resolving conflicts. Such progress has been made possible through the understanding of what the virtue ethics theory entails.
On the same note, Loewy and Springer (2004) contend that a virtuous person (one having practical wisdom) can effectively decide on which theory to apply so as to solve an issue. Take a physician for example; their primary duty is to cater for the needs of their patients. However, this is not their only obligation they have other duties such as recruiting, training and firing employees, as well as conducting scientific studies and managerial duties. All these roles are handled differently and different theories can be used to diffuse them. In such cases, an individual who has undergone the professional socialization process recommended in this theory is more likely to select and apply the theories that ethically examines and solves the problem.
Biomedical Principles Emanating From Virtue Ethics Theory
The four core ethical principles used in healthcare delivery have their roots in the virtue ethics theory (Greenhalgh, 2007). They include beneficence, non maleficence, justice and autonomy. Beneficence refers to the caregivers responsibility to extend kindness/goodness to their patients. This principle dictates that healthcare practitioners have the responsibility to keep the patients interest before their own by ensuring that they get the most benefit from all health care related practices (Greenhalgh, 2007). The second principle of non maleficence states that health care practitioners should avoid doing harm to others. This principle sets out to protect patients from practices that may put them at risk or at harms ways in a health care setting (Devettere, 2009).
The third principle of justice suggests that health care practitioners should treat their patients fairly, equitably and lawfully without malice or discrimination. The final principle is that of autonomy, which refers to the ability to make decisions for oneself without external or emotional influences. This principle holds that people should always respect the decisions made by others and that making decisions for other people without their permission is wrong or in ethical terms; paternalism. These four principles show virtuous characteristics that should be inherent in all health care practitioners. Not only do they protect the patients from harm and unfair health care practices, but they help the practitioners act in an ethically and legally acceptable manner (Loewy & Springer, 2004).
Natural Law Ethics
In this research, the theory of natural law is interpreted using the foundation laid by St. Thomas Aquinas (Engelhardt, 2006). The key idea behind this theory is that nature has a rational and providential order of occurrences (Engelhardt, 2006). As such, no human being should interfere with this order. This theory is very important in health care and it is mostly applied in debates regarding abortion, euthanasia, social justice and birth control (Cherry, 2004). As a health care practitioner, it is important to understand this theory because it helps us understand the difference between good and evil practices in accordance to the natural order of life.
This theory therefore proposes that under no circumstance should the life of an individual be cut short by another person because this would disrupt the rational and providential purpose of life. However, there are various issues that have been forwarded by critics of this theory. Opponents of this theory argue that in as much as the decisions formed through this theory are specific; the details surrounding the issue may change (Gensler, 2011). So the question is: how does a practitioner know that his/her decision is right under this theory? The principle of double effect was therefore developed to act as a guide to ethical decision making under this theory.
This theory is founded under four basic assumptions. The first assumption is that we try our best to avoid evil effects because we do not desire for them to happen. Secondly, the immediate effect of any decision made should be good. Thirdly, the good effect should not be as a result of an evil act. This assumption suggests that the end should not justify the means. Finally, the principle assumes that the good effect should always outweigh or at least be greater than the evil effect. These assumptions can therefore help a practitioner make ethical decisions in situations where there is a conflict between what is good or evil (Gensler, 2011).
For example, abortion is considered as an evil by most people, however, saving the life of a pregnant woman is considered as a good deed. Similarly, euthanasia is in some areas considered as an evil, but using morphine to alleviate pain is good. As such, by applying the principle of double effect, a practitioner is better placed to make ethical decisions because the assumptions behind this principle act as guidelines to effective and ethical decision-making.
Discussion: Value of Ethical Theories in Health Care
No matter the circumstances, decisions have to be made and accounted for. As such, understanding the aforementioned theories (among others) is pivotal to health care professionals since it helps them choose the appropriate theory t apply in different situations. Arguably, without these theories, decisions made regarding treatment, prescriptions, patient care and health care policies would be left at the mercies of personal feelings, rational and perspectives of the parties involved. As a result, patients would suffer since there would be no mechanism to determine or justify the decisions made by practitioners.
For health care managers and practitioners, these theories help them act in the best interest of the patients by applying the practical wisdom discussed in the virtue ethics theory. For clinicians, they can apply the deontological approach and perform their duties as subscribed. Managers are also better placed to decide on the best course of action, all the while adhering to the policy and rules that are set in place to govern the activities of their staff.
In regard to policy making, these theories can come in handy when a particular policy maker wishes to understand, evaluate and determine the most probable attitude held by various stake holders. Knowledge of these theories in such cases help policy makers decide on policies that are most likely going to be approved by stakeholders because they appeal to their sense of justice and ethical conduct.
Conclusion
Evidently, the twenty-first century comes with various health care ethical challenges to individuals, society and organizations that participate in this sector. As such, a deeper understanding of the ethical theories that govern this sector is not only logical, but also necessary if ethical conduct is to prevail. From this research, it is clear that individual ethical theories cannot suffice in creating appropriate responses for the challenges that are inherent of this sector. As a result, a detailed review of different theories has been provided and scenarios in which each theory can be applied provided.
While not all theories have been discussed, it is clear that having a foundation of ethical theory is critical in ensuring that quality services are offered to various stakeholders. In addition, knowledge of these theories helps health care practitioners make correct decisions, and provide adequate support for their decisions. By applying these theories and their principles, professionals in the health care sector will be able to do their work more efficiently, all the while minimizing the chances of gross misconduct and harmful practices that may eventually cost them their careers.
Cultural and Ethical Implications of DNA testing: Application of Theory
Introduction
The past few decades have witnessed great scientific breakthroughs, inventions and discoveries due to technological and intellectual advancements. The biological field of studies has as a result improved in terms of sophisticated equipment as well as advanced procedures used in diagnostic processes that were once considered as theories and reserved only for the well-to-do specialized hospitals. One of the most notable technological advances in this field is arguably the development and implementation of genetic testing. Jonsen, Veatch and Leroy (1998) define genetic testing as the process through which the presence of genetic markers within the patients body of specific ailments can be determined or detected. The importance of this testing cannot be elaborated fully considering that over 3% of all children in the united states are born with severe genetic disorders (Jonsen, Veatch & Leroy, 1998).
According to the Uhlmann, Schuette and Yashar (2010), the main purpose of genetic testing is to treat, cure or prevent disorders that are genetic in nature. One of the main benefits of this procedure is that it enables patients to know whether or not they have any genetic disorder. As such, this information can be used to formulate preventive measures or start treatment before the disorder takes its toll on the person. This paper shall set out to evaluate the cultural, social and ethical issues that surround genetic testing. This shall be done by employing various theories and analyzing the impact genetic testing has on people in regard to decision making.
Importance of genetic testing
According to the principles of biomedicine, the principle responsibilities of health care practitioners are to preserve life, alleviate pain and restore health of their patients using the available resources. Genetic testing presents practitioners with an avenue through which these responsibilities can be fulfilled. New technologies and research advancements have enabled practitioners to identify various genetic disorders and risk factors that affect mankind. Genetic testing falls under this category and it has played a pivotal role in identifying such disorders rapidly and efficiently than other methods. Lerman, Croyle and Tercyak (2002) contend that genetic testing may in the future become a common practice in medical routines.
Another advantage that can be accrued from genetic testing is that medical practitioners are able to detect dormant mutated genes that may be present in patients who physically seem healthy. This is important because people with such a condition may continue living normally oblivious of the health dangers that lurk within their bodies. The implication of such a test in this case is that once the carrier has been notified of his/her condition, viable preventive or curative measures can be recommended so that the patient is enlightened on the available choices.
This gives the patients an opportunity to make informed decision on the best course of action that should be taken to counter their condition. This advantage coincides with the virtue ethics theory which states that practitioners should always set out to do good to their patients. As such, informing the patient of the underlying condition and laying out the choices of treatment is in line with this theory and ensures that genetic testing are used for good (to better the patients well being).
Evidently, the health care systems adopted by most nations are shifting from the traditional curative approaches to preventive approaches of health care delivery. This move is supported by the deontological theory which places more emphasis on duty. The core duty of health care professionals is to improve the physical and mental well being of their patients. Genetic testing gives practitioners a chance to carryout this duty in the sense that the tests are preventive in nature. For example, if a patient tests positive for a disease such as cancer or diabetes, the results can be used to devise means of mitigating the disease from ever developing. For example, Bettina and Dunn (2001) assert that through genetic testing, genetic markers for Huntingtons disease were used to come up with the linkage analysis, which is effective in identifying unaffected carriers. This discovery has in the past decade proven to be effective when it comes to helping carriers cope with the disease.
Genetic testing has also gained popularity due to the fact that most employers today request all their employees to take the tests as part of the company policy. This move previously met a lot or criticism as people feared that it was a strategy of screening employees for genetic disorders that affected their ability to perform efficiently. However for DNA profiling to be used successfully, there has to be a DNA database where tissue samples, genetic information and personal data is stored indefinitely. This brings about the real fear that this information may be misused therefore leading to an infringement on the rights afforded to the individual. Brent (2000), states that this discriminatory tendency was forbidden by law. The author further contends that while it is legalized in some states, employers are legally advised not to make any employment decision based on the results of these tests (Brent, 2000). This is in line with the principle of justice which dictates that people should be treated equitably and fairly regardless of their differences.
The benefit of these tests to employers is that they are better placed to make informed decisions on the insurance policy to take for an employee as well as other medical allowances. In addition, these tests enable employers to identify an employees susceptibility to various working conditions thereby enabling the employer to properly assign tasks to the employee. In addition, the test results are of great importance to employers since insurance firms always require the medical history of a client so that they can effectively assess the risks and other factors. Such information help insurance companies decide on which cover an employee should be placed.
Each individual has some level of doubt regarding his/her health at some point in time. As such, it may be argued that there are many factors that may influence an individuals decision to get a genetic test. For example, most people always dream of having a family in future. Despite this parental desire, there are always some doubts on whether the child will have any complication or disability. To this end, genetic testing (prenatal testing) provides such potential parents with an ease of mind in the sense that they can be tested for genetic markers that are inheritable (Boskey, 2007). While the emotional impact of such results may affect people differently, the virtue ethics theory recommends that counseling should be offered to test subjects before and after the test to help them cope with the results.
Impact of genetic testing on decision making
Arguably, genetic testing has gained prominence in the medical arena mainly due to the fact that it is among the latest procedures in medical advancement. As a result, companies have emerged that offer these tests at a fee. While these companies propose that their aim is to provide easy access to such services to clients, some states have been forced to shut down some of these companies and in some instances discourage people from soliciting genetic testing services from the same. These moves have been necessitated by the fact that the results of these tests have varied effects on how people make life decisions (Euan, 2009).
Jonse, Veatch and Leroy (1998) indicate that in most genetic testing procedures, the decisions made by the individuals are to a large extent influenced by cultural and emotional factors as opposed to the perceived risks that the results indicate. As such, a pregnant mother may be culturally inclined to terminate a pregnancy because the results of a genetic test indicate that the unborn child may have a genetic disorder. Such a decision is not based on the risks of having the baby, but on the mothers or societal view on having a disabled child. Such a decision has no relation to the facts presented by the results.
In such a case, it may be argued that genetic testing goes against the theory of natural law, which states that, there is a rational and providential order of things in nature. This means that man should not interfere with nature since everything has a purpose and it should exist until nature decides otherwise. As such, the decision to terminate a pregnancy simply because it proves to be challenging is unethical. This point disregards genetic testing in relation to its influence in decision making.
Similarly, the choices that are made through genetic testing include but are not limited to decisions to have a child, to abort and to pursue preventive care among others. Lerman, Croyle and Tercyak (2002), state that other factors that should be considered when making decisions include the severity of the disease, available treatments and the disease in question. Hartley et al (1997) state that results from studies conducted on couples who stood the risk of getting Tay-Sachs disease indicated that 85% of the women test subjects agreed to get tested. The authors further state that out of the 85%, 81% of the women agreed to take the test because they feared that their children would contract the disease. The decisions made after the test were mostly determined by the subjects emotions rather than the findings.
In addition to this, statistics indicate that results from genetic testing carried out during prenatal care increases the chances of abortion. This is attributed to the fact that more knowledge regarding the risks that a particular disease poses to the mother and the child makes abortion an easy choice as compared to when the information is limited. As such, when a pregnant woman discovers that her unborn child is likely to be deformed or disabled in some way, she decides to terminate the pregnancy rather than risking bringing a child that will be socially unaccepted by family members and society. However, it should be noted that such choices are not made under duress and much deliberations and counseling should be done before making the final decision.
Cultural and Ethical Impacts of Genetic testing
Ethically genetic testing should be carried out in a manner that is acceptable to society and individuals. This means that the information gathered during such tests should not be used to discriminate people who are culturally different. This applies mainly to employers and insurance companies, who may be tempted to use such information for screening clients or employees.
Similarly, there are individuals with strong cultural affiliations that should be considered before subjecting them to such tests. Genetic testing in some instances result in the alteration of genetic markers. Some cultures believe that alteration of ones body is a sin. As such, practitioners are ethically bound to present all participants with an informed consent agreement which highlights the nature of the experiment, the risks and the physiological effects that the tests may have on them (European Commission, 2000).
In some cases, people have suffered greatly under the hands of unethical practitioners who put their interests and greed for knowledge before those of the patients. This is unethical and punishable by law. Patients on the other hand should be careful when providing personal information or volunteering for such tests. They should ensure that the people conducting the tests are certified and have only good intentions.
While genetic testing presents humankind with an avenue through which serious diseases can be prevented or cured, people should exercise caution when dealing with such practices. In as much as there are benefits, they should not be realized through harming others or deception (Betta, 2006).
Conclusion
This paper set out to explore an issue in healthcare that has serious implications on ethical and cultural conduct. To this end, this paper has reviewed various concepts and views of genetic testing. To this end, the description of genetic testing has been offered and the issues and concerns surrounding this procedure underscored. As a result, it has been deliberated that genetic testing is highly valued as being an important step in health care delivery, in that its application will become a fundamental component in medicine. In addition, the discussion presented herein has shown that the decisions made in regard to genetic testing results are not as simple as they seem. As such recommendations such as counseling and consultation have been offered so as to ensure that the decisions made are rational as opposed to them being emotional.
Considering that there is no standardized method that can be applied to determine how a person is going to react to the results, these recommendations may help individuals cope and deal with the results more effectively without causing harm to themselves or to others. Counselors should ensure that patients are mentally fit before recommending that they take such tests. In addition, practitioners using this method of testing should ensure that they do them in an ethical manner. This means that they should ensure that the patients understand the parameters of the tests, the benefits, weaknesses and potential impacts.
It has been observed that genetic testing comes with an array of advantages and disadvantages. However, it is evident that the advantages are greater than the disadvantages. As such, genetic testing should be promoted but policies should be put in place to ensure that the tests are conducted in an ethical and legal manner.
Research Methods and Critique
Introduction
Health care is a term that is mostly used to refer to the prevention, cure and treatment of various diseases and injuries
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