Ethics of Healthcare
Holly Ryerson Dahlman, MD, FACP
Green Spring Internal Medicine, LLC
February 17, 2018
2. Ethical Dilemmas
Framework of Medical Ethics
Beneficence
Non-malevolence
Respect/Autonomy
Justice
Micah 6: 8
“He has shown thee, o man, what is good, and what the LORD requires of thee: But to do justly, and to love mercy, and to walk humbly with thy God.”
Global Health vs “Make America Great Again”
Tip
“Love the Lord your God with all your heart, all or your soul, and all of your mind... Love your neighbor as yourself… Sum of the Law and the Prophets.”
-Matthew 22:37-40
Image Bearers
CDC to Cut by 80% Efforts to Prevent Global Disease Outbreak - Washington Post 2/1/18
Individual versus Population Health
The “Freedom” Argument
“You should have the freedom and the flexibility to choose the care that’s best for you.” Speaker Paul Ryan, 2017
https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-Snapshot.pdf
Impact of Individual Freedom re: Coverage
Harms to self: risk of catastrophe cost with inadequate coverage, lack of access to care, preventable illness
Harms to society: dependence upon safety net, preventable high cost, small risk pools raising cost for others > uninsurable high risk patients, skipped prevention like vaccination risks harm to others
Benefits to self: autonomy ( personal choice as a freedom construct is fundamentally American), not being “taxed” freedom of religion argument plays here
Benefits to society: short-term lower costs especially without Medicaid expansion and proposed healthcare cuts, States’ freedom
Matthew 7: 12
“So in everything, do to others what you would have them do to you, for this sums up the Law and the Prophets.” - Jesus, Sermon on the Mount
The Case for Universal Healthcare
Choose one approach to grab the audience’s the start:
Another Ethical Framework
Universal access
Equitable access
Affordable access (Cost)
Quality
Choice
(recently in JAMA)
(Associated Press, 1966)
What is justice?
Impact of Healthcare Ethics in Current Events
Freedom of religion > not vaccinating kids
“America First” > defunding world programs
Repeal of Individual Mandate
Healthcare and Economic Inequality
Proposals to legalize physician-assisted suicide
85% of pediatric flu deaths unvaccinated
Risk of emerging infx disease outbreak
A re-emerging class of the uninsurable ill
Neighborhoods differ 25 years in life expectancy
Loss of life, vulnerable populations exposed to abuse, incentivized by pushes to reduce cost
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Closing
The classic medical ethics framework applies to healthcare
The Bible informs Christian ethics
World health, US healthcare and our own health intersect in ethical questions
Ethics concepts live in tension
Health is our first wealth (and freedom!)