There has been an alarming number of incidents in which patients with complex or controversial medical conditions were turned away from hospital facilities or denied treatment. Two such cases were Laura Avila, who was turned away from a Dallas County Hospital after a plastic surgery went wrong, and Charlie Gard, whose parents were turned away from a New York facility where they were seeking treatment to save their son. The physicians and hospitals, whom patients turn to and entrust the health of their loved ones, are unjustly turning their patrons away. These health professionals and their associated institutions are not fulfilling their pledge to help because of insurance issues. Health systems can do more than just consider the financial health of their facilities in regards to caring for patients with controversial or complex health issues.
Right to Receive Treatment
Patients seeking treatment from a healthcare facility have a right to receive treatment from the facility regardless of the individuals ability to pay if the patient seeks services from the emergency room. According to the Consolidated Omnibus Reconciliation Act of 1985, a hospital cannot withhold treatment from a patient if the condition is severe enough that the absence of medical attention could result in impairment of bodily function or physiological worsening of preexisting condition or illness. Time that is wasted seeking health facilities willing to treat a patient with no insurance and a complex medical condition contributes to the individual’s material deterioration of health and well-being.
The Ethic of First Do No Harm
All physicians, especially new providers, must consider the code of’ ‘First Do No Harm’ as they pledge the Hippocratic Oath. Some scenarios pose a challenge in the application of the pledge. A patient with a complex illness or condition may not benefit from a course of treatment, which could result in a negative and preventable outcome. If First Do No Harm is taken literally, many patients would not receive treatment at all because laboratory tests and other diagnostic procedures would not be performed since these actions do present a small risk of harm to the patient. Physicians must consider multiple aspects of the patients’ needs and available resources.
The practical interpretation physicians are most likely to follow is the consideration of all methods of treatments whose benefits outweigh the risks. When physicians encounter patients with a serious diagnosis of inoperable cancer or irreversible brain damage, the latest revision of the physician ethics recommends shared decision making processes between doctors and family members and to establish communication with families who have experienced similar situations as a means of offering support along with palliative care to make the patient comfortable instead of treatment that may carry unforeseeable risks of harming the patient. Extending an offer of supportive care is the least hospitals can do other than turning patients away without offering an alternate course of care for the patient or other health resources for the family to investigate while hospitals consider the ethics as a separate matter from the issue of being insured.
Double Effect Ethics
Double Effect Ethics is a doctrine in which an action perceived as morally good can produce two outcomes, one of which is negative. The ethics of the act is not considered bad if the negative outcome was not intentional. The doctrine is associated with the ongoing medical debate of physician assisted suicide Jack Kevorkian brought to national attention through his cases of enabling patients to end their suffering from debilitating, terminal diseases. Another example of double effect ethics is the case of Marlise Munoz who was kept alive on life support to save her baby even though she was brain dead and had left directives not to stay on life support. Doctors and hospitals who believe a patient’s condition is beyond help may think any attempt to help the patient may be just as harmful as not accepting the patient. The final outcome, in either case, will not lead to the patient’s full recovery regardless of financial, moral or in some cases, the legal wishes of the patient and family. Uncertainty involving advanced care directives can be resolved through consultation with the institution’s ethics committee instead of an immediate denial of care. Turning away patients without offering any alternatives or ignoring advanced directives is the worst possible result of all medical ethics.
Faith Based and Non-Profit Health Systems
Health Institutions such as non-profit and hospitals based on certain religious principles have in the past served as a bridge in the gap between the underserved and healthcare access. Over the years however, these institutions have faced increasing difficulty between maintaining financial sustainability versus the original commitment to serve the populations who would have no other means to access healthcare services. Even with Healthcare reform and the Affordable Care Act, many of these hospitals have had to forego technological advancements or shift health activities towards community screenings, blood drives, or educational health events in order to retain their tax-exempt status and their commitment to the founding principles of the institution’s mission of caring for those who cannot access health services from private institutions. Other hospitals have adjusted to the changes in the healthcare industry through mergers or forming partnerships with other health systems. The safety net role of non-profit health systems depends significantly upon government programs, private donations, and state subsidized services. In spite of the financial burden non-profit health institutions carry to provide services to the uninsured, the mission of caring for the needy remains strong and intact. Help is just over the horizon in the form of a new model of health service delivery that has slowly evolved in the wake of escalating medical costs and increasing number of uninsured Americans.
Volunteer Health Models
The participants in Volunteer Health Models not only volunteer their medical expertise, but may also go as far as providing transportation to appointments, shopping, or social and recreational activities.Laypersons who want to volunteer time to healthcauses can answer clinic hotline phones,distribute health education materials. and deliver hot meals to seniors.These efforts enhances the health of the participant and recipient in a volunteer health model.
This type of healthcare delivery would reduce wait times patients endure to make appointments with larger health systems, particularly for veterans whose primary complaints are about the inability to make timely appointments with VA hospitals. Underlying health problems could be detected earlier through volunteer health services as opposed to waiting days or weeks for a diagnosis through a traditional health system. Emergency rooms would not be congested with uninsured patients and stress levels for hospital staff would also decrease. Some volunteer health models are sponsored by larger nonprofit groups to help with long-distance transportation needs, but the concept of helping those in need without regard to costs is still the primary focus of delivering healthcare to the uninsured.
National Association of Free and Charitable Clinics
National Association of Free and Charitable Clinics is an organization dedicated to preventing the uninsured from falling through the cracks of the nation’s health system. The organization is comprised of over thirteen hundred clinics and pharmacies that donate services to economically disadvantaged populations that do not have access to healthcare services. The volunteer model of healthcare delivery operates on the foundation of giving back to society through meaningful service and promotion of learning and training through volunteerism. The participating clinics do not receive any type of financial support from health or government related entities.
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