Module 6: Signature Assignment - My Growth as a Moral Agent

Brian Davis

Jun 1, 2021Jun 1 at 10:13am

This was an interesting case study. It has all the necessary plot devices for quite the drama that it actually was. I will try to keep this short but sweet. First off, we have the important stakeholders. We have the woman that was pregnant. She is a 19 year old woman from a poor area of India. She is pregnant for the first time, and her jewelry and clothing suggest she is married, and has very traditional Indian values. She really wants to have her baby in her home village, which is a overnights distance away from where she is currently living. Another major stakeholder is the government program that offers a cash payment to women to have to have the babies institutionally over home delivery. I don't think they have any cultural perspectives into the situation. Some other stakeholders are the woman's husband and her family. First we have her mother in-law, who is insists that the delivery take place in their district institution. Her parents are involved. They feel that the in-laws only motivation is greed, and they fully support their daughter. From a cultural perspective, they support their daughter, and that is their primary motivation. Another main stakeholder is the woman's husband. He along with his parents seem to be only motivated by greed, and don't seem to care at all about anything cultural. She decided to disobey her husband, and go have her baby in her home village. Unfortunately, she went into labor on the road, and lost her baby due to complications in the delivery.

It is my belief that the program should be eliminated, as we see what happens here. When there is money involved, some people tend to take a blind eye to what is the right thing to do. If this program was not in existence, this probably would not have happened. The woman and her husband would have done the right thing for their child, instead of the husband only looking at the dollar signs in his head. The implications are that the couple lost their baby due to secrets ad lies.

I feel strongly that in this case, the government should support people that want to have this type of labor and delivery, especially in a country like India. Offering money for people to have babies in a public institution really to me serves no purpose.

References:

Barrett, D. H., Ortmann, L. W., Dawson, A., Saenz, C., Reis, A., & Bolan, G. (2016). Public health ethics: Cases spanning the globe. Springer.

Edited by Brian Davis on Jun 1 at 10:15am

Collapse Subdiscussion Jesica Banda

Jesica Banda

Jun 2, 2021Jun 2 at 11:03pm

Brian,

I considered the spouse and in-laws to be stakeholders but did not list them in my post. This was because I placed greater importance on the stakeholders that are directly involved with the Janani Suraksha Yojana cash incentive. I should have included the family as they contribute to the cultural aspect of this discussion.

I see your point, initially I believed eliminating the program would not be beneficial since there has been improvement . Considering there has been a decline in progress, perhaps altering the program may be beneficial. I understand the cultural issues and split amongst spouses that may occur and that the mother's most likely will not have a say or be able to use the incentive but there has been improvement and to eliminate the program completely may not be the best option.

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Dillon Dinh

Jun 5, 2021Jun 5 at 10:20pm

Hey Brian,

Good job on this discussion. Although I can see your point about eliminating the program and how money can be a huge driving force towards people only wanting to give birth at institutions. However I believe eliminating the program entirely will not be good and have negative effects. Eliminating the program will lead to more people giving birth at their homes without any medical equipment and individuals that are specialized in delivering. This will increase the chance of infant mortality and of the mother passing away due to complications during birth. Giving birth at an institution is more safe for everyone although I think the government should do more to respect the cultures and traditions set for many generations now.

Collapse Subdiscussion Latona Bates

Latona Bates

Jun 6, 2021Jun 6 at 11:13pm

Hello Brian,

Great Post Brian. I considered the in-laws to be stakeholders as well even though they were not list in the case. I have to have blanketed the circle of relatives as they make a contribution to the cultural factor of this dialogue. I don't believe that the program should be eliminated. I know when there is money involved yes many people tend to close there eyes. I see your factor, initially I believed getting rid of this system might not be beneficial on the grounds that there has been improvement . Considering there was a decline in development, possibly changing this system may be useful. I apprehend the cultural problems and break up among spouses that may arise and that the mother's maximum probably will now not have a say or be able to use the incentive however there has been development and to do away with the program completely may no longer be the best option.

Collapse Subdiscussion Latona Bates

Latona Bates

Jun 2, 2021Jun 2 at 8:04pm

Collapse Subdiscussion Jesica Banda

Step 1: Analyze the Ethical Dimensions of the Public Health Issue and Context

· Who are the main stakeholders and what values and cultural perspectives does each stakeholder bring to this situation?

The principal stakeholders in this care are the parents of the 19-year-old, the 19-year-old vintage lady, the government and her in-laws (Barrett et al., 2016). The 19-year-old antique girl and her mother and father are firm followers of the traditional values of their subculture which insists that women need to deliver at home. Her in-laws are open to new values and views and embody the new program by the government for encouraging ladies to deliver in hospitals, an attitude that the lady’s mother and father are opposing. Since the government became conscious about the dangers of delivering a baby at home, they decide to introduce an incentive program for encouraging poor girls to deliver in institutions instead of their gong along with their traditional believes of having their babies at home.

· What role should the government play in improving the public's health?

I feel in this case that the government should provide you with public health guidelines for improving the public’s health. The government should also give you programs for educating the general public on healthy ways of living and why the general public ought to embrace fitness applications by means of the authorities. This is because humans may refuse to embrace government guidelines due to the fact, they are no longer privy to their advantages. These policies must no longer only involve incentives for selling healthy behaviors which include giving money to women to wait prenatal care and deliver in hospitals but additionally creating policies that discourage dangerous conduct inclusive of heavy taxation on gadgets like alcohol and cigarettes that are dangerous to human health (Barrett et al., 2016).

Step 2: Formulate Alternative Courses of Action and Evaluate their Ethical Dimensions

· What are the ethical implications of these options?

I strongly agree in this case, that if the government continues with this program the way it is so far, a few individuals will nonetheless now not get worried due to their cultural believes however there are nonetheless folks that will put it to use. If the program is removed, the government will have failed its duty for improving the health of its citizens and disadvantage a few contributors of the general public who could have benefitted from this system. The fine option could be to continue this system and try and clean the cultural friction inside the application by means of creating focus for the members of the general public. With time, the time will comprehend that the program is for their advantage and could embody it.

References:

Barrett, D. H., Ortmann, L. W., Dawson, A., Saenz, C., Reis, A., & Bolan, G. (2016). Public health ethics: Cases spanning the globe. Springer.

Edited by Latona Bates on Jun 2 at 9:36pm

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Jesica Banda

Jun 2, 2021Jun 2 at 11:16pm

Latona,

I also included the government as a stakeholder because without their support the Janani Suraksha Yojana cash incentive program would not exist. Since the program initially provided an increase in deliveries at a healthcare facility, research should be completed as to why a sudden decrease. My question would be, is the cultural matter the only issue or are there other reasons such as the two child limit a factor? Another factor to consider would be the quality of care provided. Are mothers afraid they are not going to receive quality care?

I feel educating the community and helping them understand the risks that are involved with traditional childbirth methods could influence their choice to deliver at a healthcare facility. I would agree to continue the program but only if action to smooth the cultural friction in the program was addressed otherwise eliminating the program would be the best option.

Brian Davis

Jun 3, 2021Jun 3 at 7:30pm

Latona,

I agree with what you are saying in regards to the government providing people with public health guidelines for improvement of the publics health. I think that money should be taken out of any incentives for the topic at hand. It seems that getting the message out to people in India is the main problem. With poverty and the sheer amount of people that live in India, I would think that it is easier said than done. Perhaps if some other type of incentive were to be thought up that would benefit people in a more helpful way over monetary way, the bad decisions that plagued the woman in this particular case study would not have happened.

The government here I do not think was really thinking about what is or was important to what they were trying to do. I do agree now that the program should be continued, and changes put in place to make it better for everyone involved.

Dillon Dinh

Jun 5, 2021Jun 5 at 10:25pm

Hi Latona,

I also believe that education will greatly increase and help public health. Having the necessary education is so important so that many people can make much better informed decisions. Education makes individuals make better decisions about everything in their life and showing the negative affects of unhealthy decisions is also important. I believe that the best option is to continue the system and try to reduce cultural friction as much as possible.

Collapse Subdiscussion Jesica Banda

Jesica Banda

Jun 2, 2021Jun 2 at 10:52pm

Step 1: Analyze the Ethical Dimensions of the Public Health Issue and Context

The stakeholders include the patient(mother), healthcare providers, healthcare facilities, and the government. The central government’s role in funding the program provides an opportunity for indigenous women to seek care outside their home. By doing so they are attempting to improve the maternal mortality ratio and decrease the rate of mortality. Healthcare providers are providing the care required to continue to improve the maternal mortality rate. Healthcare facilities are providing the needs for a safe delivery compared to an at home deliveries. The patient, by choosing the cash incentive are participating in the attempt to improve maternal mortality and improving the health status of the community.

The government is attempting to improve public health by providing the Janani Suraksha Yojana cash incentive. They should however include private practices since the goals is to lower the number of at home deliveries to improve the maternal mortality rate. I know costs could be an issue, but contracts can be provided to where the private practices are able to participate as long as they agree to contracted rates.

Step 2: Formulate Alternative Courses of Action and Evaluate their Ethical Dimensions

3. Continue the program as it is now.

To leave the program as it is now, would not be beneficial as the rates have declined. The program is not as effective due to limitations to providers and consumers. Expanding the options to private practices could help increase the numbers as some patients may prefer private practices. A change could be made to allow the incentive regardless of number of children since patients are eligible after two kids.

3. Continue the program, but only if action is taken to smooth the cultural friction in the program.

Continuing the program with consideration to the patient’s traditional culture might increase the effectiveness of the program. It would be a difficult task but educating communities with current statistics and providing the benefits of delivering in a healthcare facility may encourage them to consider a different delivery method to avoid loss.

3. Eliminate the program.

A portion of the population has considered the incentive and abandoned tradition. They may revert to tradition if the incentive is no longer an option, eliminating the program could pose a risk and cause for current progress to decline.

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Brian Davis

Jun 3, 2021Jun 3 at 7:40pm

Jesica,

Very well written, and thought out. I do agree with you regarding continuing the program as it was. To me, if it is just about money, then the benefits of it are lost, and greed becomes an unfortunate option. Making monetary incentives for healthcare to me is not a good option. I do also think that expanding the options is a good idea as well. Not being familiar with the healthcare systems in India, it would be something worthwhile looking into.

I also agree that continuing the program with cultural considerations is important, especially with the Indian cultures. Education is very important with public healthcare, and as we have seen in this country, sometimes people put political smokescreens above practical science. Its unfortunate that the woman and her family were not given better incentives for delivery in a healthcare facility.

At first, my thinking was eliminate the program, but after our team meeting this evening, I have seen that it would probably not be in the best interests of everyone to do that.

Collapse Subdiscussion Latona Bates

Latona Bates

Jun 6, 2021Jun 6 at 11:36pm

Hello Jesica,

This is an remarkable post. I do believe you regarding persevering with this system. Making economic incentives for healthcare to me isn't a very good choice. I don't think an incentive of money should be put into place when it comes to healthcare and also the quality of healthcare. I do additionally suppose that increasing the options is a superb concept as properly. Not being acquainted with the healthcare structures in India, it might be some thing that one would research.

I one hundred percent agree with you that continuing the program with cultural concerns is vital, in particular with the Indian cultures. Education may be very essential with public healthcare, and as we've got visible in this. I see now that every now and again people placed political blocks above sensible technological know-how. Its unlucky that the woman and her own family were not given higher incentives for delivery in a healthcare facility. This was a very interesting case study for me and it allowed me to definitely open my eyes. I look forward to next week study.

Brian Davis

Jun 5, 2021Jun 5 at 12:55pm

Discussion 3 – Team Decision

Step 3: Provide Justification for a Particular Public Health Decision

My teammates recommend the continuation of the program because despite the fact that it is clashing with the conventional values of the network, it's miles still useful to the public considering the fact that some will still embrace it. Continuing the program with consideration to the patient’s traditional culture might increase the effectiveness of the program. Ensuring the program is providing adequate healthcare to the public may be convincing and increase participation. In addition, altering the program to meet the needs of the mother to provide something more valuable to their health may be more convincing than a cash incentive.

The government should train the public about the advantages of the programs and with time many contributors of the general public will accept it and their health will maintain on improving. Remember it's miles the function of the authorities to enhance the health of its residents and casting off this system is compromising the health of the people.

As far as ethical principles, autonomy should be considered. One should be able to make decisions for themselves first and foremost. It seemed like the decision for where the woman was going to have her baby was made by others besides herself. Beneficence also should come into play, as what was more than likely in the best interests of the woman and her unborn baby was for her to have her baby in a hospital over having it at her home in her village.

This decision does not come lightly, as there are other factors involved. The things that the government should focus on are helping its people, first and foremost. A government health program should benefit everyone, not just those less fortunate. In this case, proper education of the public is the main thing that should be made the main point. When it’s about financial gain, then we think the message is completely lost, and people or the public will lose sight about what is really important, which is the newborn baby, and the health of its mother. Ethical principles for each culture are different, and these things all need to be taken into consideration.

Dillon Dinh

Jun 5, 2021Jun 5 at 8:54pm

The main stakeholders in this case study are the consumers, hospitals, and government. The consumers are the women who are pregnant are given the choice to give birth within an institution to help reduce the infant mortality rate in India. What values and cultural perspective that the women bring to this situation is that they are the ones that the program is focused on, especially poor women. By offering cash assistance with childbirth delivery and post delivery care. Cultural perspective that they bring is that of the sphere of their family and homes defines the lives of most women in India. Most childbirths in India are done at home due to the traditions and values placed. Because of this many women die due to complications during childbirth. The role that the government should be doing to improve public health in the situation is to provide the program they are doing while trying to work with cultural frictions and a traditions already set. This will improve the lives of many. they can do this by providing programs that include better vaccinations, education, health care, safe childbirth, sterilization, and poverty. By doing this many women will feel more comfortable giving birth in institutions with better care and have much higher chance of surviving and giving birth to a healthy child. Along with this women will be given money, maternal care, and specialized individuals during childbirth. The ethical implications of continuing the program as it is now and not changing anything is that there will be many more cases like the one described. Many women will continue to have to make a hard choice between giving birth at an institution or at home where it can be more risky. There are risk and harms of continuing like this. The ethical implications of continuing the program, but only if action is taken to smooth the cultural friction in the program is the best option. This will allow many more women and their families to be more comfortable with the program. The ethical implications of eliminating the program is not good because then the infant mortality rate will rise and many more women will be forced to give birth in their homes.

Dillon Dinh

Jun 5, 2021Jun 5 at 10:17pm

References:

Barrett, D. H., Ortmann, L. W., Dawson, A., Saenz, C., Reis, A., & Bolan, G. (2016). Public health ethics: Cases spanning the globe. Springer.