Health Inequalities and Health Inequities

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Course Learning Outcomes for Unit VIII Upon completion of this unit, students should be able to:

1. Critique arguments related to the impact of social factors that influence the U.S. health care system.

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.

3. Evaluate the impact of commonly accepted business principles used to create an equitable health care system.

4. Summarize the differences between various health care providers.

5. Explain the impact of technology on the health care industry.

6. Summarize the government’s impact on health care regulations and reform.

7. Discuss common ethical principles applied to critical bioethical issues.

8. Outline common management procedures that affect health care organizations’ strategic goals.

8.1 Discuss ethical models and how they are applied in health care organizations. 8.2 Review new technologies that could be applicable to health care.

Course/Unit

Learning Outcomes Learning Activity

1 Final Exam 2 Final Exam 3 Final Exam 4 Final Exam 5 Final Exam 6 Final Exam 7 Final Exam

8.1, 8.2 Unit Lesson Chapter 16 Final Exam

Required Unit Resources Chapter 16: Looking Toward the Future Unit Lesson In this unit, we will learn about the future of health care as new technologies are implemented. We will also cover the ethics surrounding the use of new health care technologies. Specifically, we will learn about the ethic of care model and the narrative model of ethics.

Ethics of Care Model In the 1980s, the ethics of care model grew from moral development research done by feminist Carol Gilligan. The ethics of care model focuses on the entire picture, specifically the relationships and context in decision- making (Morrison & Furlong, 2019). The use of this model has been popular with health care providers,

UNIT VIII STUDY GUIDE Looking Toward Health Care Ethics in the Future

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specifically women and nurses. The ethics of care model depicts moral agents as interconnected, dependent, vulnerable, and in asymmetric ways (Pettersen, 2011). Care is the normative core of the ethics of care model and is a normative value that is related to the ideal of not inflicting harm and aiming at preventing harm. The ethics of care model can be displayed as the combining of the ethical principle of non-maleficence and the principle of beneficence. Therefore, the normative value of care is related to promoting good (Pettersen, 2011).

Narrative Ethics Model The narrative ethics model was derived from the biopsychosocial medicine and patient-centered medicine models. The narrative ethics model is a model for health care practice that proposes an ideal of care and then provides practical and conceptual meaning to strive to that ideal (Charon, 2001). It has gained increased components in the last two decades (Morrison & Furlong, 2019). Narrative medicine looks specifically at the personal connections between the patients and the health care providers and incorporates the illness, the meaning of the health care practice for the providers, the health care providers’ collective profession of their ideals, and health care’s discourse with society (Charon, 2001). The narrative ethics model helps health care providers to improve the effectiveness of their medical practices through their work with the public, colleagues, patients, and themselves. Narrative knowledge is also applied to the fields of nursing, history, philosophy, law, anthropology, religious studies, government, and sociology. Narrative knowledge is understanding the true significance and meaning of stories through symbolic, cognitive, and affective means. In health care, this can be applied by providing a comprehensive picture of a person (the patient’s) lifestyle and situation. In health care, there are several narratives that apply: the patient and the health care provider, the health care provider and colleagues, the health care provider and society, and the health care provider and him or herself (Charon, 2001). So, what exactly is a narrative? In the health care setting, it is the story or state of affairs that a person has to tell. The patient recounts (narrates) his or her acts, set of events, etc. to the health care provider. As the health care provider listens to the patient’s narrative, he or she is often entered into and moved by the narrative of the patient (Charon, 2001). Stories are an important part of the narrative ethics model. Seen daily in the health care profession through research, teaching, academia, and patient care are the works of narratives. Having health care providers who are aware of the narrative aspects of their health care practices and ethical practices ultimately makes for a better care team (Jones, 1999).

Emergent Technologies and Ethics Health care providers need to follow medical ethics, but sometimes advances in technologies make it difficult. The University of Notre Dame’s John J. Reilly Center for Science, Technology, and Values announced a list of emerging ethical dilemmas in science and technology on a yearly basis until 2018. It is now published by Dr. Jessica Baron, formerly of the John J. Reilly Center for Science, Technology, and Values (Tech Top 10, 2018). The published list from 2019 contains a few items related to health care.

• Insect allies is creating genetically modified insects to deliver viruses to plants. This is ethically questionable as it brings about a new biotechnology regarding sticking new genes into things to make changes in the way that a person wants. Viruses are used frequently in this process.

• Seeding trials are clinical trials that are not to find the efficacy of a pharmaceutical drug but to suggest new uses to health care providers so there is scientific data to support off-label usage. This is basically a trial designed solely for marketing purposes.

• DIY neurohacking involves an at-home device to zap one’s brain in hopes of improving cognitive function. This includes obvious dangers.

If you would like to further explore the list of ethical dilemmas and policy issues in science and technology, take a look at the Tech Top 10 website.

Complementary and Alternative Medicine and Ethics

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Complementary therapies have many different names: alternative medicine, complementary and alternative medicine, integrated health care, or integrative medicine. Over the past couple of decades, alternative medicine use has grown. Complementary therapies have become an important arena within health care. Complementary therapies have a high level of acceptance in the overall population, and this can present challenges to health care professionals as well as raise ethical issues (Ernst et al., 2004). There are three ethical issues surrounding complementary therapies: safety, scope of practice, and cultural diversity. Safety, the first ethical issue, refers to the degree of safeness that complementary therapies have or lack. There are thousands of complementary therapies; many of which lack regulation through the Food and Drug Administration (Silva & Ludwick, 2001). The second ethical issue surrounds the scope of practice. If a complementary therapy is to be used within a nursing practice, does the nurse have the competence to administer the therapy and not violate standards of practice? If scope of practice is not clear to the patient and the health care provider, then harm is likely to occur. The third ethical issue is cultural diversity. The United States is becoming more and more culturally diverse. With this growth, health care staff needs to make sure they are culturally competent and nonjudgmental of a patient’s history in using complementary therapies. The health care team also needs to be sensitive to the ethical principle of justice (Silva & Ludwick, 2001). Health care providers are becoming more receptive to complementary therapies, and the therapies have gained attention in the mainstream media due to patients’ interest in their own health, well-being, and prevention (Morrison & Furlong, 2019). Health care providers are also now learning more about complementary therapies in their schooling, and there are research institutions that are actively researching complementary therapies applied to health care.

References Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. Journal of the

American Medical Association, 286(15), 1897–1902. https://jamanetwork.com/journals/jama/fullarticle/194300

Ernst, E., Cohen, M. H., & Stone, J. (2004). Ethical problems arising in evidence based complementary and

alternative medicine. Journal of Medical Ethics, 30(2), 156–159. https://jme.bmj.com/content/30/2/156.full

Jones, A. H. (1999). Narrative based medicine: narrative in medical ethics. British Medical Journal,

318(7178), 253–256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114730/ Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning. Pettersen, T. (2011). The ethics of care: Normative structures and empirical implications. Health Care

Analysis, 19(1), 51–64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037474/ Silva, M. C., & Ludwick, R. (2001). Ethics: Ethical issues in complementary/alternative therapies. Online

Journal of Issues in Nursing, 7(1). http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Et hics/EthicalIssues.html

Tech Top 10. (2018). Home. http://reillytop10.com/