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=                      Philosophy of healthcare                      =
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                            Introduction
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The philosophy of healthcare is the study of the ethics, processes,
and people which constitute the maintenance of health for human
beings. (Although veterinary concerns are worthy to note, the body of
thought regarding their methodologies and practices is not addressed
in this article.) For the most part, however, the philosophy of
healthcare is best approached as an indelible component of human
social structures. That is, the societal institution of healthcare can
be seen as a necessary phenomenon of human civilization whereby an
individual continually seeks to improve, mend, and alter the overall
nature and quality of their life. This perennial concern is especially
prominent in modern political liberalism, wherein health has been
understood as the foundational good necessary for public life.

The philosophy of healthcare is primarily concerned with the following
elemental questions:

*Who requires and/or deserves healthcare? Is healthcare a fundamental
right of all people?
*What should be the basis for calculating the cost of treatments,
hospital stays, drugs, etc.?
*How can healthcare best be administered to the greatest number of
people?
*What are the necessary parameters for clinical trials and quality
assurance?
*Who, if anybody, can decide when a patient is in need of "comfort
measures" (allowing a natural death by providing medications to treat
symptoms related to the patient's illness)?

However, the most important question of all is 'what is health?'.
Unless this question is addressed any debate about healthcare will be
vague and unbounded. For example, what exactly is a health care
intervention? What differentiates healthcare from engineering or
teaching, for example? Is health care about 'creating autonomy' or
acting in people's best interests? Or is it always both? A
'philosophy' of anything requires baseline philosophical questions, as
asked, for example, by philosopher
[https://books.google.com/books?id=RvGXLF3uxd0C&printsec=frontcover&dq=d
avid+seedhouse+health+the+foundations+for+achievement&source=bl&ots=f2lw
AOsSnz&sig=m1x991yrTldDBtju1BzbZIKTQUU&hl=en&ei=3y-mTMycK5TEsAPHsMT-
Dg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBkQ6AEwAA#v=
onepage&q&f=false
David Seedhouse].

Ultimately, the purpose, objective and meaning of healthcare
philosophy is to consolidate the abundance of information regarding
the ever-changing fields of biotechnology, medicine, and nursing. And
seeing that healthcare typically ranks as one of the largest spending
areas of governmental budgets, it becomes important to gain a greater
understanding of healthcare as not only a social institution, but also
as a political one. In addition, healthcare philosophy attempts to
highlight the primary movers of healthcare systems; be it nurses,
doctors, allied health professionals, hospital administrators, health
insurance companies (HMOs and PPOs), the government (Medicare and
Medicaid), and lastly, the patients themselves.


                        Ethics of healthcare
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The ethical and/or moral premises of healthcare are complex and
intricate. To consolidate such a large segment of moral philosophy, it
becomes important to focus on what separates healthcare ethics from
other forms of morality. And on the whole, it can be said that
healthcare itself is a "'special'" institution within society. With
that said, healthcare ought to "be treated differently from other
social goods" in a society. It is an institution of which we are all a
part whether we like it or not. At some point in every person's life,
a decision has to be made regarding one's healthcare. Can they afford
it? Do they deserve it? Do they need it? Where should they go to get
it? Do they even want it? And it is this last question which poses the
biggest dilemma facing a person. After weighing all of the costs and
benefits of her healthcare situation, the person has to decide if the
costs of healthcare outweigh the benefits. More than basic economic
issues are at stake in this conundrum. In fact, a person must decide
whether or not their life is ending or if it is worth salvaging. Of
course, in instances where the patient is unable to decide due to
medical complications, like a coma, then the decision must come from
elsewhere. And defining that "elsewhere" has proven to be a very
difficult endeavor in healthcare philosophy.


Medical ethics
================
Whereas bioethics tends to deal with more broadly-based issues like
the consecrated nature of the human body and the roles of science and
technology in healthcare, medical ethics is specifically focused on
applying ethical principles to the field of medicine. Medical ethics
has its roots in the writings of Hippocrates, and the practice of
medicine was often used as an example in ethical discussions by Plato
and Aristotle. As a systematic field, however, it is a large and
relatively new area of study in ethics. One of the major premises of
medical ethics surrounds "the development of valuational measures of
outcomes of health care treatments and programs; these outcome
measures are designed to guide health policy and so must be able to be
applied to substantial numbers of people, including across or even
between whole societies." Terms like beneficence and non-maleficence
are vital to the overall understanding of medical ethics. Therefore,
it becomes important to acquire a basic grasp of the varying dynamics
that go into a doctor-patient relationship.


Nursing ethics
================
Like medical ethics, nursing ethics is very narrow in its focus,
especially when compared to the expansive field of bioethics. For the
most part, "nursing ethics can be defined as having a two-pronged
meaning," whereby it is "the examination of all kinds of ethical and
bioethical issues from the perspective of nursing theory and
practice." This definition, although quite vague, centers on the
practical and theoretical approaches to nursing. The American Nurses
Association (ANA) endorses an ethical code that emphasizes "values"
and "evaluative judgments" in all areas of the nursing profession. The
importance of values is being increasingly recognized in all aspects
of healthcare and health research. And since moral issues are
extremely prevalent throughout nursing, it is important to be able to
recognize and critically respond to situations that warrant and/or
necessitate an ethical decision.


Business ethics
=================
Balancing the cost of care with the quality of care is a major issue
in healthcare philosophy. In Canada and some parts of Europe,
democratic governments play a major role in determining how much
public money from taxation should be directed towards the healthcare
process. In the United States and other parts of Europe, private
health insurance corporations as well as government agencies are the
agents in this precarious life-and-death balancing act. According to
medical ethicist Leonard J. Weber, "Good-quality healthcare means
cost-effective healthcare," but "more expensive healthcare does not
mean higher-quality healthcare" and "certain minimum standards of
quality must be met for all patients" regardless of health insurance
status. This statement undoubtedly reflects the varying thought
processes going into the bigger picture of a healthcare cost-benefit
analysis. In order to streamline this tedious process, health
maintenance organizations (HMOs) like BlueCross BlueShield employ
large numbers of actuaries (colloquially known as "insurance
adjusters") to ascertain the appropriate balance between cost,
quality, and necessity in a patient's healthcare plan. A general rule
in the health insurance industry is as follows: This generalized rule
for healthcare institutions "is perhaps one of the best expressions of
the practical meaning of stewardship of resources," especially since
"the burden of proof is on justifying the more expensive intervention,
not the less expensive one, when different acceptable treatment
options exist." And lastly, frivolous lawsuits have been cited as
major precipitants of increasing healthcare costs.


                 Political philosophy of healthcare
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In the political philosophy of healthcare, the debate between
universal healthcare and private healthcare is particularly
contentious in the United States. In the 1960s, there was a plethora
of public initiatives by the federal government to consolidate and
modernize the U.S. healthcare system. With Lyndon Johnson's Great
Society, the U.S. established public health insurance for both senior
citizens and the underprivileged. Known as Medicare and Medicaid,
these two healthcare programs granted certain groups of Americans
access to adequate healthcare services. Although these healthcare
programs were a giant step in the direction of socialized medicine,
many people think that the U.S. needs to do more for its citizenry
with respect to healthcare coverage. Opponents of universal healthcare
see it as an erosion of the high quality of care that already exists
in the United States.


Patients' Bill of Rights
==========================
In 2001, the U.S. federal government took up an initiative to provide
patients with an explicit list of rights concerning their healthcare.
The political philosophy behind such an initiative essentially blended
ideas of the Consumers' Bill of Rights with the field of healthcare.
It was undertaken in an effort to ensure the quality of care of all
patients by preserving the integrity of the processes that occur in
the healthcare industry. Standardizing the nature of healthcare
institutions in this manner proved provocative. In fact, many interest
groups, including the American Medical Association (AMA) and Big
Pharma came out against the congressional bill. Basically, having
hospitals provide emergency medical care to anyone, regardless of
health insurance status, as well as the right of a patient to hold
their health plan accountable for any and all harm done proved to be
the two biggest stumbling blocks for the bill. As a result of this
intense opposition, the initiative eventually failed to pass Congress
in 2002.


Health insurance
==================
Health insurance is the primary mechanism through which individuals
cover healthcare costs in industrialized countries. It can be obtained
from either the public or private sector of the economy. In Canada,
for example, the provincial governments administer public health
insurance coverage to citizens and permanent residents. According to
Health Canada, the political philosophy of public insurance in Canada
is as follows: And the driving force behind such a political
philosophy in Canada was democratic socialist politician Tommy
Douglas.

Contrasting with the U.S., but similar to Canada, Australia and New
Zealand have universal healthcare systems known as Medicare and ACC
(Accident Compensation Corporation), respectively.

Australian Medicare originated with Health Insurance Act 1973. It was
introduced by Prime Minister (PM) Gough Whitlam's Labor Government,
and was intended to provide affordable treatment by doctors in public
hospitals for all resident citizens. Redesigned by PM Bob Hawke in
1984, the current Medicare system permits citizens the option to
purchase private health insurance in a two-tier health system.


                      Research and scholarship
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Considering the rapid pace at which the fields of medicine and health
science are developing, it becomes important to investigate the most
proper and/or efficient methodologies for conducting research. On the
whole, "the primary concern of the researcher must always be the
phenomenon, from which the research question is derived, and only
subsequent to this can decisions be made as to the most appropriate
research methodology, design, and methods to fulfill the purposes of
the research." This statement on research methodology places the
researcher at the forefront of his findings. That is, the researcher
becomes the person who makes or breaks his or her scientific inquiries
rather than the research itself. Even so, "interpretive research and
scholarship are creative processes, and methods and methodology are
not always singular, 'a priori', fixed and unchanging." Therefore,
viewpoints on scientific inquiries into healthcare matters "will
continue to grow and develop with the creativity and insight of
interpretive researchers, as they consider emerging ways of
investigating the complex social world."


Clinical trials
=================
Clinical trials are a means through which the healthcare industry
tests a new drug, treatment, or medical device. The traditional
methodology behind clinical trials consists of various phases in which
the emerging product undergoes a series of intense tests, most of
which tend to occur on interested and/or compliant patients. The U.S.
government has an established network for tackling the emergence of
new products in the healthcare industry. The Food and Drug
Administration (FDA) does not conduct trials on new drugs coming from
pharmaceutical companies. Along with the FDA, the National Institutes
of Health sets the guidelines for all kinds of clinical trials
relating to infectious diseases. For cancer, the National Cancer
Institute (NCI) sponsors a series or cooperative groups like CALGB and
COG in order to standardize protocols for cancer treatment.


Quality assurance
===================
The primary purpose of quality assurance (QA) in healthcare is to
ensure that the quality of patient care is in accordance with
established guidelines. The government usually plays a significant
role in providing structured guidance for treating a particular
disease or ailment. However, protocols for treatment can also be
worked out at individual healthcare institutions like hospitals and
HMOs. In some cases, quality assurance is seen as a superfluous
endeavor, as many healthcare-based QA organizations, like QARC, are
publicly funded at the hands of taxpayers. However, many people would
agree that healthcare quality assurance, particularly in the areas
cancer treatment and disease control are necessary components to the
vitality of any legitimate healthcare system. With respect to quality
assurance in cancer treatment scenarios, the Quality Assurance Review
Center (QARC) is just one example of a QA facility that seeks "to
improve the standards of care" for patients "by improving the quality
of clinical trials medicine."


Reproductive rights
=====================
The ecophilosophy of Garrett Hardin is one perspective from which to
analyze the reproductive rights of human beings. For the most part,
Hardin argues that it is immoral to have large families, especially
since they do a disservice to society by consuming an excessive amount
of resources. In an essay titled 'The Tragedy of the Commons', Hardin
states, By encouraging the freedom to breed, the welfare state not
only provides for children, but also sustains itself in the process.
The net effect of such a policy is the inevitability of a Malthusian
catastrophe.

Hardin's ecophilosophy reveals one particular method to mitigate
healthcare costs. With respect to population growth, the fewer people
there are to take care of, the less expensive healthcare will be. And
in applying this logic to what medical ethicist Leonard J. Weber
previously suggested, less expensive healthcare does not necessarily
mean poorer quality healthcare.


Birth and living
==================
The concept of being "'well-born'" is not new, and may carry racist
undertones. The Nazis practiced eugenics in order to cleanse the gene
pool of what were perceived to be unwanted or harmful elements. This
"race hygiene movement in Germany evolved from a theory of Social
Darwinism, which had become popular throughout Europe" and the United
States during the 1930s. A German phrase that embodies the nature of
this practice is 'lebensunwertes Leben' or "life unworthy of life."

In connection with healthcare philosophy, the theory of natural rights
becomes a rather pertinent subject. After birth, man is effectively
endowed with a series of natural rights that cannot be banished under
any circumstances. One major proponent of natural rights theory was
seventeenth-century English political philosopher John Locke. With
regard to the natural rights of man, Locke states, Although partially
informed by his religious understanding of the world, Locke's
statement can essentially be viewed as an affirmation of the right to
preserve one's life at all costs. This point is precisely where
healthcare as a human right becomes relevant.

The process of preserving and maintaining one's health throughout life
is a matter of grave concern. At some point in every person's life,
his or her health is going to decline regardless of all measures taken
to prevent such a collapse. Coping with this inevitable decline can
prove quite problematic for some people. For Enlightenment philosopher
René Descartes, the depressing and gerontological implications of
aging pushed him to believe in the prospects of immortality through a
wholesome faith in the possibilities of reason.


Death and dying
=================
One of the most basic human rights is the right to live, and thus,
preserve one's life. Yet one must also consider the right to die, and
thus, end one's life. Often, religious values of varying traditions
influence this issue. Terms like "mercy killing" and "assisted
suicide" are frequently used to describe this process. Proponents of
euthanasia claim that it is particularly necessary for patients
suffering from a terminal illness. However, opponents of a self-chosen
death purport that it is not only immoral, but wholly against the
pillars of reason.

In a certain philosophical context, death can be seen as the ultimate
existential moment in one's life. Death is the deepest cause of a
primordial anxiety ('Die Anfechtung') in a person's life. In this
emotional state of anxiety, "the Nothing" is revealed to the person.
According to twentieth-century German philosopher Martin Heidegger,
And thus, for Heidegger, humans finds themselves in a very precarious
and fragile situation (constantly hanging over the abyss) in this
world. This concept can be simplified to the point where at bottom,
all that a person has in this world is his or her Being. Regardless of
how individuals proceed in life, their existence will always be marked
by finitude and solitude. When considering near-death experiences,
humans feels this primordial anxiety overcome them. Therefore, it is
important for healthcare providers to recognize the onset of this
entrenched despair in patients who are nearing their respective
deaths.

Other philosophical investigations into death examine the healthcare's
profession heavy reliance on science and technology (SciTech). This
reliance is especially evident in Western medicine. Even so, Heidegger
makes ang allusion to this reliance in what he calls the allure or
"character of exactness." In effect, people are inherently attached to
"exactness" because it gives them a sense of purpose or reason in a
world that is largely defined by what appears to be chaos and
irrationality. And as the moment of death is approaching, a moment
marked by utter confusion and fear, people frantically attempt to
pinpoint a final sense of meaning in their lives.

Aside from the role that SciTech plays in death, palliative care
constitutes a specialized area of healthcare philosophy that
specifically relates to patients who are terminally ill. Similar to
hospice care, this area of healthcare philosophy is becoming
increasingly important as more patients prefer to receive healthcare
services in their homes. Even though the terms "palliative" and
"hospice" are typically used interchangeably, they are actually quite
different. As a patient nears the end of his life, it is more
comforting to be in a private home-like setting instead of a hospital.
Palliative care has generally been reserved for those who have a
terminal illness. However, it is now being applied to patients in all
kinds of medical situations, including chronic fatigue and other
distressing symptoms.


                          Role development
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The manner in which nurses, physicians, patients, and administrators
interact is crucial for the overall efficacy of a healthcare system.
From the viewpoint of the patients, healthcare providers can be seen
as being in a privileged position, whereby they have the power to
alter the patients' quality of life. And yet, there are strict
divisions among healthcare providers that can sometimes lead to an
overall decline in the quality of patient care. When nurses and
physicians are not on the same page with respect to a particular
patient, a compromising situation may arise. Effects stemming from a
"gender gap" between nurses and doctors are detrimental to the
professional environment of a hospital workspace.


                              See also
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*Ethical problems using children in clinical trials
*Ethics of circumcision
*Catholic Church and health care
*Philosophy of medicine


                           External links
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* [http://www.iep.utm.edu/h-c-ethi/ Health Care Ethics] article in the
'Internet Encyclopedia of Philosophy'
*[https://web.archive.org/web/20080414202540/http://democrats.senate.gov/pbr/sum
mary.html
Summary of the McCain-Edwards-Kennedy Patients' Bill of Rights]
*[http://www.clinicaltrials.gov/ct2/info/understand Understanding
Clinical Trials]
*[http://www.cancer.gov/aboutnci/overview/mission Mission Statement of
the National Cancer Institute (NCI)]
*[http://www.fda.gov/cder/guidance/7086fnl.htm Guidance for Industry,
Investigators, and Reviewers in Exploratory Drug Studies (FDA January
2006)]
*[http://www.qarc.org/ Quality Assurance Review Center]
*[http://www.capc.org/palliative-care-across-the-continuum/
"Palliative Care across the Continuum" (Center to Advance Palliative
Care)]
*[http://www.cms.hhs.gov/center/hospice.asp "Hospice Care Center"
Centers for Medicare and Medicaid Services (CMS)]
*[https://www.un.org/Overview/rights.html "Universal Declaration of
Human Rights (UDHR)" (United Nations)]
*[http://www.medicare.gov/Default.asp Medicare (The Official U.S.
Government Site for People with Medicare)]
*[http://www.ssa.gov/history/briefhistory3.html Historical Background
and Development of Social Security; includes information about
Medicare]


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