Ethics Review Procedure - Assignment Example

Ethics Review Procedure: Assignment One Implementing an ethical review policy is important in avoiding the type of tragedy depicted in the “Rainmaker” film, where an insurance company denies coverage for a critical operation that would have saved a man’s life. The inherent problem with a profit oriented or commercial healthcare system is that it is unequal, providing preferential care to patients with wealth and resources while devaluing the suffering of the poor who cannot afford critical care. In “Rainmaker,” the ethical conflict is dramatized to pose the question in stark moral terms, asking the audience directly to decide whether or not a company that denies treatment for an operation such as a bone-marrow transplant out of cost concerns in complicit in the death, or “manslaughter” of the insurance policy holder. (Cook, 2009) That the drama is set in legal terms only heightens the sense of conflict by dramatizing the need for a decision. Nevertheless, the sympathy of the audience is with the patient who needs treatment, and an evaluation of the reasons for audience sympathy with the character in the film can lead to a more just insurance and healthcare policy through the administration of ethical review boards. The first question developed in “Rainmaker” revolves around whether an insurance company or employer who sponsors an insurance policy as part of a staff benefits policy is guilty of “manslaughter” or even murder if they withhold treatment for vital services or operations out of concern for the financial costs. (Cook, 2009) A person with bone cancer or another disease may have a terminal pronouncement, leaving that person with a diminished expectation of lifespan. Assuming that the healthcare issue is not a result of workplace conditions, neither the employer nor the insurance company is technically at cause for the disease or illness of the worker. The insurance policy is a contract, and on this basis the employee or employer contributes regular payments to the firm in exchange for an agreed upon level of service. There are different costs dependent on the various levels of healthcare coverage, and a person may choose one of several plans that best fits the needs of his or her family. While this system may not be as just as a universal, free healthcare system, the for-profit model exists de facto in the United States, making opposition to that system a cause for political reform. In this regard, there can be no higher recourse than the terms of the contract which the parties agreed to when establishing the initial healthcare policy. Yet, “Rainmaker” also poses a second question to the audience, asking it to consider if there is not a higher law or justice beyond the legal framework of the healthcare insurance program, and under what circumstances or setting one can appeal to this higher power. In this example, the higher power is not strictly religious but more of a moral power that is based in humanity and shared subjectivity. In searching for a basis of common morality, the most fundamental source which is found across innumerable religious traditions is the “golden rule” of “do unto others as you would have them do unto you.” In this context, the injustice of the for-profit healthcare system is more obvious and becomes an affront to human nature and dignity. No one would want potentially lifesaving healthcare denied to them individually or personally because of financial condition or status of the insurance contract. As human beings, people feel an inherent need or instinct to help each other, and above all to save another life when it is at risk. People selflessly risk their own endangerment to save the innocent from drowning or a burning building, and so similarly common morality expects the healthcare system to operate with the same sense of urgency and importance given to every life. When these decisions become part of an immobile, unresponsive, and corrupt corporate bureaucracy serving its own interest of profit rather than saving lives, people find the situation and example morally offensive. The government in many ways shifts the responsibility for universal healthcare onto the employer or onto the worker, and makes the private sector bear the cost of a for-profit system of healthcare. Doctors are well respected in American society, but may earn over 10 times the salary of the average worker. The poor worker struggling paycheck to paycheck to support a family may be unable to afford the health insurance plan with the greatest number of benefits and full coverage. Similarly, small businesses may not be able to offer the most expansive level of benefits as they are already in a difficult economic environment. However, unless there is political support for universal healthcare on a widespread level in the electorate and their favored candidates, the popularly envisioned “free, universal” healthcare may not materialize. Nevertheless, when the audience of a film like “Rainmaker” views a moral conflict like the one depicted, they will not likely change their reaction if it is the government denying service or the corporation denying service. In both instances, the appeal to common morality and “the golden rule” suggests that the ill, infirm, and dying should always be helped and comforted. The moral sentiment does not pay sufficient taxes or give enough in charity to support free healthcare for every procedure demanded or requested, and because of this there needs to be some sort of review for treatments to be covered by these insurance policies. Similarly, the best solution for free, universal healthcare is a system where every person is equal, has the same rights, costs, and quality of treatment, and no one is denied life-saving procedures sue to economic discrimination. The U.S. electorate and its representatives have had repeated opportunity to enact an egalitarian, socialized healthcare program as countries such as Canada, the U.K., France, Sweden, etc. have done but they reject both the tax burden and the influence of government in socialized medicine. Consequently, with charitable contributions insufficient to bear the costs, there is inherent inequality. Blaming business for this is not correct, nor is it technically correct to blame the government. The people themselves, who failed to organize, enact, and reform a new healthcare system failed politically in their organization if free, universal healthcare is truly the ideal and morally correct position. The cost savings argument is generally hollow in justifying the denial of treatment, but when enshrined in law it cannot be effectively opposed unless the law is changed. Similarly, the ineffectiveness of treatment argument also falls short, because if this is a reason to deny treatment then all medicine would be seen to be pointless because everyone dies eventually in the end. Therefore, the main issue is inequality in society, and how to maintain common standards of human decency through ethics and moral concern. To alleviate these problems within the current political environment, a policy of “ethical review” is suggested with three levels of appeal available to the policyholder. If a healthcare procedure deemed critical to the patient is denied, the policyholder can first file an appeal to an ethical review officer who will conduct a background investigation on the case by contacting the doctor assigned to the case. The ethical review office should swiftly address the concerns of the individual in accordance with the terms of the policy, providing an exact report on why the healthcare was denied or the decision reversed. If the policyholder disputes this resolution, he or she should have the right to appeal before a counsel consisting of 1/3 workers from the company, 1/3 management, and 1/3 healthcare professionals. These meetings should be available twice per month to hear any cases that are appealed from the initial hearing. The committee should function as a “jury of peers” to consider the compassionate basis first and foremost as a request for treatment. In the last resort, the ethical review policy should include support for legal counsel or assistance if the policyholder wishes to appeal the decision in court. While this should be avoided in the majority of cases, the policy insures fairness on behalf of administration, in that budgetary support should be given not only to defend against claims or settlements, but also to challenge unjust decisions by advocating for the employees on a company basis. When the company is siding with the employees, workers, and staff as an advocate of their concerns, and not seeking to avoid payment of healthcare costs through legal litigation, the person suffering from illness can feel that at minimum the company has done the best on their personal behalf to resolve the situation justly. In summary, the employees need to be clearly educated on the differences in healthcare coverage provided by the different policies if the company offers tiered plans or lesser-cost coverage plans that do not include universal coverage. The company should be the advocate of the workers rather than the insurance company, and maintain this position of advocacy in all situations. The staff in charge of healthcare reviews and appeals should consider the fundamental aspects of moral concern and compassion in making their decisions, and this is based on the “golden rule” of shared-subjectivity. The balance between workers, management, and healthcare professionals on the review board should be rotating and not permanent, and these individuals should discuss any appeal directly to reach a consensus. While this does lead in some instances to privacy issues, there is no way to avoid a semi-public hearing on an issue of healthcare service appeal. This system should not be expected to solve every problem, but rather to unify the company in advocacy of the compassionate care and assistance for workers or former workers who are having difficulty navigating the legal landscape to receive healthcare treatment. The company should not base employee activism or political views as a subject for termination or demotion, but rather view the process as a manner to display exemplary corporate citizenship. This solution is similar to making the best for all involved in a complex and difficult situation, without changing the fact that the political issues are intractable and difficult to solve without a broader social resolve. Sources Cited: Cook, Dean (2009). John Grishams "The Rainmaker". DanCook.net, Saturday, May 30th, 2009. Retrieved from: http://www.deancook.net/2009/05/john-grishams-rainmaker.html Read More