Question

2. Dr. Harried is at work for another typical day. He is seeing 26 patients today. A few years ago a typical day would have been 22 patients but the ris- ing costs of his practice including the electronic medical record system he has put in place and the benefits package for his employees have forced him to see more patients. One year ago he stopped taking patients with one type of insurance because it was paying less than the others. M., the first patient of the day, presents with a sore knee. He is not sure what caused it. He is aged 38 and well. The exam is not helpful. An X-ray is ordered because his insurance does not cover an MRI. A return visit is ordered to discuss the X-ray results. A medication for inflammation is ordered. P, age 40, presents later in the day with a similar story. An MRI is ordered since it is covered by P's insurance (see Brody, 2010). Is Dr. Harried ordering based upon what the insurance will cover ethi- cal? Does Dr. Harried have a responsibility to decrease national health care spending or is his role only to treat his patients? 3. A debate erupts when Community Hospital announces that as a cost saving measure it will close its emergency room from 10:00 P.M. until 6:00 A.M. The hospital explains that it is in danger of going bankrupt, and its emergency room is a very expensive hospital department. Patients will

Answer 1

2. ANS: Dr. Harried have a responsibility which is not only limited to his patients but also to decrease national health care spending. In order to do so, he shouldn't prescribe cheap diagnosis, such as an X-ray in place of MRI. He should prescribe the required diagnosis to the patient and then let them decide (with his suggestion) which one would be better. If need be he can ask them to pay from their pocket but not compromise in the treatment. But Dr. Harried is ordering based upon what the insurance will cover, which is not ethical, because although a different kind of radiology test is required he is prescribing for something else, only what the insurance will cover.

3. ANS: In order to judge if the decision is ethical or not, we need to look at the ethical principles that guides the decision. If we consider principles such as beneficence, non-malfeasance, autonomy and justice, we can see that the decision is likely ethical. This is because; if the hospital goes bankrupt it will be worse for the greater good of the community. By restricting their working hours, they will however be able to serve certain part of the community. Thus overall, the decision is ethical. The community hospital is not guilty of indirect dumping. The decision to reduce the emergency room’s operation is due to maintain their own survival and to continue serving the community. The indigent patients will have a little more trouble in getting to a hospital 7 miles away and there may be challenges mainly for the poor. However, they could access the hospital transport such as ambulance to get to the state hospital. Considering last two arguments, the healthcare community should have prepared a way to fund the community hospital. Especially through volunteer programs or through fundraising activities that is specifically meant for the emergency room, they could probably solve the problem.

Healthcare professionals have an ethical duty towards the community and one of those duties is to prevent misdistribution of healthcare. Uneven spread of hospital location is one of those cases which cause misdistribution. However, healthcare professionals are limited by their access to resources and even if the will to prevent misdistribution exists, it may not be practically possible.