Few Issues For Contemplation And Discussion

Medical assistants will encounter ethical and bioethical issues across the lifespan. A few issues are identified for contemplation and discussion. Issues of bioethics common to every medical office are the allocation of scarce medical resources,

Infants:
In premature, deformed, or severely disabled babies, ethical issues include the decision to provide or withhold treatment. Health care professionals and parents are not always in agreement. Central to this issue, also, is the expense involved in certain treatments and deciding who pays the cost of treatment.    
Vulnerability of infants can lead to issues of negligence, abuse, or rejection. Parents are vulnerable too, for often they may not understand the ramifications of certain decisions about care of family members. Sometimes these decisions can lead to hundreds of thousands of dollars in medical expenses. Parents are also vulnerable because they may be unable to cope with the needs of the entire family.    

Children
Children who are ill-fed, housed, educated, and clothed exhibit great needs for preventive, curative, and rehabilitative health care.    
Minors with sexually transmitted diseases often seek treatment without the parents' knowledge; they can be treated without parents' consent. Treatment also must be offered without parental consent to pregnant, infected, or addicted minors. Some health care professionals consider this an ethical issue and a violation of parents' rights. Child abuse presents an ethical dilemma, especially when a child confides physical, sexual, or emotional abuse to a health care worker but does not want the information divulged. Health care professionals, as mandated reporters, must report suspected child abuse. Will the child/patient view this as a violation of confidence or suffer dire consequences as a result of the reported abuse?    

Adolescents
Adolescents as young as thirteen- to eighteen-years-old may seek abortion without parental knowledge or consent. Is this a violation of parents' right to medical information regarding their children? Or should the adolescent, fearful of parental reaction, have the right to decide? The adolescent's growing autonomy, need for independence, changing values, and desire for peer acceptance lead to a number of ethical issues that may involve the health care environment.

Adults:
Adults are increasingly faced with loss of jobs because of downsizing and layoffs. Previously with job loss, health care benefits could be lost. In August 1996, the Health Insurance Reform Act (Kassebaum-Kennedy Bill) was adopted. Among other things, this Act helps limit preexisting conditions and assures availability of individual policies for those who leave jobs voluntarily or involuntarily.    
Many low-income women do not have sufficient access to prenatal care, which has proven to be a cost-saving medical measure that is critical to the health of both mother and infant. As employers seek to reduce the cost of health insurance benefit programs, many individuals and families are finding themselves shifted from one insurance program to another, leaving them with little or no continuity of care. Also, in some managed care programs, adults may receive medical services from a number of health care professionals with whom they have no opportunity to establish an ongoing physician-patient relationship. Even with a physician's directive or a living will, a dying patient's wishes may not be followed. Technological advances in medicine have created a situation where patients may not be able to exercise a choice in the death issue even in states that may allow physician-assisted suicide.

Senior Adults:
Dementia is a common problem that is physically and financially exhausting for the caregiver, who is usually a spouse or adult child. How do caregivers cope with their own needs and the needs of dependent adults? Decisions about how and where to provide care for the senior adult pose ethical dilemmas with no easy answers. Often, the elderly may reject nursing home placement, and there may be limited funds for such long-term care. Elderly patients have the right to maintain dignity and privacy, but often their dependency on others deprives them of these basic rights. Physician-assisted suicide for terminally ill patients is a prominent issue in our society, especially when elderly patients sense a total loss of dignity. Such a decision, however, is never easily made.