In the following scenario, do you think it's fair that some qualify for these services and some don't? Is this ethical? What do you feel the criteria should be for these services? What role should Ethics committees have in these cases?
According to the American Case management Association (2009):
"Case Management in Hospital/Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination."
To over simplify this, case managers should be a hub for the healthcare of their patient. They will coordinate the care of that patient with all the specialists that patient is seeing and oversee all their conditions being cared for by all their providers. They would assist care givers with the scheduling of their appointments, results, referrals and more. They can be as involved or in the background as the patient, (or care giver) needs. It's a great service to caregivers and patients alike.
Do you think it's fair that some qualify for these services and some don't? Is this ethical? What do you feel the criteria should be for these services? What role should Ethics committees have in these cases?
American Case Management Association. (2009). Retrieved on November 20, 2013 fromhttp://www.acmaweb.org/section.asp?sID=4&mn=mn1&sn=sn1&wpg=mh
I would argue that it is fair and ethical to offer these services for some and not for others so long as the people running the program use appropriate criteria to decide who gets the services and who does not.
You could argue that the fairest situation is one in which everyone gets exactly the same sorts of services when it comes to health care. However, the sad truth is that not everyone gets the same health care in this country. A person who has no health insurance, for example, is not going to get much health care at all. This is not fair, but it happens. Therefore, it does not seem right to say that denying extras like the program discussed in this question to some people is a great injustice.
It would, however, be a great injustice if access to the program were granted or withheld on the basis of inappropriate criteria. For example, if the program were only available to people of one race, it would be unethical. However, there are many criteria on which to base this selection process that would make it fair and ethical. For example, you might say that older people would qualify for these services and younger ones would not. This would be due to the fact that older people typically need more kinds of care and to the fact that older people might have a harder time keeping track of all of the kinds of care that they are undergoing. As another example, you might offer the services only to people who do not have a great deal of education. You might argue that they are less likely to be able to understand all the things their doctors tell them. If this is the case, they would be more likely to need help navigating the system.
These are the kinds of criteria I might use. I might use age, educational level, income level (on the idea that poorer people are more stressed and can’t concentrate on their medical needs as well), or I might simply give the services to the people who are undergoing the most kinds of care since they have the most information that they need to keep track of. Any of these would, in my view, be fair and ethical.