New ethical dilemmas for healthcare

Title of Essay: New ethical dilemmas for healthcare 

Student’s Name:

Grade Course

Tutor’s Name

Date of submission:

Introduction

Provision of proper healthcare service requires participation of all stakeholders in the health sector. At the outset, health care providers play a major role as far as delivery of such services is concerned. Their practice is governed by the legal, ethical as well as professional codes of conduct laid down by either a regulatory organ, internal administrative body or the government. The health care providers critically focus on the confidentiality and autonomy of the patient in addition to recognizing the duty of care that the latter is owed. The patients on the other hand play an equally important role in the health care delivery by fully cooperating with the clinician to enhance treatment. It is however noteworthy that health care delivery has been dogged by a lot of ethical, legal as well as professional challenges in the recent past and is still on the rise. For instance, advancement in technology as well as changes in the health care environment presents great ethical dilemmas to the health care industry (William, 2004).

Emerging issues

Technological advancement in the health sector is vital in the provision of health care service to the populace as well as improving the economic development of a nation. Developments in medical technology have enhanced provision of quality health care services thereby improving the relationship between the health care providers, patients as well as the industry. Medical technologies may include a variety of diagnostics such as treatments using genes as well as laboratory tests based on DNA among other practices. Such technologies have been employed in service delivery including ante-natal care as well as immunization to prevent disease transmission and reduce mortality. Moreover, medical technologies have to a great extent diversified the health care options for the patients in addition to leveling the international impediments exhibited before. Finally, development in medical technology has been beneficial to the developing countries that have a large number of technologically-trained professional workforces by generating revenues through medical tourism (NBC, 2007).

The medical technologies should however be aligned with the changes in the public policy so as to realize the benefits including reduced costs as well as accessibility of the health care by many citizens. Besides, such technologies should be distributed evenly to ensure that the required health care services are offered to those who need it. Health care providers who practice in settings that are short of such technologies are either forced to ration the service or operate without the modern technologies that are often vital in health care delivery. Besides, medical technology has classified the patients into two separate groups particularly in the largely market-based system. In such situations, the socio-economically advantaged individuals are capable of paying for the sophisticated treatment employing modern technologies while the poor can not afford the expenses. This has therefore exacerbated inequality as well as poverty among the populace (NBC, 2007). Moreover, the use of medical technology in prolonging life of patients is facing stiff opposition from the society with some people demanding the avoidance of such practice by allowing their relatives die a natural death. Finally, the use of such technologies in the determination of sex of the unborn in the field of reproduction also raises ethical concerns. The health care providers can utilize modern medical technologies to manipulate the characteristics including sex of the fetus thereby changing the ratios in a state (NBC, 2007).

Despite its importance in the medical arena, the use of medical technologies in health care delivery is facing challenges which require argent attention from all the stakeholders in the health sector. To begin with, overdependence on modern medical technology in the health care delivery has led to the neglect of equally important primary health care services that may be required by the society.

How U.S. should handle licensing issues for clinicians practicing telemedicine across state or national borders.

Both the federal and state governments in the U.S are mandated to protect the public from impaired or incompetent health care professionals through licensing of health care delivery services. Telemedicine is not extensively practiced in the U.S; however, its licensure laws hinder health care practices across states in the country in addition to subjecting the professional accountability of the health care providers in the aforementioned areas to test. Currently, most states in the U.S. require that physicians obtain full license to practice in those territories (William, 2004). However, the U.S. government should consider provisions where the health care providers can be granted licensure to only practice telemedicine in the concerned states. Some of these provisions require uniform set of standards of discipline, credentials as well as professional conduct among the health care professionals. Other provisions require that the standards are set and the authority to administer license vested upon recognized bodies and not the government. According to William (2004) such bodies have immediate contact with the patients compared to the government hence are better placed to understand their problems. Finally most provisions encompass regulations guiding the activities of health care professionals who are out-of-state (William, 2004).

To begin with, the states should adopt programs of registration that would allow the out-of-state health care professionals to practice telemedicine within their state territory. This program which would include standards for format as well as confidentiality prevent unregistered persons from practicing telemedicine in the concerned states as it has provision for disciplining health care professionals who violate such rules. Such registration was successfully implemented by the state of California in 1996 (McHale & Tingle, 2000).

Secondly, adoption of multi-state licensure system that would not only allow free movement and practice by clinicians but also enhances telemedicine across the states is also essential. Such licensure system would be administered by the state authority (McHale & Tingle, 2000).

Besides, the government should implement the federal licensure system where the federal government establishes its own national standards on health care delivery followed by issuance of a single license that is valid throughout the country. Administration of the system may be carried out by the states locally or federal agency nationally. Even though the administration at the federal level may be cumbersome, it relieves clinicians of the burdens while practicing (IOM, 1996).

Alternatively, U.S. should consider adopting the national licensure system where licenses are issued depending on the laid down standards concerning the health care delivery in the entire country. Implementation of such system is carried out by a professional body operating on a national level and would address vital issues including loss of state revenues, the method for financing the health care system, as well as the legal ability of the states. The states would agree on the common standards as well as carrying out disciplinary measures at the state level (Tschudin, 1992).

States can also resort to mutual recognition of the license administered by partner states to a healthcare professional. In such situation, the host state and the home state voluntarily harmonize and agree on licensure standards and professional conduct that are crucial to the health care system. Through such an agreement, the health care provider secures a license and is not required to avail an additional license. Moreover, the health care professional may be allowed to practice a wide range of health care delivery services or be limited to specific activities such as offering medication through telecommunications only. However, the professional has to inform the states he/she intends to practice in prior (McHale & Tingle, 2000).

States should also form an agreement of reciprocity where one state extends the privilege for the health care professionals from a different state to practice within its jurisdiction with an expectation that the concerned state would provide such benefits to its professionals. Such arrangements provides for the negotiations of member states to agree on specific standards followed by recognition of licenses issued by the partner states. As a result, there are no additional credentials required in order for health care professional to practice in a partner state. Such agreements may involve two or more states. Unlike in mutual recognition, agreement on reciprocity does not involve harmonization of standards hence the health care professional exhibit a lot of requirements. Even though such agreements may be complicated and time consuming, it is a positive step towards licensure standardization process (IOM, 1996).

How U.S. should handle liability issues for clinicians practicing telemedicine across state or national borders

The medical malpractice by the health professional concerning the practice of telemedicine in the U.S. is not well defined in the liability system. Given the fact that different have varied statutory limits concerning professional malpractices, issues of laws as well as the venues where such acts are committed should be taken into consideration in an attempt to develop a network of multi-state health care system. Currently, the malpractice insurer as well as the health care professional is affected by the financial implication of the malpractice. The insurer should adopt new policy to evaluate the malpractice depending on the service provided during the practice of telemedicine. Besides, the relationship between the patient and the physician should be redefined in addition to expounding on what constitutes malpractice in telemedicine. Such definitions would constitute implications on the health care quality as well as their legality in telemedicine (IOM, 1996).

Conclusion

The rapid changes in medical technology as well as health care environment constitute one of the most pressing issues in the provision of modern health care services to the patients. Such medical technologies have provided divergent options for patients in addition to improving health standards of the populace. However, the technologies pose health risks as aforementioned (William, 2004). There are a variety of impediments in the existing policies and procedures concerning inter-state as well as cross border telemedicine practices. Telemedicine strives to take health care services to the patients hence the increased restrictions currently witnessed between the states as far as licensure systems are concerned. The government therefore needs to harmonize the existing policies and procedures so as to eliminate inter-state barriers and enhance licensure standardization process. It is also bequeathed with the responsibility of improving the liability systems between the states so as to develop a strong network of health care delivery.

Reference list:

Institute of Medicine, (1996). “Telemedicine: A Guide to Assessing Telecommunications in

Health Care” National Academy Press.

McHale, J. & Tingle, J., (2000). Law and Nursing 2nd Ed. Butterworth-Heinman.

NBC (2007). Moral and ethical imperatives of health care technologies: scientific, legal and

socio-economic perspectives. Indian Journal of Medical EthicsHYPERLINK “http://www.issuesinmedicalethics.org/issue151.html”; 4(1).Retrieved on 25th Sept 2010 at: HYPERLINK “http://www.issuesinmedicalethics.org/151fc35.html”http://www.issuesinmedicalethics.org/151fc35.html

Tschudin, V., (1992). Making Ethical Decisions in ethics in nursing: The caring relationship, 2nd

Ed. London: Butterworth Heinemann.

HYPERLINK “http://findarticles.com/p/search/?qa=Bross,%20William” William, B. (2004). Emerging Ethical Issues. HYPERLINK “http://findarticles.com/p/articles/mi_qa4090/”Alabama Nurse. Retrieved on 25th Sept, 2010 at:

http://findarticles.com/p/articles/mi_qa4090/is_200409/ai_n9465350/?tag=content;col1