Ethical Issues in Performing Unnecessary

Ethical Issues in Performing Unnecessary Surgeries

Even before the drastic changes that began evolving in healthcare during the late 1970s and through today, surgeries have always been the focus of scrutiny and intense insurance payer oversight, because unnecessary surgeries can be difficult to detect. The implications of performing unnecessary surgeries is defined as to the ethics involved in the decision to perform this kind of surgery by the description using the word "unnecessary."

Unnecessary surgeries constitute the biggest single reason why health care reform began in the latter part of the twentieth century. The allegation was that hospitals, physicians, and others in the industry failed to police their selves, and treated healthcare reimbursement like a free-for-all. The lack of ethical judgment on the part of physicians who perform unnecessary surgeries, and the healthcare hospital providers who fail to provide the oversight that affords the physician the place and opportunity to perform an unnecessary surgery helped put the healthcare industry, delivery of care, and access to services into the hands of managed care (Leyerle, Betty, 1994, 20).

Managed care is at the foundation of healthcare reform, the industry's answer to an unregulated industry that was especially concerned about women's health and performing circumcisions; women, because more unnecessary surgeries are performed on women's reproductive organs each year than on men (Beck, Christina, and Ragan, Sandra, 1997, 17), and, circumcisions, because the controversy over whether or not circumcisions are necessary has been a debate long argued (Gollaher, David L., 2000). This is where the controversy becomes convoluted, because physicians argue that circumcisions are necessary, because young, inexperienced mothers would not know how to properly care for uncircumcised babies, putting them at high risk for infections that could lead to more complicated health problems (Gollaher, 125).

The opponents of infant circumcision hold that there is no research to substantiate claims that circumcisions provide deterrents to disease in infant health (Gollaher, 126).

They also argue that as an unnecessary surgery, circumcisions could in fact contribute to the rate of infant risk of infection (125). These same opponents hold, too, that there should be concerns on the part of the public about circumcisions, because there is no way to know the number of circumcisions performed each year (125). Also, because of lack of research, there is no way to determine the problems that arise out of circumcisions, or circumcisions that are not performed well, and therefore cause the infant problems that he might never have experienced had the surgery not been performed at all (125).

In the American system of private insurance, payers automatically covered the costs of the procedure based on physician consensus that it was medically beneficial. Not until the 1960s, in a period of intense challenges to received wisdom and institutional authority, did American doctors seriously question the legitimacy of routine neonatal circumcision. Why was it, asked the editors of the Journal of the American Medical Association in 1963, that an operation so well accepted by practitioners for its power to "relieve' phimosis, to 'prevent' infection... (Gollaher, 127)."

Any surgery is invasive, and puts the person who is having the surgery at risk of infections and complications that could be life threatening. Women's health, it is reported by managed care and other industry specialists that as many as ninety percent of the hysterectomies performed on women each year are unnecessary surgeries. Women and children, then, are the heart of the controversy that surrounds the ethics involving unnecessary surgeries.

With these concerns in mind, the industry, particularly the managed care component of the industry, is suggesting that women and children are being targeted by unethical physicians performing unnecessary surgeries. These industry watchdogs have the best interest of the patient at heart when they warn of physicians and healthcare providers who perform these unnecessary procedures; this is not necessarily true. The very nature of managed care, its premise and foundation is one that is designed to prevent access to healthcare services (Birenbaum, Arnold, 1997, 14).

What produces value in managed care is a good health outcome rather than medical intervention. Not every visit to a doctor is necessary; nor is every test conducted, every medication prescribed, or every placement in an intensive care unit going to produce an effective outcome. Ideally, medicine should be ruled by rationality and efficiency in the choice and implementation of evaluations and treatments. This means that the variability between providers not only should be but can be eliminated, and the only factors that should make a difference in deciding who to treat and what treatment to undertake is the nature of the patient's disease or injury (Birenbaum, 14)."

What these opposing views tell the insured, the uninsured, and those of us who rely on the expertise and ethical practices in an industry that has our very lives in their hands, is that they're not making decisions in our best interest - from either side of the argument, and that their action and their interests are profit based. This tells the public two things: first, that there is a need for private based and funded research in order to understand the implications of what is happening in our healthcare system as it pertains to the question of unnecessary surgeries. Second, it suggests that healthcare reform must include a component for policing the decisions of insurers and physicians who have failed to exercise ethical judgment in performing surgeries on patients, and who have left them at risk to other life threatening conditions as a result. There must be penalties imposed upon the industry and professionals who would take advantage of the public, especially women and children.