Ethics: principles, applications, and contemporary issues

Ethics Issues in Nursing

The quality of healthcare experienced by patients today is radically impacted by the personal resources that can be accessed by those in need of routine healthcare, preventative healthcare, and medical treatment. Well-to-do patients have always been able to purchase quality medical treatment at a premium, and the opposite has also always been true: patients who are marginalized by society or live in poverty typically forego preventative healthcare and often receive medical treatment for both chronic and acute conditions when it is too late to be effective.

The poverty analysis statistics provided by the Gini Coefficient ("Measuring Inequality," 2012) paint a grim picture of impoverished people living in the Gulf Coast states who experience levels of inequality equivalent to those experienced by people living in sub-Saharan Africa. Dr. Peter J. Hotez is the dean of the National School of Tropical Medicine at Baylor College of Medicine and the president and director of the Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development. Hotez resides in a poor county in Texas where he has observed the link between poverty and a cluster of tropical diseases that are typically considered to be a problem only in developing countries (Hotez, 2012, p. SR-4). In addition, Hotez is clear that fiscal incentives are weak or nonesistant for pharmaceutical companies to develop new vaccines and treatments for these tropical diseases (Hotez, 2012, p. SR-4). In his words,

A key impediment to eliminating neglected tropical diseases in the United States is that they frequently go unrecognized because the disenfranchised people they afflict do not or cannot seek out health care. Even when there is a clinic or community health center in an impoverished area, it often lacks the necessary diagnostic tests, and the staff is rarely trained to recognize and manage neglected tropical diseases. (Hotez, 2012, p. SR-4)

With many healthcare fronts today requiring funding and service redesign, tropical diseases may not fare well in the line-up until and unless they impact mainstream populations. But what about those diseases that are common in the overall population, for which treatments do exist, yet the provision of service is inadequate or ineffective? This is the healthcare issue that gets a full-court press from Dr. Aaron Shirley. Dr. Shirley has personal and institutional memory of healthcare in Mississippi: he was the first black resident at the University of Mississippi Medical Center, served as physician at the first community health center in the Mississippi Delta in the 1960s, and is a co-founder of the HealthConnect system in Mississippi (Hansen, 2012). In 1993, Dr. Shirley received a MacArthur Foundation "genius" award as a health care leader. Yet, in 2012, Shirley said, "I've been coming here [the Mississippi Delta] for 40 years and nothing has changed" (Hansen, 2012, p. SR-4). The issue is that regardless of Medicaid or health insurance, or access to community clinics or home health services, poor people in Mississippi continue to have health problems. "They don't get better, and the diseases borne of poverty and obesity are not prevented; thousands of people frequent emergency rooms for illnesses that could have been tackled by primary care. They need something more." (Hansen, 2012, p. SR-4). Ironically, the healthcare solution for Mississippi Delta residents may reside in a model based on prerevolutionary Iran. James Miller, healthcare system consultant learned about the Iranian model for primary-healthcare during a meeting in Europe and recognized how well the model could overlay the Mississippi healthcare crisis. Miller noted, "When the