Ethics Is Knowing the Difference Between What

¶ … Ethics is knowing the difference between what you have a right to do and what is right to do" (1). Ethics and its subsequent practice have been a very contentious issue in American society of late. Our current economic resulted almost entirely of excessive greed and unethical actions of key financial institutions. As a result of their lack of integrity, the entire world economy has subsequently suffered in a very severe manner. Many have lost their homes; even more have lost their retirement savings, while still others have lost their livelihoods. Such is the power of ethics and how its practice can have both positive and negative consequences on society as a whole. With all the attention placed on the financial community and in particular, Wall Street, many are often neglecting the unethical practices of the health care industry. I believe a very ubiquitous and widespread issue apparent within the health care industry is that of patient dumping. Throughout this document, I will provide the ethical considerations regarding patient dumping and methods in which to prevent the spread of its practice.

To begin with, patient dumping is not an entirely new phenomenon. The practice of patient dumping and refusal to care still, and will continue to be a widespread issue within the healthcare system. Patient dumping, in essence, is simply a large game of hot potato. Its practice involves dropping off patients, a large proportion of which are homeless, to other hospitals in hopes that they will be taken care of upon discharge from their former hospital. In short, one facility transfers a patient to another facility or refuses treatment entirely due to the patient's inability to pay. Its subsequent practice is as ubiquitous as the ethical issues that govern it. There has been however acts initiated to stop its practice. One such act is the Emergency Medical Treatment and Active Labor Act (EMTALA) which was established in 1986 (2). This act essentially attempts to prevent the practice of patient dumping and refusal to care. It does this by establishing three requirements in which all medical institutions must follow. These are to first conduct medical-screening examinations, and second, provide necessary stabilizing treatment to any patient seeking emergency medical. For those hospitals that are unable to do provide the necessary services do have the option of transferring the patient to a facility that can properly care for the patient. However, the facility too must strictly adhere to EMTALA guidelines (3). Upon an initial assessment of these regulations, one would think these guidelines would be sufficient to stop the practice of patient dumping. However the exact opposite has occurred. Ten years after the laws inception (1986-1996) more than 700 hospitals have violated these statues (4). Even with Federal Government action, hospitals are still practicing patient dumping

There are many ethical considerations with the practice of patient dumping. Should physicians, tax payers, and government force hospitals to care for individuals who can not afford to pay? This fact is further compounding, by the fact that many of the patients that are subsequently "dumped" are those that are homeless and don't contribute to society anyways. Should society in essence subsidize the treatment of individuals who otherwise would not contribute to the furthering of our nation? If so, who will pay for this initial cost in the midst of our countries current debt situation? I believe the answer to be yes. To better illustrate my point, I will use an analogy.

The income of our government is almost entirely that or corporate and personal income tax. During periods of extensive economic growth, the government generates a corresponding increase in funding. However during times of economic turmoil, the government takes in much less income. Ironically, during this time on contraction, this is the period in which the government spends the most due primarily to stimulus related activities. These activities are designed to help those harmed by the greed and misfortune caused by others. First, it is the nature of our government to help failing businesses and individual citizens when inevitable economic downturns occur, why would this instance be any different? Currently, as this paper is being written, trillions of government bonds are being purchased in an effort to spur the economy and generate job growth. As of now, the only people who are profiting, ironically, are the same businesses and executives, that creating the entire ordeal in the first place. Why should the government then, not provide some subsidization for hospitals to at least care for the homeless who are too in trouble just like those who the stimulus package was intended? I do realize that the government is in the midst of budget cuts, and any increase in spending will be met with harsh criticism. However, I believe that our nation should raise taxes to help fund this initiative. We simply cannot demand that our government and other institutions fund our lifestyle and yet not have a subsequent increase in taxes. As such, I believe it necessary, for the good of our society, to increase taxes to help fund this initiative.

Ethical Considerations

According to the four basic principles of biomedical ethics, patient dumping violates them all. Subsequently in order to further correct this problem I believe the following ethical questions and statement should be examined in detail to determine a solution.

1) The ability to sort morally relevant issues from morally irrelevant issues in any given situation.

2) The ability and willingness to research issues and reflect upon them.

3) The ability and willingness to seek advice.

4) The ability to form a well-reasoned and unbiased, conclusion in any given situation.

5) The ability to justify this position and act

With these ethical questions, I believe hospitals can come to a better informed decision in which to alleviate the problem of patient dumping. A simple examination of these questions reveals how troublesome the problem actually is.