Discussion # 8 and # 9

Discussion # 8 ‘Affordable Care Act’ or more informally known as ‘Obama Care’ has recently been under a lot of media attention for its claim of universal insurance and affordable medical coverage of 100% population. So far the Act has been unable to fulfill its promise. The 2012 Census found that when Obama care was launched America had 37 million people without health insurance, of which 36 million were people who had stable income and were above poverty level. they chose to pay for their medical expenses and remained uninsured (Gregory, 2013). As per promise Obama care will cover all the populace, but by 2016 there will still be 30 million uninsured Americans, but they will be mostly those who cannot afford insurance or private medical treatment and fall in the gaps (Gregory, 2013). A Harvard study established that at this rate a huge number between 26,000 to 37,000 Americans will die because of not receiving medical coverage (Gregory, 2013).The major stake holders are the Policy Makers, Health Care providers, pharmaceutical companies, American Nurses Association and the patients who will be subjected to the policy (Bright, 2013. beforeitsnews, 2013. Front, 2009. PBS, 2009). It has been argued that setting criteria for people to be eligible for insurance in not ethical and also the cost of the insurance can be a heavy burden with lesser provision. especially when the burden of the policy is falling in major on the tax payers (Vecchione, 2012).Steps of Policy Development Anderson and Mcfarlane (2011, pp. 123-125) have outline 5 steps in Policy Making.1. Problem Recognition and DefinitionRather than focusing on health assurance and disease prevention, the Affordable care act focuses on disease treatment. Although America invests $70 billion into health care every year, the annual life span of an individual is 60 to 70 years (Coburn, 2013).2. Policy FormulationA proposal must be written to propagate healthy life style and living. should be forwarded in the city council meeting and discussed there (Anderson and Mcfarlane, 2011. pp. 123-125). The concerned health care givers and stake holders of the community should be involved in the process. Vaccination and annual complete checkup should be an integral part of the disease prevention policy. 3. Adoption of the PolicyAfter the disease prevention policy has been formulated adoption by community health centres and agencies. Educational and awareness programs should be arranged for people and even concerned authorities. 4. ImplementationThe agencies should ensure adoption by hospitals, care givers, care providing facilities and homes. Charts should be maintained and individuals informed of their upcoming checkups. Monitory penalty in form of health neglect should be implemented.5. EvaluationAfter implementation the policy should be regularly evaluated to determine its efficacy. Data should be obtained on health and factors contributing to betterment of health to ascertain if the policy is having beneficial effects.Discussion # 9Experience of Ethical Dilemma Recently I read in a website about an ethical dilemma that the patient was a 42 year old suffering from intractable pain (Vee, 2010). The mother did not want to let go of the son and thus kept on asking the doctors to operate on him whereas nothing could be done to help him (Vee, 2010). The patient had already stated his wishes regarding that he did not want treatment but the mother threatened to sue if the wishes were followed (Vee, 2010). The young man was made to suffer for more than a year and his mother was not informed that the surgeons and care givers could no longer help the patient and only prolong the suffering he was already going through (Vee, 2010).History Although the patient knew his condition but the mother was not made aware that his condition had no chance of improvement regardless of the medication and surgery (Vee, 2010). the patient had not given informed consent for carrying on with further treatment due to his knowledge of the deteriorating condition and that the doctors would not be able to help no matter how many surgeries are conducted. The doctors and nurses need to be communicative and should know how to handle the patient vs. family conflict and also make the family and the patient aware of the concept of a good death (Mohanti, 2009). The mother of the patient. just like in a case of a woman suffering from intractable pain due to ovarian cancer. had the concept that heavy sedatives or prescribed drugs for the pain would hasten the process of death and will cause sedation (Mohanti, 2009). Had the mother been informed and the autonomy of the patient respected the patient would not have suffered so much. Ethical Principles Autonomy is a very significant concern for patients while under medical care. It is the duty of the nursing staff to ensure the patient feels free to act in accordance with his own beliefs (Jech, 2009). The autonomy of a patient is overridden when the aims of another are given priority over the aims and goals of the patient (Jech, 2009). e.g. if a nurse is running late for home and encourages the patient to skip the blood test as it is just routine checkup, this will create an ethical dilemma, as indirectly the patient was encouraged to skip his test but the patient harbors that it was his/her decision to do so. At times patients also prefer refusing treatment although the physician or nurse may disagree, but the patient has complete freedom to decide if he/she considers treatment necessary for his self (Barnett, 2013). It is the nurse’s duty to protect the patient from wrong information which could lead him to take uninformed decision (Barnett, 2013). Beneficence is a principle which means that it is not only necessary for the nurse to protect the patient from harm but also to ensure health and betterment of the patient (Jech, 2009). Beneficence is principal aim of all nurses and health care providers to ensure that not only minimization in terms of harm is ensured but also the best interest of the patient is taken into account (Kennedy, 2004).ReferencesAnderson, E. amp. Mcfarlane, J. (2011). Community as Partner: Theory and Practice inNursing (6th ed.). Philadelphia: Lippincott, Williams, amp. Wilkins.Barnett, J. W. (1986). Ethical Dilemmas in Nursing. Journal of Medical Ethics, 12/3, 123-126. Retrieved March 28, 2013, from JSTORBeforeitsnews. (2013). Obamacare Scandal – We Are Missing Trillions of Dollars. Retrieved on March 28, 2013 from, L. (2009). Obama Speech to American Nursing Association on Health Care. Retrieved on March 28, 2013 from Coburn. (2013). Medicare and Medicaid. Government Public Index. Retrieved on March 28, 2013 from Front, G. (2009). Major Stake Holders in Health Reform Debate Call for Improvements in Scoring of Congressional Health Care Proposals. Retrieved on March 28, 2013 from Gregory, P. R. (2013). Obama care: Affordable Care Act’s False Promise of Universal Coverage. Retrieved on March 28, 2013 from Jech, A. O. (2009). Everyday Ethics for Nurses. Gannett Healthcare Group. Retrieved on March 28, 2013 from Ecollege websiteKennedy, W. (2004). Beneficence and Autonomy in Nursing. A Moral Dilemma [Abstract]. British Journal of Perioperative Nursing: the Journal f the National Association of Theatre Nurses, 14/11, 500-506, Retrieved on March 28, 2013, from NCBI.Mohanti, K. B. (2009). Ethics in Palliative Care. Indian Journal of Palliative Care, 15/2, 89-92, Retrieved on March 28, 2013, from NCBI.PBS. (2009). In Wisconsin, Obama Pitches Health-care Reform to the Public. Retrieved on March 28, 2013 from Vecchione, A. (2012). Debating Ethical Implications of the Affordable Care Act. Retrieved on March 28, 2013 from Vee. R. (2010). Ethical Dilemmas Encountered by Nurses. Retrieved on March 28, 2013 from

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