A Research-Analysis on the Principles of Biomedical Ethics Essay

Introduction â€Å"The uninsured† is a term that is coined to people who don’t posses any form of insurance who primarily include paperless immigrants, minorities, children and or teenagers without insurance, employees of small businesses, people who belong on the lower part of the social strata and also a significant number of the elderly.   In effect, such a group of people suffered a lot in terms of seeking and receiving the health service that is necessary to prolong their lives. Corollary with this, are the disposition of those patients who initially have a health insurance but experience a significant degree of difficulty in terms of having the insurance company subsidize the treatment and or operation that is necessary for their health condition.   Such a problem creates an ethical dilemma on the end of the doctors, patients, insurance providers and also the courts. This research provided various medical cases, biomedical ethics theories, and a number of laws that explained how the uninsured disposition is, the personal and psychological, monetary, and legal issues that they faced. Consequently, the author provided his own interpretation of the cases and significantly relates them on the principles of biomedical ethics and justice.   The research then looked into the basic principles of biomedical ethics: beneficence, non-maleficence, justice and autonomy and other ethical theories such as Utilitarianism and Deontological Ethics, and significantly relate them to the problem of the uninsured based on the literature and cases that were presented. Background of the Problem   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Initially, insurance is something that is only made available to wealthy Americans.   On the turn of the 20th century, there have been two major changes which took effect in terms of how insurances are disseminated.   The rise of the private insurances and the government subsidized insurances has seemed to provide a temporary solution on the problem of inequality in terms of health services.   Such an initiative has caused companies to provide insurances to their employees and by 1950’s almost two thirds of the population already have insurance.   Due to the relative availability and accessibility of the population to insurance, some segment of the population were forgotten, hence the uninsured (Jost 1998, p.106).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Initiatives on the part of the government were introduced in order to solve this problem.   General welfare programs during the 20th century were also introduced in order to cater to the marginalized.   In addition, a New Deal program was also made available to the population living in the rural areas.   On the span of the 20th century, progressive and labor interests asserted the necessity of compulsory national health insurance, but such efforts were hindered by a number of significant and powerful institutions in the country such as various business interests and the medical profession in itself (Jost 1998, p.106). However, the bill that was passed on 1960 which eventually legislated on 1965 paved the way for the establishment of the Medicare and the Medicaid.   Medicare caters to the elderly which insured the hospitalization and other doctor services that are necessary; on the other hand, Medicaid emphasized on the needs of the marginalized and the disabled. The Medicare and the Medicaid resolved all conflicts between the hospitals and the government because of the assurance of monetary funds for those who are insured and the paying of services which are formerly given free or in a reduced fee.   However, critics of Medicare and Medicaid counter argued that such insurances are too costly, hence a new initiative was raised by a physician in Minnesota which is now known as the Health Maintenance Organization (HMO) (Jost 1998, 107-108).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The HMO required the consumers to pay a relatively small amount in order to cover for the former and also for his or her families. Such an idea appealed to the government, hence on 1973, the Health Organization Maintenance Act of 1973 was passed.   The managed health care proved to significantly reduce costs , and by 1995, it was estimated that 150 million Americans have their HMOs. However, conflicts between doctors and patients emerged when allegation such as doctors and HMO administrators have created some sort of incentive programs which would make the latter diminish its recommendations for certain medication, treatments, or operations. Such a case paved the way for a direct refusal for the needed medical care, treatment and operations.   In addition, complaints such as delays on the release of authorization and/or funds were also cited (Jost 1998, 109). Review of Related Literature   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Kenneth Jost (1998, p. 101-105) posed three major issues with regard to patient rights.   These are: Is it possible for manage-care health plans to make the patients choose doctors who are not included on the plan’s network of physicians? Should the manage health care plans be liable if there be any chance that malpractice is detected amongst their physicians? Is there a necessity for a stronger safeguard be imposed on the patients’ medical records and other related information? Jost emphasized that the dilemma that was brought forth due to the request of some patients to choose their own physicians has been an issue that is very difficult to resolve.   Since the primary purpose of the manage health care plans is to reduce costs, the proposal of each patient to choose their own doctors would pave the way to the further increase of fees amongst the health plans, in addition to the payment that the patient has to shoulder. Some health care plans intentionally limit the number of physicians that the patients can choose from so that referrals for treatment, medication and or operations could be regulated by the company, hence reducing costs and increasing profits.   However, some health care plans allow their consumers to apply for a Point of Service (POS) which will allow them to choose their own doctors; only for an added fee.   In relation with this are some statutory laws imposed by some 30 states for pregnant women, allowing the latter to select an obstetrician that could act as their primary health care provider (p. 101-103). The second issue was with regard to the malpractice that was conducted by in-house physicians, which on a legal perspective makes the physician alone liable to the damages done to the patient and makes the managed-care plans company exempted from the legal repercussions.   The case presented was that of Ron Henson, who died in Kaiser Permanente Hospital and later on sued HMO.   The conflict stem out due to the claim of Mrs. Henson that Kaiser controlled the costs of her husband’s treatment by limiting hospital admission in cardiac cases. The physicians who treated Mr. Henson was employed by Kaiser, hence making the latter liable to the said malpractice.   A suit was then filed against Kaiser which was then settled by the latter for 5.3 million in 1997. However, at present only the state of Texas has such laws regarding the accountability of managed care plans.   Jost also made a point by asserting that when health insurance companies will be made liable to the malpractice that could have been done by their physicians, such could further result to the increase of the fees being collected from their clients (p.103-104). The necessity of privacy and confidentiality of medical records is another important matter that Jost touched into.   The importance of disclosing medical information for the patient’s health purposes alone (Shalala, 1998 as cited from Jost 1998, p.105) and for government use for health and law enforcement has been criticized as further broadening the law for access for medical records.   The proposal set forth by Shalala has been criticized due to favoring the government to have more access to medical records, hence a possible case of invasion of privacy.   However, Shalala have emphasized that such a proposal is only a more clear interpretation of the law that currently exists. The author perceived that Jost (1998) emphasized more on the notion of Justice within the managed health care system and the relation of Autonomy on the notion of Justice. In addition, Jost was able to present a balanced view of the legal issues on managed health care system.   He provided almost all possible dimensions of the issue and allowed the reader to deduce the arguments on their own. The discussion of the laws which is relative to every state makes it difficult to address the legal issues that stem out because of medical malpractice (taking the issue of Mr. Henson for instance).   In addition with this, certain changes from the ways of the health care system defeats the primary purpose of the former which is to reduce costs and make health opportunity available and equal to all people. Such a dilemma between the right to choose or autonomy and the statutory laws which serves as the backbone of most managed health care system becomes very hard to reconcile.   In addition with this, the matters of privacy are something that is in conflict with the principle of autonomy and the greater good (i.e. the principle of utilitarianism). Keith Epstein (2002) has presented the issues of uninsured patients which normally are comprised of young adults (p. 524) and minorities (p.529).   Epstein touched three major issues in which is comprised of the question weather the United States can afford health insurance for all; if Medicare should cover the prescribed medicines for the marginalized senior people; and if small businesses could band together to apply for the insurance of their employees in order to reduce its costs. The fist issue was addressed by Epstein by arguing that since the passing of the Balance Budget Act of 1997, there has been a huge cut back on medical costs.   Medicare has cut on reimbursement and some states have also cut on Medicaid payments.   However, Young (President of the Health Insurance Association of America) as cited from Epstein, claimed that America can do afford insurance for all if it only has the will power.   Young emphasized that the uninsured has already been subsidized due to the increase of costs in insurance payments and also for hospital services because initially, these insurance companies and hospitals are adding up their costs in order to cover for uninsured patients. Solutions in subsidizing the uninsured in terms of taxes are also one of the solutions that he presented (p. 526).   The issue in subsidizing the marginalized seniors’ drug prescription has also been tackled as could be resolved by having the government subsidize a certain percentage of the price by those seniors of having the salary cap of less than $13,000.   However, part of the issue is the lack of funds or the possible soar of the taxes in order to subsidize such a change. The third issue is with regard to the passing of a bill which would allow small companies across states to band together in order to apply for insurance for their employees and consequently to reduce costs.   Such an idea according to Lehnhard, (Blue Cross Senior Vice President) would only provide temporary savings on the end of these small companies because since the associations will not be regulated by the state rules, it is possible that such companies would engage in discriminatory underwriting.   An example that was given is that there might be some cases wherein the program would encourage health people from joining, and unhealthy people from not joining (p.530). The author perceived that Epstein’s essay touched on the use of the existing law in order to apply the principle of justice as fairness.   It could be seen, that the relevance of the law has been the foundation of the arguments which normally appear in conflict with various perceived implications due to the desire to alter the law in order to cater for those percentage of the population who are relatively incapable of securing their health concerns and problems.   The perceived attempts to make the lives of the uninsured relatively better in order to bring forth justice in the form of a fair medical and health treatment has been argued to be a cause that is far fetched because of political will power, unequal allocation of funds and lack of trust to human goodwill. A more recent article which emphasized the relevance of the law in order to cater to the needs of the uninsured is those of Owcharenko (2006).  Ã‚   Owcharenko provided three major recommendations in which the government could do to solve the growing number of uninsured population in the country. The first is to offer the uninsured â€Å"direct subsidies in the form of a refundable tax credit, to lower-income working individuals and families for the purchase of private health care coverage† (p. 95).   Owcharenko emphasized that enormous tax breaks are normally given by the government to those high-earning individuals, rather than to those who have relatively lower incomes. The tax exclusion also provides more generous health care coverage to those individuals belonging in big companies. In addition with this, those people who don’t have any health coverage at all does not enjoy any tax break at all, thus they are left with no choice rather than to use after-tax dollars to purchase their insurance.   Owcharenko emphasized that if a new and robust system of individual health tax credits will be given to low-income families, these people will have the buying power to secure their own private insurance rather than opt to rely to Medicaid which is relatively spread on a small number of population. The Health Savings Accounts (HSAs) that was enacted on 2003 was perceived by Owcharenko as a good program for the government because it allowed people to â€Å"purchased a high-deductible insurance plan to establish a tax-preferred savings account that allows carryover of unspent funds† (Owvahrenko, 2006, p. 96).  Ã‚  Ã‚   This plan however needs certain changes in order to function more proficiently.   Owcharenko focused on the use of the flexible spending account (FSA) and the health reimbursement arrangements (HRAs) such according to her would allow patients to exercise more autonomy on choosing their heath care.   Such a step would allow the patients to gain more control on determining the amounts which they want to contribute and significantly decide how they wanted to apply these funds.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The recommendation is for the government to allow federal contributions to be used in order to improve the health status of every state.   Consequently, the state should be able to provide a feedback on the effectiveness of their reforms by â€Å"reducing the number of the uninsured, improving access, and remaining fiscally visible†.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The author perceived that the recommendations of Owcharenko (2006) touched on the notion of justice, fairness, and beneficence.   In relation with this, the perception of the author in making the insurance reforms unique in every state will significantly help a lot in terms of reaching a huge number of the uninsured population.   Since the focus of the health reforms will be focused primarily on the individuals on every state, it is more likely that even the people who do not belong on the financial caps that are subsidized under Medicaid will be considered as well.   The marginalized on the other hand will also be given a fair and immediate treatment towards health.   The research of Young et al (2004) focused on the life saving health care of undocumented children.   Undocumented children are offsprings of paperless immigrants which consequently forms a huge percentage of the population for the uninsured.   Undocumented children often times did not have an access to health services as they don’t have any contact to any insurance other than the Emergency Medicaid that was given by the Federal Government in 1986. However, the Emergency Medicaid could only be used in severe cases wherein a patient experiences severe amount of pain (p.1316).   In addition, Medicaid can only pay for a portion of the hospitalization costs, which is why some hospitals needed to seek support either from various organizations or individuals or from the country of the immigrant himself. Such an attempt of some hospitals although noble, may prove to further increase the costs of the treatment because of the delay of the latter.   Young et al. claimed that such prolonging could result to a long-term morbidity and a high risk of death (p. 1318).   Young emphasized that immigrants served a relevant part of the society.   They do jobs that could highly affect a huge number of the population if by any case they acquire communicable diseases. In relation with this, failure to immunize their children and treat their sicknesses could also result to a significant impact in the society. Young et al. touched on the principles of beneficence and non maleficence on his paper.   Both sides of the issues are presented (i.e. why the government cannot subsidize the health care of the undocumented children versus the effects that it could bring in the society).  Ã‚   Young et al explained the aid that the Emergency Medicaid has provided to the undocumented children and the other options that the hospitals can do in any case that the hospital cannot fully subsidize a child on expensive treatments and operations.   The principle of beneficence was clearly presented on this part.   On the other hand, the principle of maleficence could be seen as further attempts of the government to give improve the health status of the immigrants’ children are made.   McLaughlin et al (1999) touched on the role of nurse case managers in terms of providing solutions to the ethical dilemmas that were brought forth of the uninsured.   Case management as defined by The Case Management Society of America (CSMA) as a â€Å"collaborative process which plans, implements, coordinates, monitors, evaluates options and services to meet the individual’s health needs through communication and available resources to promote quality cost effective outcomes† (p.51).   The role of the nurse care manager is highly important because he or she acts as an advocate to raise funds; also, he or she acts as a facilitator as well in order to weigh treatment options for the patient and the family. The case of Natalie M involves the problem of dealing with her family that later on paved the way for her to be rejected in most of subacute or skilled nursing units.   Conflicts with the family as to weather to put Natalie on a subacute nursing units or take care of her at home poses a problem as well that the nurse manager has to deal with. The nurse care manager solved the issue by having Natalie participate in the decision process and make sure that the decision of Natalie is not a mere reflection of her family or guardian. The case of Natalie M. is a clear representation of the strict adherence of the nurse case managers on the principles of autonomy, principle of veracity, the principle of beneficence and avoided paternalism.  Ã‚   The article clearly laid out the process as to how particular treatment options are arrived into by discussing it with the guardian of Natalie and Natalie herself. Similarly, the nurse care manager make sure that the decision was a true reflection of the desires of Natalie, and corollary with this, the principle of beneficence was reflected in the steps of the nurse care manager to do make sure that whatever options that Natalie would take, it would be safe and would significantly help her improve her condition.   Tunzi (2004) has emphasized the case of the sluggish economy and the budget deficits that significantly affects the disposition of the uninsured.   According to the statistics, the uninsured comprises of 23 million male, 20 million female, in which 21 million are white, 13 million are Hispanic, 7 million are black, and 2 million are Asian or Pacific Islander (p.1357).    The major implication of being an uninsured is primarily characterized by worse cases of illnesses because of the failure to regularly check with the doctor, or failure to seek care until the illness is already terminal.   In relation with this, Tunzi also emphasized that majority of the uninsured are children and most likely they are more prone to poorer health or may die prematurely.   Hence, according to Institute of Medicine’s (IOM) 2002 report (as cited in Tunzi, 2004, p. 1358) that the lives of children will be made longer and their long term development would be significantly improved if they are covered with insurance. To solve this problem, the IOM has ensured a Broadbased Health Insurance Strategy which caters to preventive services, outpatient prescription drugs, and specialized mental health care, in addition to general ambulatory and hospital medical care (p.1359).   In addition, the Bush Administration has also launched the expansion of the Community Center System; however, the author perceived that such a program is not sufficient enough due to certain limitations that it posed.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The article of Tunzi (2004) touched on the principles of beneficence and justice.   The attempts to cover for the health of the uninsured and the expansion of government services and NGO’s are significant factors that are ethical in its very nature.   The issue of the caste system that is very imminent on hospitals is the issue that was tacked by Romano (2002).   There are certain hospitals that are viewed as practicing the so-called boutique medicine wherein they require their patients to pay an annual membership fee in order to gain access to the services of their hospital. However,   Ã‚  Lois Snyder, director of the Center for Ethics and Professionalism at the 115,000-member American College of Physicians-American Society of Internal Medicine as cited from Romano (2002, p.5) have reiterated that such ways of some hospitals are certainly against the their manuals.   Snyder emphasized that indiscriminate perception should be applied regardless if the patient is insured or uninsured.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Such a step of certain hospitals to intentionally reject patients on the name of profit is something that violates the principle of beneficence and also it is a violation of the basic principles of the deontological ethics’ claim that man should never be used as a means to an end. Dateline NBC (2005) has presented a case of a child who suffered from a ferry boat accident who’s got his legs amputated.   The child has no insurance and the father has no idea where to get the money to pay for the hospital bills.   On this case, the government nor any NGO did not helped the child; hence the father was forced to take the option of selling their house.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This case provided by dateline NBC, is relatively short and is made primarily for popular reading.   However, such a case would make one see how the government or the hospital for that matter did not take any advocacy steps in order to help the said family.   Analysis The article of Jost (1998) provides a clear picture of the conflict between various principles of biomedical ethics.   As the author have stated on previous paragraphs, the principle of Justice and Autonomy appears to be in conflict when discussing legal issues and keeping up with the notion of equality on health care services.   In addition, the idea of the greater good or the principle of utilitarianism appears to be in conflict as well with the laws against invasion of privacy. On the first issue that Jost presented, the principle of autonomy would normally state that it should really be the case that patients should be provided with the choice to have a physician of their own preference.   Since, man by nature as argued by the Kant as rational, then it necessarily follows that they should really be making their own choices.   However, it should be taken into consideration as well that legal contracts or agreements impinge this basic right of man for order and in some cases for social equality.   Tracing back in its philosophical roots, the very notion of the statutory laws emerged from the desire of man to engage himself into a social contract (i.e. Hobbes, Rousseau, Mill) in order to lift himself in the state of nature which is primarily characterized by the lack of order and domination of the strongest. Relating this to the conflict of the law (i.e. imposed by managed health care) and the principle of autonomy (i.e. the right of patients to choose their own doctors) simply makes sense.   If taken for instance that every patient lets say Xs that is enrolled on a managed health care, lets say A is given the opportunity to chose their own doctors, then A would cease to be a managed health care system at all since its very purpose which is to reduce costs will be defeated. In addition, inequality in terms of health care services will again stem out because relatively rich people will get the degree of health service that they prefer.   The author thinks that in order for the managed health care system to live on its purpose and prevent their customers to further increase their costs, they should be able to shift their perspective from profit to quality and humanitarian service.   The insurance industry is accountable for hundreds or even millions and billions of lives, and no amount of money could ever replace a life that is lost because of malpractice.   The essay by Epstein (2002) which tackles the law as one of the major vehicles in order to change the existing disposition of the uninsured has been seen by the research as something that is significantly related to the notion of justice and fairness.   The notion of justice is directly related to the laws that are imposed by the state.   However, since justice is only a result of human convention which is also partly dependent on the culture and the demands of the society, then it necessarily follows that it is imperfect. The essay of Epstein which emphasizes on the capacity of the government to insure majority of the citizens, most specially those who didn’t have the capacity of doing such; subsidizing the medicines of the marginalized seniors and associating small enterprises in order to afford the insurance of their employees is something that could be interpreted as a result to put more justice in the existing laws.   However, the author, basing the arguments from Epstein could significantly assert that such proved to be far fetched due to certain factors such as the political will, the inappropriate allocation of government funds and the lack of trust on human goodwill.    The political will as perceived by the author is the initiative on the end of the government to significantly allocate a percentage of the taxes that it collects for the uninsured.   In relation with this is the political will as well to help the marginalized, the immigrants and the children to acquire the insurance necessary in order to secure their health.   Corollary with this is the government’s investment on war versus the immediate need of its citizens’ health.   A proper allocation of the national budget is seen by the author as one of the primary solution to the huge number of the uninsured. The notion of the human goodwill as emphasized by Immanuel Kant is something that could be significantly related to the assumptions of discriminatory underwritings that could stem out from the associations of small companies across the border in order to provide insurance for their employees.   Kant asserted that man is inherently good and the author believes it to be so.   The mere premise that these small companies wanted to provide insurance for their employees is a valid reason enough to deduce that the former has a genuine concern on the plight of the latter.   Owcharenko (2006) presented her recommendations which are majority in a form of law changes and reforms in order to cater for the uninsured.   The author agreed with Owcharenko on her perspective that the best way to reach out and cater to the needs of the uninsured is to make national reforms in terms of the laws that governs every state.   Although the author perceived that advocacy on the part of the hospitals to solicit funds as a significant solution as well; the reforms on the laws would be able to cater on a relatively huge number of population. The principle of utilitarianism and beneficence in addition to the principles of justice could be seen as the core ethical foundation of the recommendations of Owcharenko.   The necessity of extending the health reforms to majority of the population is in conjunction with the principle of utilitarianism which is the greatest happiness for the greatest number of people.   In addition, the principle of duty of the Deontological Ethics could be applied as well. The basis of the morality of a certain act is significantly related to the â€Å"duty† that each person has.   This duty is perceived by Kant as something that is absolute or on his own terms â€Å"unibversalizable†.   In relating this to the government, the author perceived that part of the duty of the government is to assure that every individual regardless of social status and income will have the same access to health medications and treatments.   The notion of duty is significantly related to the justice that ideally should always be existing in a certain society.   Young et al (2004) has tackled the importance of the health of the undocumented children in the American society.   In order to present this, two principles from the ethics of principlism was touched- beneficence and maleficence.   The principle of beneficence asserts the relevance of thinking who benefits from one’s actions and in what such manner.   The principle of maleficence emphasizes on the notion of not harming any person or party.   The principle of beneficence was clearly applied on the disposition of the undocumented children and the principle of maleficence was applied on the existing laws for and against undocumented children. Due to the principle of non-harm, attempts on the end of the hospitals and the government to be more sympathetic, and more humanitarian to the undocumented children were executed.   Also, the principle of utilitarianism could be significantly related on the case of the undocumented children as well.   It could be noted that Young et al. has emphasized that these children and their parents served a significant part of the society.   Hence, their poor health could also affect the entire population.   Taking the principle of utilitarianism and its maxim which is â€Å"the greatest amount of happiness for the greatest number of people†, one could significantly deduce that the health of the paperless immigrants and their children could also translate to an overall increase of utility on the entire state.   The case of Natalie M. on the writings of McLaughlin et al (1999) presents the principles of autonomy, veracity, beneficence and avoided paternalism.   In certain cases wherein the patient has the mental capacity to decide for herself, the nurse case manager makes sure that the autonomy of the individual is emphasized.   Similar to the essay of Epstein (2002), the emphasis on the rationality of the individual is always taken into consideration. The notion of the â€Å"truth† is another ethical principle that is necessary for those patients who are under a care of a certain guardian or who has a family who is very picky and difficult to deal with in terms of negotiating treatment options.   The importance of arriving on the true desires of the patient is directly related on the principle of autonomy.   This would then make sure that paternalism will be avoided, although the nurse care manager also makes sure that such a decision that the hospital will arrive at is relatively the best step in order to improve the disposition of the patient, hence beneficence.   Tunzi (2004) has made a direct correlation on the principles of beneficence and justice.   By presenting various solutions on the case of the uninsured through government and non-government initiatives, it is evident that attempts to provide equal opportunity in terms of health services are attempted to be provided in almost all people regardless of their status in the society. Such a step could be seen as would present a great benefit on the end of the uninsured, hence beneficence.   Upholding profit versus the necessity of the human life is the case that was presented by Romano (2002).   The practice of so called boutique hospitals is something that is against the principles of Deontological Ethics which claimed that man should never be used as a means to an end. This means that if the hospital for instance rejects the admission of an uninsured patient because the latter does not have enough finances to pay, then it necessarily follows that profit is seen as the most relevant factor for the hospital and not really to save lives.  Ã‚   Then man or the patient for that matter would only be seen as an instrument for profit and not really the ‘end’ purpose of the hospital in itself.   The case of presented by Dateline NBC (2005) would show that there are really cases wherein besides of the efforts and the claims presented by the hospitals, NGOs and the government, there are still a lot of cases wherein the uninsured is being left out.    The case of the child who got his legs amputated which later on made his father decide to sell the house is something that could be prevented only if advocacy steps on the part of the hospital or the government was implemented.   The debt and or the decrease of the quality of life that this family might suffer after this crisis could also directly impact how the child will continue his healing process and or adapt to the new change that recently happened in his life.   Conclusion   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"The uninsured† is a term that is coined to people who don’t posses any form of insurance who primarily include paperless immigrants, minorities, children and or teenagers without insurance, employees of small businesses, people who belong on the lower part of the social strata and also a significant number of the elderly.   In effect, such a group of people suffered a lot in terms of seeking and receiving the health service that is necessary to prolong their lives.   Corollary with this, are the disposition of those patients who initially have a health insurance but experience a significant degree of difficulty in terms of having the insurance company subsidize the treatment and or operation that is necessary for their health condition.   Such a problem creates an ethical dilemma on the end of the doctors, patients, insurance providers and also the courts. In comprehending and analyzing the eight articles that was presented on this research, the author have deduced that the health care industry of the country is facing a huge dilemma most specially in distributing fairness in terms of the allocation of health services that is due not only to every American citizen but also to other races who lives in the country as well.   Such a growing injustice in the health industry has been attempted to be solved many times starting from the nurse advocates, the hospitals, non-government organizations and also the government as well. However, even though more than seven decades has passed since the necessity of insurance was perceived, the government still is quite slow in terms of providing solutions to the health problems of its citizens.   The budget deficit has been blamed due to the lack of monetary support, however, it is very evident that the government’s finances were clearly improperly allocated to certain war endeavors which a number of critics have argued to be null on the first place.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The ethical dilemmas that stem out due to the lack of funds, legalities, concern for profit (of insurance companies) are directly affecting the marginalized, the children, the minorities, and the senior people.   The author perceived that a reevaluation of the priorities of every significant institution which played an important role on the health of the citizens are relevant in order to set things on a right path and establish justice and fairness which has been the primary purpose on the first place of establishing a social contract, a government and the set of statutory laws which supposed to make the life of man better and in order. 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