Introduction and Background Information
Policies in healthcare systems are faced with numerous ethical issues. Ethics is a vital aspect of medicine and healthcare delivery, especially in the determination of wrong or right actions. Larson (2013) suggested that almost every policy in healthcare has critical ethical implications to pertinent stakeholders, including patients, care providers, and healthcare leaders. 1 For example, The Affordable Care Act (ACA), also referred to as Obamacare, has raised numerous ethical issues, especially its constitutionality and norm conformity.
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Obamacare was legislated in 2010 to become what is arguably the most comprehensive and extensive law in US healthcare in the last five decades. Obamacare institutes a unique and novel direction for the federal healthcare system, which stresses preventive services and primary care.2 Moreover, the ACA allows for insurance coverage for the uncovered and attempts to augment patients’ outcomes.
Various theoretical frameworks have been put forward to explain ethical issues in healthcare systems. This research paper investigates ethical issues surrounding the ACA while applying ethical theories to the associated controversies.
The utilitarian, libertarian, and deontological ethical theories concerning the ACA
Since the ACA is faced with numerous ethical issues, it is imperative to consider some of the ethical theories that can be applied in addressing its administration. Some of the common theoretical frameworks that are applicable to ACA include utilitarian, libertarian, and deontological theories.3
The deontology theoretical framework is based on the principle that the morality of a course of action is determined by its consistency with moral norms. As such, an action is only deemed ethical if it complies with societal expectations. On the other hand, the utilitarian theoretical framework is principled on the view that the morality of a course of action is determined by its outcomes or its consequences.
If the consequences of an action are positive, then the course of the action is considered ethical.4 5 6On their part, libertarians base their ethical framework on individual self-governance, where there is minimal interference from the authorities. When an action, especially from the authority, hinders individuals’ autonomy, it is deemed unethical.
A striking comparable characteristic among the three ethical frameworks concerning ACA is that they all emphasize on the basic human right to healthcare. All the theories explain that providing healthcare to the public is vital and, therefore, some of the ACA’s intentions are justifiable.
Nevertheless, the three theoretical frameworks differ when it comes to the constitutionality, the administration, and the techniques adopted by the implementation of the ACA. A key contrasting element between the deontological and utilitarian theories is that while the positive outcomes of ACA will justify its essence in utilitarian, ACA positive outcomes would not be justified in deontology if they do not comply with social norms. 7 Libertarian differs from the other two since it emphasizes individual autonomy and, therefore, any policy, including ACA, should uphold individual governance.
Ethical issues regarding the implementation and administration of the ACA
As mentioned earlier, the ACA, like any other healthcare policy, is faced by numerous ethical issues. Some of the major ethical issues pertinent to the implementation and administration of Obamacare include the individual right to health, the American cultural values (including the right to personal autonomy), and employment.
Healthcare provision at optimal levels is one of the key fundamental human rights. Every person is entitled to the best possible healthcare. However, the issue of optimal healthcare, especially the ethical aspect, has not received due support in the form of discussion and necessary backing in the US. This is especially evident where the discussion of the federal provision of healthcare is often avoided. Most of the discussions tend to be on economic and political angles, particularly on matters on the financial burden of the provision of healthcare and commercial freedom.
The human right to healthcare ethical issues supports the ACA since the policy is based on the provision of assistance, especially to the less privileged and those whose right to health may be hindered by economic class.8
Second, the implementation of Obamacare will have an impact on American culture and values. As such, defining American society concerning individual mandate, personal freedom, individualism, and the moral need to uphold common good would be influenced. As such, individuals are compelled to purchase insurance cover while insurance companies are denied certain aspects of autonomy. It is worth noting that autonomy and individuals’ freedom are protected in the federal constitution. As such, ACA raises huge concerns about individuals’ autonomy.
Third, implementation of the ACA has ethical effects on employment.9 Many companies are compelled to comply with the ACA’s provision. Consequently, they take drastic steps such as laying off full-time employees and replacing them with part-time workers with the intention of cutting costs. These practices have huge implications for employees and societies in general. It is, therefore, apparent that unemployment could have opposing effects on the ACA.
An argument for ACA
According to utilitarianism, the end of a course justifies its means and, therefore, the ACA’s positive outcomes will make the policy morally and ethically correct. Obamacare’s key intention is to deal with the ethical issue of providing optimal levels of care as a fundamental aspect of human rights, especially through the expansion of Medicaid.10 As such, the ACA will not only drop the number of the uninsured but also augment the level of access to healthcare.
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For instance, it is estimated that the ACA would drop uninsured Americans’ levels by half when fully implemented. Particularly, the White House approximations credit 8 million and 3 million in HIEs and Medicaid respectively to the administration of the ACA.
Moreover, Obamacare forbids private insurers from denying coverage to patients with pre-existing conditions such as mental health disorders.
On access, the ACA is set to provide healthcare and drastically increase the number of people who can get optimal healthcare. This would be realized based on the principle individual mandate for the attainment of the common good. The less privileged in the society would have a leveled playground when it comes to accessibility. Moreover, the coverage of people with pre-existing factors would help such people access care.
Decisively, Obamacare is justifiable under utilitarianism since the major of its intended outcomes are positive, especially in addressing the issue of access.
An argument against ACA
As mentioned earlier, libertarian theorists fight for individual liberty. As such, government involvement in making decisions in individual financial, entrepreneurial, social, and other aspects is highly unethical. Moreover, it is worth noting that one of the key ethical issues in the administration of ACA is upholding American culture, partly based on individualism. Since Obamacare is based on mandated insurance, it is considered inherently anti-libertarian.11
Libertarianism necessitates structural safeguarding of the constitution, which provides and limits the executive powers. On the other hand, Obamacare tends to over-examine federal power in regulating individual mandate and Medicaid expansion.
Americans are compelled to purchase insurance cover in an attempt to expand Medicare and making it more affordable. The forcing of individuals to make such purchases is against the principle of individual autonomy and freedom to choose, which form the key elements that define the American culture.
Healthcare systems play critically significant roles in any society and, therefore, policies made to address medical issues are discussed and criticized by numerous stakeholders. The healthcare stakeholders are concerned with augmenting outcomes while upholding what they deem ethically correct. Therefore, different ethical frameworks are put forward to address issues in healthcare.
This paper has discussed some of the key ethical issues surrounding the administration of ACA. ACA as a legislation was enacted to improve healthcare insurance coverage and increase access, especially to the less privileged. The administration of the ACA, however, has faced both positive and negative critics on ethical grounds.
Three ethical theories including, utilitarian, libertarian, and deontological perspectives have been used to critic the ACA. Utilitarianism supports the ACA since its outcomes are positive. Deontological theorists are concerned with the ACA diverging from societal norms. Finally, libertarians are opposed to the government’s over-involvement in making critical decisions and infringing on individual freedom and autonomy.
Blackman, Josh. The Libertarian Challenge to Obamacare, (2013). Web.
Brown, Stephanie Anne. Ethical Implications of the Affordable Care Act on Employment, (2015). Web.
Christopher, Andrea S., and Dominic Caruso. “Promoting Health as a Human Right in the Post-ACA United States.” AMA Journal of Ethics,17, no. 10 (2015): 958-965.
Fieser, James. Ethics, (n.d.). Web.
Friesdorf, Rebecca, Paul Conway, and Bertram Gawronsk. “Gender differences in responses to moral dilemmas: a process dissociation analysis.” Pers Soc Psychol Bull, 41, no. 5 (2015): 696-713. Web.
Gawronski, B, and JS Beer. “What makes moral dilemma judgments “utilitarian” or “deontological”?” Social Neuroscience, (2016): 1-7. Web.
Hawk, William, and Gerald Schlabach. A Short Primer on Ethical Theory, (1998). Web.
Larson, Jennifer. Five Top Ethical Issues in Healthcare, (2013). Web.
Lathrop, Breanna, and Donna R. Hodnicki. “The Affordable Care Act: primary care and the doctor of nursing practice nurse.” OJIN 19, no. 2 (2014). Web.
Mandal, Jharna, Dinoop Korol Ponnambath, and Subhash Chandra Parija. “Utilitarian and deontological ethics in medicine.” Tropical Parasitology 6, no. 1 (2016): 5–7.
Vail, Robyn L. Golden and Matthew R. “The implication of the Affordable Care Act for mental health care.” Journal of the American Society on Aging, 38, no. 3 (2014): 96-103.
- Larson, Jennifer, Five Top Ethical Issues in Healthcare, (2013). Web.
- Lathrop, Breanna, and Donna R. Hodnicki, “The Affordable Care Act: primary care and the doctor of nursing practice nurse.” OJIN 19, no. 2 (2014).
- Mandal, Jharna, Dinoop Korol Ponnambath, and Subhash Chandra Parija, “Utilitarian and deontological ethics in medicine.” Tropical Parasitology 6, no. 1 (2016): 5–7.
- Fieser, James, Ethics (n.d.). Web.
- Friesdorf, Rebecca, Paul Conway, and Bertram Gawronski, “Gender differences in responses to moral dilemmas: a process dissociation analysis.” Pers Soc Psychol Bull, 41, no. 5 (2015). Web.
- Gawronski, B, and JS Beer, “What makes moral dilemma judgments “utilitarian” or “deontological”?” Social Neuroscience (2016): 1-7.
- Hawk, William, and Gerald Schlabach, A Short Primer on Ethical Theory, (1998). Web.
- Christopher, Andrea S., and Dominic Caruso, “Promoting Health as a Human Right in the Post-ACA United States.” AMA Journal of Ethics 17, no. 10 (2015): 958-965.
- Brown, Stephanie Anne, Ethical Implications of the Affordable Care Act on Employment, (2015). Web.
- Vail, Robyn L. Golden and Matthew R, “The implication of the Affordable Care Act for mental health care.” Journal of the American Society on Aging, 38, no. 3 (2014): 96-103.
- Blackman, Josh, The Libertarian Challenge to Obamacare. (2013). Web.