Posted: October 27th, 2022

DW3- Trends In Healthcare Policy (Nursing)

Week 4 Discussion

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Advance Care Planning and Analysis

Read the section titled “Reflective Practice: Pants on Fire” from the chapter “Health Policy, Politics, and Professional Ethics” (ATTACHED) and address the questions below.

·  How do you judge Palin’s quote below, as an effective strategy to oppose Democrats’ plans for health care reform or unethical scaremongering? 

o  “And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care. Such a system is downright evil.”

·  Reflect on what informs your judgment: commitment to advance care planning, analysis of facts, and/or political party loyalties?

·  Is it right for nurses to endorse health reform legislation even if the legislation is not perfect?

·  Does this apply to the recently failed American Health Care Act?

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the 

University Online Library

. Below are guides that are located in the library and can be accessed and downloaded via the 

University Online Citation Resources: APA Style page

. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at 

APA Style.

The ethics of influencing policy

An ethical critique of human behavior involves paying attention to the intention of the moral agent, the nature of the act performed, the consequences of the action, and the circumstances surrounding the act. Ethics has to do with right and wrong in this world, and policy and politics has everything to do with what happens to people in this world. Moreover, both ethics and politics have to do with making life better for oneself and others. Surely both deal with power and powerlessness, with human rights and balancing claims, with justice and fairness, and with good and evil. And good and evil are not the same as right and wrong. Right and wrong pertain to adherence to principles; good and evil pertain to the intent of the doer and the impact the deed has on other people. Surely policy and politics involves justice in the distribution of social goods; fairness and equity in relationships among and between people of different races, genders, and creeds; and access to education and assistance when one is in need. Although the goodness of an action lies in the intent and integrity of the human being who performs it, the rightness or wrongness of an action is judged by the difference it makes in the world. Therefore the principles applied in ethical analysis generally derive from a consideration of the duties one person owes another by virtue of commitments made and roles assumed, and/or a consideration of the effects that a choice of action could have on one’s own life and the lives of others.

In a perfect world, legislators would all intend the good of the public they serve and use ethical means to achieve good outcomes. In the real world, legislators and lobbyists intend many things other than the good of the public and some use unethical means to achieve dubious ends. A democracy with an increasingly heterogeneous public necessarily involves compromise. Which strategies to influence policy can nurses use without sacrificing personal and professional integrity? Each advocacy strategy involves a variation of the same question—that is, what means can be legitimately used to achieve an end that someone (or a political party or the electorate) believes to be good? Should we assure the passage of health care insurance reform (a good end) by strong-arm tactics (an evil means)?

The price we pay for freedom and human rights is to grant them to all people, not just a favored few. And yes, it is risky and it may reduce our “efficiency,” and in some cases it may even lead to loss of life, but the alternative is that no one has rights (i.e., just claims); rights become the privilege of a favored group, whereas all other individuals are utterly helpless before the power of the state.

Certainly the electorate does not consent to the corruption of the legislative process, and even if a majority did approve of bending the rules of fair engagement to ensure that a particular piece of legislation is passed, would that make it right? Would it not end up threatening the very foundations of a free society (because the foundation of a republic lies in the honesty of its processes)? What are the differences between normal legislative wrangling and abuse of power? What does it mean when political parties refuse to participate in the legislative process and/or use blatant scare tactics? What is legitimate dissent, and what is a refusal to accept democratic outcomes unless you happen to agree with them? Without civil disobedience, we would still have the Jim Crow laws. And without respect for the law, a society degenerates into either despotism or anarchy.

What is a true difference of judgment about what would benefit society versus knowingly lying to deceive the public to achieve a political end? Why do we now have numerous resources to uncover media bias and to fact check? When people ask whether it is wrong to lie about something (e.g., the number of people affected by a particular disease) to get funding for research and/or treatment of patients with a particular disease, in a word the answer is yes. It is wrong. Why is lying wrong? It’s wrong because it undermines the foundation of any relationship: trust. Trust is the fabric that holds society together. In like manner, lying to further a political agenda is wrong not only because it undermines trust, but also because it fosters further dishonesty. Judging by the amount of political dishonesty reported in the media, one is led to the conclusion that there is a lot of lying going on! Adding to it, telling more lies to further our own agenda will only make matters worse.

Reflective practice: Pants on fire

Sarah Palin is famous for urging her supporters to oppose Democratic plans for health care using the scare tactic of death panels. She said the Democrats plan to reduce health care costs by simply refusing to pay for care:

And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care. Such a system is downright evil.

In fact, there was no panel in any version of the health care bills in Congress to judge a person’s level of productivity in society to determine whether they are worthy of health care.

The truth is that the proposed health bill would have allowed Medicare, for the first time, to pay for optional doctors’ appointments for patients to discuss living wills and other end-of-life issues with their physicians. PolitiFact awarded Palin with the 2009 Lie of the Year for the death panel claim and it made the list of FactCheck’s “whoppers,” but the political impact of her statement is hard to overstate. In 2011, the Obama administration even deleted all references to end-of-life planning in a new Medicare regulation when opponents interpreted the move as a back-door effort to allow such planning. So even in the regulations, Palin achieved her goal (

Holan, 2009

).

1. 1. How do you judge Palin’s quote? Effective strategy to oppose Democrats’ plans for health care reform or unethical scaremongering?

2. 2. Reflect on what informs your judgment: commitment to advance care planning, analysis of facts, political party loyalties?

3. 3. Is it right for nurses to endorse health reform legislation even if the legislation is not perfect? (The answer is yes; it may indeed be the right thing to do.)

Remember, politics is about relationships, and relationships cannot prosper when one party insists that the other party must agree with them on every (or even any) issue. It is not wrong to compromise; compromise is part of the give and take of relationships, and it is part of the give and take of politics. What is critical is knowing when it is possible to compromise without sacrificing personal integrity. This prompts the question of whether it can be acceptable to distort an issue to manipulate public opinion or to win the support of a particular piece of legislation. It is usually, however, possible to frame a discussion in a manner that is more acceptable to a certain constituency without lying in this manner. For example, in the health care arena, one can use words that appeal to known values, words such as tradition and legitimate authority (words that tend to appeal to conservatives), and words such as autonomous and experimental (words that tend to appeal to liberals). Knowing the target audience and framing the issue in words that will help them listen (or at least not harden their opposition) is smart, not unethical.

Any professional group has a duty to push forward laws and policies that protect or advance the best interests of those whom they serve. And any citizen, particularly a knowledgeable one, has a civic duty to speak out for the common good.

Professional ethics and moral agency

A professional ethic is built around three essential components: its purpose, the conduct expected of the professional, and the skills and outcomes expected in professional practice. Society demands that professionals be held to a separate moral standard of conduct because the choices professionals make affect other people’s lives more than their own. Nursing’s foundational documents make each nurse’s advocacy and health policy responsibilities clear. Although some may think that advocacy and health policy are an ethical ideal, they are rather a nonnegotiable moral obligation embedded in the nursing role. The American Nurses Association (ANA) Code of Ethics for Nurses states: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient” (2015). Provision 8 of the code, reflecting the stronger emphasis of the 2015 edition on nursing’s advocacy responsibilities, reads: “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” ANA’s Social Policy Statement: The Essence of the Profession was published in 1980 and revised in 1995, 2003, and 2010. The introduction to the 2003 revision emphasizes nurses’ central role in effecting health policy.

Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care. The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems (p. 1).

The 2003 revision also included for the first time in its list of values and assumptions of nursing’s social contract, “Public policy and the health care delivery system influence the health and well-being of society and professional nursing” (p. 4). This phrase appears again in the 2010 revision under the heading, “The elements of nursing’s social contract” (p. 6). The 2010 revision also notes as a key social concern in health care and nursing “Expansion of health care resources and health policy” (p. 4).

Once professional nurses understand what is reasonable for the public to expect of them, the next step is to determine if one has the capacity to meet these expectations—that is, “Am I trustworthy?” Moral agency is quite simply the ability to be what is professed: a human, a parent, a professional nurse. Moral agency in any specific situation requires more than knowing what is the right thing to do; it also entails moral character, moral valuing, moral sensibility, moral responsiveness, ethical reasoning and discernment, moral accountability, and transformative moral leadership (

Taylor, 2019

).

Nurses who value their moral agency are familiar with the principles of bioethics which commit them, all things being equal, to (1) respect the autonomy of individuals, (2) act so as to benefit (beneficence), (3) not harm (nonmaleficence), and (4) give individuals their due (justice). Other principles include keeping promises (fidelity) and responsiveness to vulnerability. A commitment to social justice and the common good has long characterized the profession of nursing. This commitment calls for the creation of a society in which all can flourish, not only the affluent, and the creation of a bottom floor, beneath which no one can fall regarding access to basic nutrition, safe housing, education, health care, and employment.

REFERENCE

O’Grady, D.J.M.D.B.G.F.H.O.E. T. (2020). Policy & Politics in Nursing and Health Care – E-Book. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323597951/

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