The issue of health care rationing was an important factor in the debate over the health care bill that President Obama signed into law in 2010. Whether such rationing will occur remains to be seen.  If it does, though, it will undoubtedly have the greatest effect on the elderly — that is, some government administrator or health care panel may decide that certain expensive medical procedures will not be approved for people above a certain age. Similar decisions could also be made about the level of care given in assisted living facilities and nursing homes. A very competent druggist, well versed in the latest pharmacological studies, receives a prescription from a physician and recognizes that it is for a dangerous, highly addictive, and largely discredited medication.  She calls the physician and is told curtly to mind her own business.  As the customer waits in the front of the store, the druggist ponders the situation. “Should I refuse to fill it? Should I tell the customer I am certain the doctor has made a mistake?  Should I call the medical board and report the incident?”  She decides to fill the prescription. A doctor on duty in a hospital emergency room one Halloween night treats a 15-year-old boy whose eye was injured by an exploding firecracker.  He notices the boy is drunk.  Because the extent of the injury is not certain, he has the boy admitted to the hospital and notifies his parents.  When they arrive, the boy is under sedation, so his drunken condition escapes their detection.  Nevertheless, the doctor informs them that their son had been drinking. A psychiatrist is treating a very disturbed and potentially violent man. One day the man tells her that he has recurring thoughts of killing a stranger, whom he will choose at random.  He details exactly how he will carry out the crime.  A few days later the psychiatrist reads in the newspaper that the very same crime her patient described has been committed.  She has no doubt that her patient committed it; every detail is identical.  The psychiatrist would like to inform the police, but she decides not to.

Health care rationing has been a significant topic of discussion in the debate surrounding the 2010 health care bill signed into law by President Obama. Although it remains uncertain whether rationing will occur, if it does, it will have a particularly significant impact on the elderly population. Government administrators or health care panels may potentially make decisions to restrict costly medical procedures for individuals above a certain age. Furthermore, similar decisions could extend to the level of care provided in assisted living facilities and nursing homes.

In the first scenario, a competent druggist encounters a prescription from a physician for a dangerous, highly addictive, and discredited medication. The druggist raises concerns with the physician, only to be dismissed and told to mind their own business. As the customer waits in the store, the druggist is faced with a moral dilemma. Should they refuse to fill the prescription? Should they inform the customer about the potential mistake made by the doctor? Should they report the incident to the medical board? After careful consideration, the druggist decides to go ahead and fill the prescription.

The second scenario involves a doctor working in a hospital emergency room on Halloween night. The doctor treats a 15-year-old boy whose eye has been injured by an exploding firecracker. During the course of treatment, the doctor becomes aware that the boy is intoxicated. Concerned about the extent of the injury, the doctor admits the boy to the hospital and notifies his parents. However, due to sedation, the parents fail to recognize their son’s intoxicated state upon arrival. Despite this, the doctor informs them about their son’s alcohol consumption.

In the third scenario, a psychiatrist is treating a severely disturbed and potentially violent individual. One day, the patient confesses to the psychiatrist that he has persistent thoughts of randomly killing a stranger. He provides detailed plans on how he intends to carry out the crime. A few days later, the psychiatrist reads in the newspaper that the exact same crime described by her patient has occurred. She is convinced that her patient committed the crime, as every detail aligns with his previous revelation. Although the psychiatrist would like to report this to the police, she ultimately chooses not to.

These scenarios highlight ethical dilemmas faced by healthcare professionals in their day-to-day practice. Each vignette presents a complex situation where the professionals must navigate conflicting values and responsibilities. In the first scenario, the druggist is torn between respecting the autonomy of the prescribing physician and ensuring patient safety. Although the druggist may have concerns about the potential harm caused by the medication, they ultimately decide to defer to the authority of the physician.

In the second scenario, the doctor confronts a situation where they must balance the duty to provide medical care with the obligation to inform parents about their child’s substance abuse. Despite the parents’ inability to detect the intoxication due to sedation, the doctor believes it is important to communicate the information to facilitate appropriate follow-up care and intervention.

The third scenario delves into the realm of psychiatry and the dilemma faced by the psychiatrist when she becomes aware of her patient’s intentions to commit a serious crime. This case highlights the tension between confidentiality and the duty to protect potential victims. Although the psychiatrist strongly suspects her patient’s involvement in the crime and acknowledges the potential harm to others, she ultimately decides not to breach confidentiality and report to the police.

These scenarios underscore the complexity of healthcare ethics, where professionals must grapple with conflicting moral principles and navigate the intricacies of their respective fields. Decision-making in healthcare involves considering the values of patient autonomy, beneficence, non-maleficence, and justice, among others. In each case, the healthcare professionals make choices guided by their understanding of these ethical principles and the particular circumstances at hand.