There have always been major access and service availability problems with the mentally ill. The mentally ill were shifted from inpatient to outpatient without sufficient community planning which has led to a great disparity in care as well as prejudice against those that are seen as less than the average person (Aday, 2003). Research finding that heart attack victims with mental illness receive less aggressive treatment fits the scenario that people have a severe prejudice against the mentally ill.
The scenario given definitely has ethical issues imbedded in it. First of all healthcare in the United States is not a right. It is provided to those that can afford it and emergently to those that need it. Many times, not only are mentally ill people unable to afford elaborate healthcare but they also do not understand it. They already have many issues that prevent them from understanding the world around them and they are, after all, not contributors to society. Why would we do the most elaborate expensive treatment available on them when most of them are on Medicaid anyway and are not going to follow through we the orders given anyway.
Ethically after all, this is a values clarification, right? No moral code fits everything and is it morally prudent to continue to treat someone that does not follow orders or who is not contributing to society in general? Supporting that view is ethical realism. If all the funding is spent on those that can use it the least such as the mentally ill and aggressive cardiac surgery, then how can those same resources be used for those that are not mentally ill and need aggressive cardiac surgery.
In other words, there are only so many resources and they should be spent on those that are most likely to do well with them. There are just some cases in which the use of resources does not make any sense and this is one of them. Would this not justify utilitarianism and the greatest good is saved for the greatest number? The public comes before the private good, in other words, is it not in the public good to have less mentally ill wondering the streets?
On the other hand, these patients have the same rights and should have the same access as any other patient. Is it not a possibility that they are non-compliant because we have not taught them well? Do we even know if they actually are more compliant than others or is that bias opinion? Those questions need to be answered. As to contributing citizens, many are contributing and some wonder the streets but then some normal folks wonder the streets to so that is not a good reason at all.
It is true that utilitarianism states that the public good should come before the private good. It even states that the decision should be made in an effort to have the greatest good for the greatest number. It also states that the consequences of the decision not the decision itself is what is right or wrong. There is an element of possibility by using this theory that minorities may be harmed. Nursing is a caring profession and physicians have an oath to do no harm. Certainly is harmful and it is less caring for healthcare personnel to treat any group such as this differently when it comes to providing healthcare.
Deontological theory is touted as meaning the end justifies the means and certainly if you want to get rid of those that are mentally ill, the means in this case will get you there. However, in this theory the act itself carries the moral value. In this instance, the act is omission and this omission causes harm and shows lack of caring so in the medical profession, this is very difficult to support. This theory rejects acts that cause harm to minorities and individuals so in this case its supports the lack of moral decision making made in these cases.
We are free in the United States and healthcare may not be a right such as the freedom of speech but in this country there is a belief of moral and ethical care. The right is always chosen over the wrong and to do no harm is important. These things cannot be thrown out or there will be no healthcare as we know it. Prejudice is a terrible thing and disparities in healthcare in this country are rampant. Lu Ann Aday in At Risk in America spells out the many disparities that exist in this country and they are shocking.
In conclusion, mental health care has been a problem in this country for many years. Is it because there is the feeling that these people are somehow less human than the rest and because of that they deserve less care? Is it because they look and act different and the prejudice that so many of us feel affects their care.
The country did not want to spend resources on mental healthcare and released many people to the streets that were unable to care for themselves. Now they do not want to spend resources caring for these people when they are sick. What is the answer? If we ignore them will they go away? This writer thinks not and this writer also believes that these patients deserve the same care as all other patients in this country regardless of their mental illness.
Furthermore, there should be no disparities of care in a country as rich as this one when health is the most important resource that anyone can have and healthcare in this country is morally and ethically bound to put blinders on when it comes to all of the reasons we come up with for rationing care.
Aday, L. (2003). At Risk in America. 2nd ed. Jossey-Bass: Boston.