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Ethics of Care Essay

Ethics of Care Essay 

This essay will discuss the view that the service-user’s rights to autonomy and dignity should outweigh all other considerations. Autonomy is the right to chose or refuses care. The service users (and their workers) have the right to dignity The government’s Dignity in Care initiative highlights that ‘High quality health and social care services should be delivered in a person-centred way that respects the dignity of the individual receiving them’. One crucial element of achieving dignity is for providers to understand the significance of human rights legislation.The legal framework of human rights and anti-discrimination law requires that health and social care workers, alongside other providers of public services, respect the dignity of people using services. Ethics of Care Essay Paper

As the Department of Health points out in ‘Human Rights in Healthcare – human rights ethos is an important way to improve services: Quite simply we cannot hope to improve people’s health and well-being if we are not ensuring that their human rights are respected.

Human rights are not just about avoiding getting it wrong, they are an opportunity to make real improvements to people’s lives. Human rights can provide a practical way of making the common sense principles that we have as a society a reality. Human rights principles are very closely related to other principles of good professional practice that have underpinned public service provision for a long time. Human rights and health and social care practice share an ethical basis of concern with the autonomy, privacy and dignity of people using services.So, even before the vocabulary of human rights was developed, good practice in the delivery of social and healthcare recognised needs for privacy and dignity, and also recognised the tensions between these requirements and the need sometimes to protect people in vulnerable situations from harm. However, the introduction of the Human Rights Act provided a real opportunity to look at traditional practices in social care and health services.

It puts the focus on the person using services and so is different from a paternalistic culture where assumptions are made by professionals about what is best for the people in their care.Instead it gives us a way by which individuals or their advocates can articulate demands on services. A judge, His Honour Justice Munby, emphasised the importance of human dignity in a case that concerned health and safety regulations. He said: The recognition and protection of human dignity is one of the core values – in truth, the core value – of our society and, indeed, of all societies which are part of the European family of nations and which have embraced the principles of the Convention…The other important concept embraced in the ‘physical and psychological integrity’is the right of the disabled to participate in the life of the community. Ethics of Care Essay Paper

.. This is matched by the positive obligation of the State to take appropriate measures designed to ensure to the greatest extent feasible that a disabled person is not ‘so circumscribed and so isolated as to be One special feature of human rights requirements is that they may be enforced, or made to work, through legal action by people using services or their representatives.However, human rights cannot work solely through individual enforcement. The government takes responsibility for the enforcement of standards through guidance, inspection and regulation. In addition, organisations and individuals that deliver care and treatment need to understand human rights principles, accept challenges to the traditional way of doing things and adapt their practices in response.It is not only organisational policies or paperwork which must respond to positive participation in service delivery; everyday practices such as providing support with personal hygiene, eating and the discussion of confidential information with other people may be challenged by people using services and their advocates and will require responses from frontline workers.

This does not mean that every assertion of human rights must be complied with.Health and social care workers have a number of other legal responsibilities imposed on them, for instance through health and safety laws, through ‘common law’ duties of care, through legal requirements that personal information should be treated as confidential and processed in accordance with the principles of the Data Protection Act 1998 or through their contracts of employment, which may at times or in some circumstances appear to conflict with the necessity to respect human rights.Particular dilemmas may face staff when there is a conflict between their legal responsibility to protect someone and that person’s human right to self-expression, for example, of their sexuality. Moreover, people work in organisations that impose a whole range of demands and targets on them and it can be hard to see the relevance of human rights to these targets, never mind their central importance.What is often required is a careful consideration of the human rights issues involved, which need to be weighed against the other duties imposed on provision. Depending on the nature of the right asserted the right should only be infringed if it is legitimate, necessary and proportionate to do so(according to………. ) Ethics of Care Essay Paper

What is a health needs assessment? A health needs assessment (HNA) is a systematic method of identifying unmet health and health care needs of a population and making changes to meet those unmet needs. It provides information: (1) to improve health; (2) for service planning; (3) for priority setting and (4) for policy development. Health needs assessment is not a health status of population assessment. It aims to improve health and it incorporates the concept of a capacity to benefit from an intervention.

Defining Needs An understanding of health needs assessment requires a clear definition of need.Need implies the capacity to benefit from an intervention. The above diagram can help demonstrate how different notions of need interact. 1. A need is felt and expressed, but not identified as a normative need. Example: Cosmetic surgery procedures where professionals do not agree that there is a medical need. 2. Ethics of Care Essay Paper

A need is felt, and identified as a normative need, but not expressed.

Example: Psychiatric interventions, where a need is felt, professionals would agree that there is a need, but the need is not expressed. 3. A need is felt, expressed and identified as a normative need.Example: Someone experiencing severe chest pain and going to A&E. 4. A need is not felt, but it is expressed and identified as a normative need.

Example: Someone attending their GP to obtain a sickness certificate, even though they are over their illness. Bradshaw’s Classification of Needs Approaches to Health Needs Assessment There are three approaches to doing a HNA: Comparative This compares levels of services between different populations. It should take into account local population characteristics (demography, mortality, morbidity) CorporateThis is based on the demands, wishes and perspectives of interested parties (professional, political and public views). This approach was encouraged by the 1989 reforms with its ‘local voices’ and current emphasis on partnership and collaboration (and public involvement). It is essential if policies are to be sensitive to local circumstances. A disadvantage with this approach is that it blurs the difference between need and demand and between science and vested interest. Epidemiologically based This combines epidemiological approaches with patient’s perspectives, assesment of the effectiveness and possible cost-effectiveness of interventions. Ethics of Care Essay Paper

Imagine living in an area where an appointment to see a primary care physician takes weeks or sometimes months. Or even worse, imagine if there were no primary care physicians in your area at all. These are realities many people in rural areas of the United States face. According to the Bureau of Health Professions, there are “2,100 rural underserved areas in the United States” (Health Resources & Services Administration, 2001) with roughly “20% of the U. S. opulation residing in a primary medical care Health Professional Shortage Area. ” (Health Resources & Services Administration, 2007) The Agency for Healthcare Research and Quality states that Americans who reside in rural areas are more likely to: •“Be older, to describe their health as poor or fair, and to lack private health insurance.

“Face longer distances to reach hospital or other health care services, especially dental or medical specialty care. •“Receive care in a less timely fashion as compared with urban dwellers. Ethics of Care Essay Paper

” (Agency for Healthcare Research & Quality, 2002) With these issues to overcome, a few questions have to be asked: What are the barriers facing the rural population that need health care in the United States? Who makes up this underserved group of people? What are the barriers the rural population face when trying to access health care? What challenges do health care workers face when trying to deliver health care services to rural areas?

Once these questions are asked, studied, and answered, we will then be able to discuss solutions that can alleviate some of the issues facing rural health care delivery in the United States. According to the U. S. Census Bureau’s classification, an area is classified as rural if it is located outside an “urban cluster – a dense area with between 2,500 and 49,999 people or an urbanized area -a dense area with at least 50,000 people with a 1,000 person per square mile overall density. (Agency for Healthcare Research & Quality, 2002) Urban areas are typically defined and classified by multiple criteria whereas rural areas are defined by exclusion. The Office of Management and Budget and the U. S. Census classifies “rural” using different terms and criteria. The Office of Management and Budget classifies areas as metropolitan or non metropolitan and focuses on counties.

The U. S. Census Bureau classifies areas as rural based on populations and area. The U. S. Census classifies “25% of the opulation (roughly 61 million) Americans as rural. The OMB classifies 23% (55. 9 million) Americans as being non metro. ” (United States Department of Agriculture, 2005) With these government agencies using different classification criteria, coming up with different numbers, and using a process of exclusion, none of which clearly defines what is rural, is there any wonder why this population is so often neglected? Between 2000 and 2005, the non-metro areas of the United States gained 1. 1 million residents, an increase of 2. 2%. Ethics of Care Essay Paper

According to Rural America at a Glance, a 2006 report issued by the U. S. Department of Agriculture Economic Research Service, International migration supplied nearly a third of the population growth in non-metro areas, and accounted for all statistical non-metro population growth in the Midwest. The states with the largest non-metro growth were North Carolina (111,308), Florida (110,471), Georgia (84,336), and Texas (77,724). The states with the fastest non-metro growth rates were Delaware (12. 7%), Nevada (11. 9%), Florida (10. %), and Hawaii (10. 3%).

Age and ethnicity play a large role in the makeup of non-metro populations. In general, non-metro areas tend to have a higher concentration of older residents than metro areas. Almost “15% of the population that live in rural areas are 65 years old or older in comparison to 12% living in metro areas. ”(Fox & Rosenthal, 2000) From 2000 to 2005, non-metro areas saw a 7. 8% increase in people between the ages of 40-59 while there was a 5. 3% decrease in non-metro populations under the age of 20. United States Department of Agriculture, 2006) Depending on the area of the country (North, South, East, and West), the ethnic makeup of rural populations will vary.

The African American rural population is concentrated in the south and southeast as is the Hispanic rural population. The non-Hispanic white rural population is more dispersed throughout the country. Living in a rural area poses many hurdles to accessing quality health care. One problem many people do not consider is the topography and weather extremes in rural areas.

This could be mountainous areas or areas susceptible to heavy flooding and snow. This problem could be somewhat overcome by better public transportation but due to a lack of paved roads and tight financial constraints many cities and states face, expansion of public transportation services is many times not an option. Poverty is another factor that impacts rural health care access. According to Rural Health Statistics, “more than 14% of rural Americans live in poverty while only 11% of urban Americans live in poverty. (United States Department of Agriculture, 2007). Ethics of Care Essay Paper

Poverty and less education generally lead to less healthy populations. Problems more prevalent in poor rural areas include higher rates of chronic illnesses such as ling cancer and diabetes, and unhealthy behaviors such as smoking and alcoholism. These are some of the reasons why rural areas have higher death rages for children and young adults in comparison to urban areas. Managed care such as Medicare, Medicaid, and the State Children Health Insurance Program (SCHIP) are often the only means of access to health care in many rural areas.

A major problem with a large population being so reliant on publicly financed managed care programs is that the people who use these programs are more heavily impacted by federal and state budget crises and coverage changes. Managed care programs also tend to categorize large rural areas without regard for the makeup of these populations. An example of this is the policy used for Medicare hospital reimbursement. This policy uses a wage index to calculate almost “70% of the reimbursement payment rate and pays a fixed amount to hospitals per diagnosis related group (DPG) per Medicare patient. (Heady, 2002) The problem with this system is that for rural areas there is one index used for an entire state.

This poses a problem for large states with diverse rural populations. For example, one rural area in a state may have a high concentration of elderly residents while another area may have a large concentration of single mothers. Obviously these populations have very different medical needs but the government does not make this distinction. In addition, states can set income eligibility at almost any level.