RIGHT OF CHOICE IN HEATH CARE

“Right of Choice” in heath care practice (Elderly care)

“Right of Choice” in heath care practice (Elderly care)

Introduction

Since the early 1970s many hospitals have voluntarily adopted, as policy, various versions of the Patient Bill of Rights. It was not until 1989, however, that laws were enacted by the legislature declaring that, as a matter of public policy, acute care hospital patients had certain specific rights. The law also provided for a mechanism to enforce those rights. The newly passed bill and the administrative regulations that were promulgated under its authority came to be known as the Patient Bill of Rights.

With the protection of legislation, the provisions of the regulation were designed to be overseen by a body external to the health system itself, in this case the State Department of Health and Senior Services. By way of explanation, the State Department of Health and Senior Services are not integrated with the structure of the various hospitals and health care systems in the state. It is an administrative agency, part of the executive branch of government, charged with, among other things the licensing and regulation of acute care hospitals in the state.

Hospitals and health care providers are mainly private, for profit or not-for-profit entities, with large county facilities having been phased out. The majority of hospitals are self-governing, but are tied to state and federal regulation through the Medicare and Medicaid reimbursement they receive. Therefore, while the state is the regulatory overseeing body, the hospitals and health care systems in are not part of a state-run health care system.

Finally, it should not be presumed that the system is either purely one of collective, communally delivered health care, or purely a more individual model. The system involves a mixture of both in varying proportions. For example, the national education programme expounding the benefits of a low-fat, high-fibre diet has been made widely available as a way by which community health may be improved. It is, however, the responsibility of the individual to espouse the healthy diet and lifestyle and, it is hoped, thereby improve his own health. Enough individuals accepting responsibility in this way should, in theory, result in a healthier community as a whole.

The ethical concerns rose in the "just" delivery and distribution of health care to those concerned with their individual needs, rather that the greater welfare of the community, does begin to rear its head at this point. Clearly a self-care-motivated health system has the potential to impinge upon the "just" distribution of health care resources. However, self-care should not be confused with selfish behaviour, and the former should be explored carefully because there is great value in individuals accepting personal responsibility for maintaining their own good health.

Discussion

The United Nations Principles on Older Persons acknowledge five rights for the elderly or older persons. These are the rights to independence, care, self, fulfillment, dignity; participation. The principle of independence recognizes the wish of older people to be independent as far as ...