As ethics enters mainstream, "politicization" results
Media often distort information
One fortunate change in 25 years is that medical ethics has entered the mainstream of discussion and debate, but increased visibility can have unfortunate drawbacks, as well.
Medical ethics often involves an aspect of law and policy at the federal or state level, as much as it includes patient/family decision-making with the physician or other health care provider at hand.
"To me, the most upsetting thing that has occurred over the last 10 years has been the way so many of these bioethical issues become politicized, and quite frankly, distorted by politicians and the media," John D. Banja, PhD, tells Medical Ethics Advisor.
"With these health care reform debates, we've seen so many people — and let us hope they're not representative of America — I mean, people acting in a very selfish, narcissistic kind of way [by saying] 'I'm concerned about what this health care reform means particularly to me; I don't want to lose my benefits.' And number two, we've seen, I believe, a profoundly uninformed public nevertheless weighing in on these kinds of issues," Banja says.
Death panels, or end-of-life conversations?
Probably the most widely publicized disagreement in meaning was then Gov. Sarah Palin's terming as "death panels" what medical ethicists say were simply financial incentives included, at one time, in health care reform legislation, as a way to incentivize physicians to have end-of-life planning conversations with their patients.
According to Kuczewski, the legislation's financial incentive provision "was just a meager attempt to say, 'Well, if we give some reimbursement for this, maybe more people will have these conversations with their doctors.'"
In the proposed legislation at that time, Kuczewski says, "the doctor could claim a small reimbursement for having a conference with the patient to talk about their end-of-life wishes and advance directives."
The "hopeful" aspect of the attention the topic received was that as a result, the thinking shared by many in health care — that patients are not participating to the extent they could in their overall plan of care — is "getting some attention nationally," he says.
Confusion over screening mammogram debate
Another difference of opinion between a medical ethics approach and politicization occurred approaching the end of 2009, Banja says, when new research supported a change in existing guidelines by suggesting that women would not get screening mammograms until the age of 50. The previous screening guidelines suggested that women begin getting screening mammograms at age 40.
"The Obama [health care reform] plan was being criticized because of the possibility that it might not cover screening mammograms for women, and that caused a big furor," Banja says, noting that this particular message was a "falsehood."
"Doesn't America understand that those kinds of problems are part and parcel of what it means to provide insurance coverage? That insurance companies are constantly making these benefits-burdens tradeoffs, [that is], if we pay for this particular coverage, it may cost us a tremendous amount of money and may actually not yield very, very much by way of patient satisfaction or patient treatment," Banja says.
What is likely to come
Participatory democracies "work best when the public is informed," Banja says, and that is endangered when various media either don't understand or distort the truth.
"I'm very, very worried that . . . so many of the ethical dilemmas are going to be politicized, and in the process of that, we're going to lose the kind of rational and informed debate we should have about these kinds of issues," Banja says.
Rather than becoming educated about ethical issues related to health care provision in the United States, Banja suggests that instead, individuals may make choices because a particular news pundit suggests they see the issue a certain way.
"That's one of the most upsetting things I'm anticipating for the next decade," he says.