Health Ethics: Commodification
Savannah SIdle
Memorial University
Health Ethics
People talk about 'commodification' in medicine like it's always a bad thing, but it’s not; sometimes it is OK to be treated as a commodity.
A commodity refers to an item produced for sale and valued because of the usefulness it has to the consumer. The price, cost, distribution, and availability depend on the free marketplace operations, which are constrained by minimal regulations by the government. Medicine and healthcare, on the other hand, refer to the provision of assistance to people who need cure and care by other professionals with the skill and knowledge to assist them. Therefore, in health care, the essential feature is the personal relationship that exists between the individual seeking assistance and the healthcare professional. For this reason, there is nothing wrong with treating health care as a commodity.
Commodification
Principally, there is no problem with the argument that there are specific services or goods that should not be treated as a commodity. There are two principal cases where this claim is justifiable. The first argument entails the observation that specific kinds of goods are so closely related to people's integrity that selling and buying them is not consistent with human dignity. These types of items are, by their very nature, unsuitable for trade. Market creation for them establishes perverse incentives, which violate the integrity of persons. This is the reason people do not buy and sell transplant organs, and why most people are convinced that surrogate motherhood contracts should not be allowed among other medical procedures. Nevertheless, there people typically do not complain and say that there is something utterly wrong with selling and purchasing health care services, or that it defies human dignity when the services are bought or sold. The common problem in most instances is the refusal to provide such services that provokes anger.
The second argument is much more essential because it relates to moral incentives. Notably, it has been viewed that in many cases that moral incentives help in securing a higher level of provision of a particular good as compared to commercial ones. Since market creation tends to foster self-interested behaviour, commodification has the power to affect provoking collective action issues, and thus minimizing the efficiency of a particular sector. Such dynamic is well described in the Richard Titmuss study on the supply of blood. He argues that a system of voluntary blood donation attracts more donors than people who get paid to donate their blood.
When evaluated literally, the argument that healthcare should not be treated as a commodity is feeble. Concerning the police force analogy, there is no doubt that personal security is a fundamental human right in the community and not a commodity. However, people do not make the suggestion that those with the resources should be barred from selling them. Additionally, there is a growing private security services sector that operates alongside the public sector. The simple fact that something is right does not mean that it cannot become a commodity, especially in instances where there are individuals with a desire and the resources to consume more of it than the general public. Therefore, there is nothing wrong with the idea of abortion or surrogate motherhood because those with the resources can purchase the commodities, which will bring additional happiness to their lives.
Surrogate motherhood
Most people who go against the medical practice of surrogate motherhood mistakenly argue that children are treated as commodities. Kids are considered items in cases where the surrogate mother falls prey to concerns of eugenics. Typically, contracts of surrogate motherhood have clauses that demand the fetus to undergo genetic tests. The contracts also state that the surrogate mother should abort the fetus in case the child fails to pass these tests (Pence, 1977). Moreover, genetic counselling clinics are encountering a dilemma because the tests that disclose if the fetus is suffering from certain genetic defects also reveal the sex of the child. So, when a mother aborts a healthy child because the contracting parents desire children of a particular sex is one way of looking at kids as commodities (Krimmel, 2000, p.37).
However, these and other moral complications of similar stature can take place whether or not law permits surrogate motherhood. Nonetheless, this discussion does not support that children are treated as items to the extent that a particular sex continually gets aborted. There is no problem with people striving to better themselves as long as their efforts do not lead to intolerance to things that are not perfect (Krimmel, 2000, p.38). Besides, what is problematic with people who have the resources wanting to get a child to fulfil a biological imperative?
Reproduction via surrogate motherhood deviates from cultural reproduction norms, and as a result, it seems wrong and immoral to many people. However, surrogate motherhood and commodification of children may be beneficial for all the involved parties. Surrogate contracts satisfy the desire of a couple, enabling them to bring up a child that is healthy and has the genetic structure of one partner. Further, the need for surrogate motherhood often arises when a woman suffers from a sex-linked genetic disorder or a dominant autosomal such as hemophilia. Another reason would be infertility, and the couples possess a strong desire to have children. A number of infertile couples endure endless marital conflicts due to an inability to have children. Also, such couples are filled with self-doubt and anguish. Therefore, if surrogate motherhood is the only way to bring happiness to such couples, then the commodification children or medical practice of surrogacy is not such a bad thing (Robertson, 2000, p.29).
Equality in the distribution of medicine
Most people who are against the idea of commodification of medicine argue that health care should not be treated as a commodity; instead, they suggest that it should be distributed according to need and not the ability to pay. The argument is not that there is anything intrinsic to healthcare that makes it unsuitable for sale and purchase. The underlying rationale is an array of fundamental concerns of distribution. If justice on distribution is the issue, then there is something unclearly demagogic about the contention of commodification. After all, there is a consensus (reasonably widespread) among empirical analysts that states that access to healthcare in America has become relatively equal compared to what is was in the last quarter century, and Canada provides a fairly adequate healthcare system that provides equal opportunity. Therefore, the issue should not be about equality in healthcare opportunities, but it should be on whether such balance will persist or not (Gutmann, 2000, p.542).
Nevertheless, it would be impossible to expect that all people will be willing to undergo the same type of medical procedures, especially when some people are wealthy enough to afford more expensive services. Mainly, several concerned healthcare providers acknowledge that the advanced medical provision has cajoled more Medicare services than the government can deliver to every single person. Most countries have more need for medicine than the resources to actualize it. This is one of the reasons the healthcare system status quo cannot be sustained (Lamm, 1993, p.14). No modern society can afford to provide all the "beneficial" health care, and this is promoting the success of the private medical system, meaning that for the government to provide all the required health services, the private sector is essential. In Canada, there are numerous procedures and benefits that are not covered by provincial health insurance such as many prescription drugs, prescription glasses, EMDR and many private psychological services, chiropractic care, and dental care; many of these services have to be obtained from a private insurance company.
Commodification violates medical core values
Some critics argue that establishing the market competition benefit for healthcare, when it is treated as a commodity, may destroy professionalism. Trust and confidence are essential for the stable personal and continuing relationship between a doctor and patient. Human health is essential for people to thrive, which is one of the reasons it should not be treated as a commodity. According to market/business ethics, emphases are placed on expenses being less than the revenues. When patients are seen as commodities, then they are weighed as centres of either loss or profit. Moreover, in market ethics, the pursuit of self-interest and profit-making are legitimized and if applied in healthcare, they lead to inequality in the distribution of treatments and services, which is unfortunate, but not unjust.
Medical professionals have a code of ethics that they are supposed to observe, and the code most affected by commodification patients are beneficence, justice, respecting patients autonomy, and non-maleficence. The principle of justice states that patients in similar situations should be given the same care. When people are at their most vulnerable conditions, they require additional protection than business ethics can provide. In contrast, Gutmann (2000, p. 535) argues that the idea of respecting the autonomy of patients and being just should not be a problem because patients will receive health care for the services they pay for in the two-tier class system. There will be no room for unjust treatment due to commodification since you receive the care for the service in which you paid.
Conclusion
From the above arguments, it is clear that commodification of medical services is not always a bad thing. It only becomes unethical when patients who are in need fail to get services. However, if they can access affordable services, then there is nothing morally wrong if the affluent patients want to purchase more superior healthcare services. Commodification creates room for medicine to be viewed as an item used to increase the level of happiness. There is nothing wrong if individuals want to purchase an additional private security to ascertain their safety, so there should not be a problem when it comes to buying additional healthcare.
References
Gutmann, A. (2000). For and Against Equal Access to Healthcare. In G. E. Pence, Classic works in Medical Ethics: Core Philosophical Reading (pp. 542-560). Michigan: McGraw-Hill.
Krimmel, H. T. (2000). The Case against Surrogate Parenting. In G. E. Pence, Classic Works in Medical Ethics: Core Philosophical Reading (pp. 35-39). Michigan: McGraw-Hill.
Lamm, R. D. (1993). Saint Martin of Tours and the New World of Public Policy. The Humanist, 13-15.
Pence, G. E. (1997). Classic works in medical ethics: core philosophical readings. Michigan: McGraw-Hill
Robertson, J. A. (2000). Surrogate Mothers: Not So Novel after All. In G. E. Pence, Classic Works in Medical Ethics: Core Philosophical Reading (pp. 28-34). Michigan: McGraw Hill.
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