Classical ethics and care
Let’s talk ethics.
The greats – Aristotle, Kant, and Socrates – all who were able to contribute to the transformation to the idea of human thought. Each of these lines of thought have influenced western medical ethics for centuries, however culture and religion are both some of the most influential aspects medical ethics in Ethiopia.
In order for there to be a greater understanding of the decision-making that the physicians made, I wanted to understand what ethical framework was used by physicians. The ethical framework that the physicians used will ultimately determine which individual will receive priority for treatment and which patient will have access to the limited medical supplies that are available.
Each hospital that I visited had similar value systems in order to give priority for patients. Some hospitals used a point system, while other hospitals used a triage system – a complex formula in order to determine which patient should have priority, or others as simple as red flag, yellow flag, and green flag in descending order. There are different modes of thinking in terms of providing health care service, however for many general practitioners the majority of decisions that are made are up to the physicians which specialize in certain fields.
As children, many of us are taught first come-first serve for various situations. However, this same framework is used in hospitals across the urban and rural hospitals in Ethiopia. This first-come, first-serve basis applies to any individuals who are admitted to the hospital. This first-come first-serve basis is problematic for low socio-economic patients who have travelled from hours away to receive treatment – often taking days to be treated without sleeping accommodations or nightly transportation available. Luckily, the only condition that supersedes the first-come, first-serve basis is the severity of the condition of the patient. If a patient is in need of immediate medical care and each second puts them at a higher risk of death, they will receive treatment first. Sadly, for a patient who has travelled days to be treated will have to wait many more for treatment due to this first-come first-serve framework.
Utilitarianism is a form of thought made famous by John Stuart Mill and Jeremy Bentham. This mode of thought is used in hospitals as well. Through multiple interviews, I found that many doctors – unknowingly using utilitarianism – used this framework to determine which individual will have priority for treatment. Many doctors would give adolescents and teenagers priority for treatment as opposed to older individuals and the elderly. This belief is based off of the higher chance of survival for the younger patient and greater years of life that the individual will be able to live as opposed to the elderly. This framework is both used for priority for treatment of patients and for access to the limited medical supplies that the hospital has available.
These forms of thought all contribute to the ethical framework that doctors use in order to give priority for treatment and use the limited supplies that they have available. The value system, first-come first-serve basis, and utilitarianism framework provide their own set of benefits and drawbacks; however, the root of the issues stems from the lack of ample medical supplies available in order to treat these patients. If these supplies were available, then the process would run much smoother. In summation, the last question asked to each doctor was whether their frameworks used was learned from medical school or personal beliefs and practices in order to give patients priority for treatment and access to medical supplies. The answers were spilt down the middle. Some physicians explained that this was taught in medical ethics during their time in school, while other individuals explained they it came from their personal religion or Ethiopian culture to treat the patients.
To take note, the one aspect that was shared across all hospitals throughout Ethiopia – both urban and rural is the quality of care in terms of time. Whenever the hospital was overwhelmed with patients, each doctor that was interviewed explained that the quality of care is lowered with less time spent per patient due to the influx of patients. This can pose as a problem when trying to diagnose a patient and things can be overlooked which may be detrimental longer-term for many patients. This is different from developed countries health care providers such as the United Kingdom and United States – where hospitals have enough medical doctors and supplies where there is not a time scarcity to treat patients.