Clinical Conflicts of Interest in Healthcare

This chapter discusses Clinical Conflicts of Interest in healthcare. While there can be an abundance of these clinical scenarios, the chapter centers upon pivotal life and death issues of abortion and euthanasia to indicate where Conflicts of Interest arise and how they should be resolved.



a) Abortion:


The chapter focuses on typical Conflicts of Interest that can arise by reflecting the tension between dignity and pluralism, and the tension between consent and financial incentives. The issue of abortion has turned into a controversial debate amongst the scholars and other interested parties across the globe. While the opponents of the contentious issue argue against the act, with assertions that it is against the societal morals and values, some support the move by emphasizing that women deserve the right to make decisions concerning their pregnancies. As such, the involved parties strive to attain public support as well as try to seek legal justification for their claims.


More often, the supporters of abortion incline towards creating the ‘abortion rights’ chorus, thus making the majority to believe that the action is moral and justifiable. Despite their strive, the anti-abortion campaign supporters, on the other hand, assert that the killing of the fetus as well as risking of the life of the child bearer are among the burning issues that make them differ from the opinions of their counterparts.
Abortion, the majority of individuals who undergoes it claim capitalize it on moral grounds, indeed violates the medical regulations and societal values. As the wrangles intensify, the issue has turned political with the legalization taking effect in some nations, while other opposing to abortion creating tough anti-abortion laws, to bar its people from practicing in doing the act.
Regardless of the squabbles from the two sides, the core subject that emerges is whether abortion promotes or violates the values and ethics that define the human dignity and rights. It, therefore, raises the issue, is abortion morally defensible in the light of universal codes? The paper seeks to analyze and elaborate on abortion and its impact on human decorum and Rights.
Again, this chapter will base various potential sources of Conflict of Interest surrounding abortion, such as the cultural diversity and pluralism, the national policies regarding the issues together with the consent of the society. Further, the analysis will weigh the risks involved in undertaking the abortion as well as the legal measures for and against the subject.


a.i. Human Dignity & Pluralism:


Scholars associate the ethical debate over abortion with the tension between human dignity and pluralism. That tension can create Conflicts of Interest in healthcare. The conservative stance advocates for the legal prohibition of abortion because it contravenes the rights of the unborn child, while the progressive stance argues for the legalization of abortion because it supports rights of women.
The main ethical arguments against abortion explain that the embryo possesses human dignity (and thus it is entitled to human rights), that abortion is not permissible because it does not show respect for life because of undermining human dignity, and that abortion undercuts human dignity because it disregards the sanctity of human life.
In the stance against abortion, the Abortion Act of 1967 in Great Britain construes women as patients who are in the process of seeking medical care, rather than as individuals seeking abortion services. That is, “women are vulnerable subjects in need of assistance to make responsible decisions.” However, the opposition argument claims that abortion abrogates human dignity because it creates conflicts between the right of women to autonomy and the embryo’s life, arguing for the end of the prioritization of women’s dignity over the embryo. From this perspective, abortion is opposed because it disregards the life of the fetus by placing it at the whims of the medical professional. In particular, human dignity is the lens through which the claim of the woman to independence and the interest in the life of the fetus are best construed. This stance allows for the reconciliation and simultaneous protection of the bodily integrity and autonomy of the woman and the life and dignity of the fetus.
In contrast, the pro-choice stance argues that abortion should be permitted in many cases of problematic pregnancies. The philosophical underpinnings of this position are that the fetus lacks a moral value since it should not yet be construed as a person, that abortion is morally permissible due to many different circumstances, and that the responsible employment of abortifacients.
According to Lopez, abortion ought to be ethically legitimate in circumstances where “the mother does not want the child, the father does not want the child, the mother will possibly die from giving birth, and the pregnancy is the result of rape.” A mother’s choice to abort may be founded on the grounds that the mother is aware that the child possesses mental or physical abnormalities, she is addicted to drugs such as alcohol, or she is overly insecure and immature. Nonetheless, proponents of abortion advocate for reasonableness in the process of orchestrating it. Furthermore, physicians should adhere to codes of ethics and thus offer the best advice to women considering an abortion.
The tension of these differing positions can raise potential Conflicts of Interest in healthcare when physicians either inappropriately assist or hinder women from seeking an abortion. On the one hand, for conservatives who consider abortion unethical because it contravenes human dignity, clinicians may impose undue pressure on a woman to avoid an abortion, accommodating their own beliefs about abortion rather than serving the patient. On the other hand, for those who seek to uphold the rights of the mother, they may impose undue pressure on a woman to undertake an abortion, again accommodating their own beliefs about abortion rather than serving the patient.

Abortion and its Perils:


The act of abortion can be very risky, more so the medical abortions. Actually, the opinions about tailored medicine likens to making a bet at a discotheque. More often, the outcome might not be victorious to the extent of causing harm, or even death. Statistics indicate that the medical abortions that take effect in the first nine weeks into pregnancy are less risky or rarely lead to complications. However, the abortion after nine months is quite risky and requires experienced professionals to undertake such processes. According to 2014 UNESCO statistics, about 37% of women across the globe lose their lives due to medical and other forms of abortion. These and other statistics from medical scholars testify that the act of abortion carries intrinsic risks to women and girls, regardless of the reputation of the clinic where the action takes effect.


As the society experiences the rapid increase of health-conscious issues, abortion serves among the major health threats that the society should prohibit. Various well-documented researches together with the reports from the peer-review journals indicate that the risk of abortion is quite vast than even miscarriage and birth in that it contributes to massive deaths as well as causes severe health challenges of the individuals that undertake the act.
In most cases, the medical complications, as well as the health risks involved with abortion tend to undermine the false information that features from the abortion, industries together with the information emerging from the supporters of the issue. Most arguments in support of the abortion move assert that the society should consider both sides before deciding on the issue, that is whether to safe or sustain the life of the mother or develop concern about the rights of the unborn baby.
More often, some individuals in the society argue that the risks of birth are quite higher than the risk of abortion, not knowing that even if the mother survives in the event of abortion, she is likely to develop more health complications than the later. However, the truth is that his regulation of abortion by the society creates more benefits, as well as saves the lives of both the child and the mother. This is contrary to the situations where most women die because of abortion, with some developing some enormous medical complications the situation that they could have avoided through birth.
Research indicates that the risk of fatal anaphylaxis with penicillin is quite higher in that it causes death at the rate of two in every 50 users of the same. Other medical abortions that most individuals trust but are all equally risky include the use of the mifepristone and misoprostol, thus yielding to more health complications on the involved parties. A good example is in Europe whereby about 1.6 million women have utilized the medications mentioned to terminate their pregnancies in the past one year.
However, the outcome has turned disastrous, with the majority of these reporting some complication or tending frequent medical cares. Worse still, some women and girls involved in the practice face numerous complications in delivered or even become barren. Further, the scientific information indicates that very serious complication outcomes from medical abortions arise compared to the birth process, which is normally safe and healthier to both the mother and the born child.
Using other forms of treatments, more so the use of the antibiotics while undertaking abortion is riskier and can cause significant arm. Unfortunately, most of the women and the girls alike prefer to undertake abortion, not forgetting that the move is indeed risky and affects the future conceptions. Worse still, some individuals argue that the expenses of giving birth to a child are indeed higher, whereby they range between $3000 and $27000 in the United States alone. However, this is not true considering the cost of medication that one is likely to incur in the process of developing health complications in the event of abortion.
It is also apparent that some individuals happen to acquire their pregnancies through other ways that are not society supported for instance in the event of rape or incest cases. In such a situation, the majority tend to ignore the medical risks to undergo the abortion process, with an argument that the move will cover the committed atrocities and dispel the necessary stress. In the event, such individuals tend to regret later after facing some complication, the factor that makes them suffer more and even face death.


Risks of Abortion:


It was clear in the earlier arguments that the act of abortion violates the human ethics as well as deprives the humans their right to survive among other demerits. Therefore, the abortion process completely alters the life of humanity and leads them towards a painful life filed with long-term physical, spiritual and physiological torture. Again, he process itself is indeed risky, the factor that makes its prohibition a right alternative. Various risks arise in the process of undertaking the act of abortion. Immediately after the abortion, some immediate and undisputed risks emerge, thereby making the life of an individual more miserable and most irritating. Among the immediate risks, include the blood clots, the injury that takes place on the cervix, excessive hemorrhage together with the possibility of the occurrence of incomplete abortions, which cause excessive pain.
Medical experts also assert that the process of abortion can easily cause cardiac arrest together with the renal failure. In the event of such occurrences, an individual can easily die or face other body consequences that can turn very painful. In some situations, some individuals undertaking the act of abortion have experienced respiratory arrest, sudden shock together with the possibly of metabolic disorders, the factor that turns into a life threat. It is apparent that such situations arise due to abortion, hence an indication that the abortion process is indeed very dangerous and life threatening. Again, statistics indicates that these immediate effects about 15% of the women undergoing the abortion process with about 2% of them succumbing to death.
Other than the immediate effects, the abortion process also creates permanent effects on individuals. These consequences occur in the form of physical and psychological and they encompass, the consequent preterm birth experiences in women, the occurrence of placenta previa leading to excessive bleeding, severe mental health setbacks together with the possibility of frequent miscarriages. In other cases, individuals involved with abortion may acquire breast cancer because of the depravity of defensive outcome of an initial full-term conception. Considering these risks, it is indeed quite risky for an individual to prefer abortion to the normal childbirth process.
Another risk that arises due to the abortion process is the possibility of the occurrence of the pre-term birth in the consequent pregnancies. To elaborate, the pre-term birth is a condition whereby a woman gives birth to a child in an earlier period than the projected nine months. In most cases, this duration ranges at about three or more weeks earlier than the stipulated period. Various scholars and other peer reviewed articles have associated the induced abortions with the preterm births (PTB), the factor that has revealed that the two issues relate. According to some reliable scientific research sources, about 40% of women that undergo preterm births underwent through the abortion process. Actually, the preterm births tops on the global chats as the major causes of infant mortality, with the death figures as a result of it reaching about 4 million in a year.
The western countries such as UK and US are the most hit regions due to the rampant abortions practiced due to the flexibility on the issue of abortion. Other than causing deaths, the preterm birth children become underweight during the birth process, the factor that makes them to suffer from numerous medical complications or even meet their early death.
Statistics also indicate that such children suffer from developmental problems such as the cerebral palsy, vision deformities, and mental and chronic health issues among others. Some can even suffer from cognitive destruction together with the underdevelopment of sensory organs within their bodies, the condition that is quite painful to the parent and the child. Worse still, parents that undergo preterm births utilize more income to enable the child revive and reach the level of attaining independence and self-reliance.


a.ii. Consent and Finance:


This tension between pro-life and pro-choice camps, with their accompanying propensity for Conflicts of Interest, is accompanied by another terrain that raises potential Conflicts of Interest, the landscape of financial interests. According to Sawicki, “the legal norms of informed consent during abortion often deviate from moral norms since they make neutrality, objectivity, and impartiality impossible and unwarranted.” This focus on the legality or legal norms may be inappropriately connected with financial interests that accrue from providing abortion services. Jones et al. state that many patients undertaking abortion come from financially disadvantaged backgrounds, “yet most pay several hundred dollars out of pocket for abortion services.” This can be an example of a potential Conflict of Interest where providers accrue significant financial gain, especially from poor patients who can least afford the services. This Conflict of Interest contravenes the physician-patient relationship. This scenario of potential Conflicts of Interest can arise when consent to an abortion (in the context of significant financial gains to the provider) highlights the lack of private and public health insurance coverage of abortion-related services.




Abortion as a Nationwide or Local Strategy:


The issue of abortion has become an issue of controversy amongst various states and regions across the globe. More often, various countries and international bodies develops such regulations as means of securing the lives of their people as well as ensuring that some societal rights are effective and favor the human dignity at all times. In the actual sense, various states across the globe have received the mandate under the international human rights to protect the health status of their citizens. Actually, the enhancement of communal interests is typically among the major goals of governments in the event of serving their citizens. However, in some cases, this common benefit guiding principle goes against personal approval.


Despite the reality that some health-related guidelines and regulations associated with the fortification of human rights, others take the wrong direction more so when they criminalize, forbid and control admittance to essential health services. A good example owes to the laws that prohibit abortion and other issues such as the conception capacity, in the name of life protection by the governments and societies are against the human ethics and rights. More often, the doctors and the involved parties may take a drastic decision aimed at saving lives, but fear to undertake the act, due to the fear associated with the punitive measures by the government. In such a situation the governments and societies should ensure that, such bioethics seeks consent of the patient. In most cases, some patients fall victims of endangered health, as well as the deprival of the individual rights to decide on the right course for one’s health.

Cases that Occur


More often, an assortment of cases happens whereby the administration takes the illegalization or justification pronouncement without informing the parents or the folks that feel the direct impact of the issue. As such, the prohibition of abortion can encourage the majority to search for insecure abortion methods, which will ultimately impinge on their prospect lives. On the other hand, the justification of abortion is prone to cause much damage in the event of poor administration strategies. Eventually, the majority of the people will hold close the abortion and accept it as a substitute so solve their crisis after participating in the unprotected sex. Due to such, the approval of the parents together with the application of human ethics and rights will play a big role when deciding the right move that will apply and win support from the majority. As a rule, the argument concerning abortion is an infinite subject likely to cause incongruity amid the cohorts as well as the opponents to the issue. It is evident that any pronouncement by various governments is likely to gratify several individuals and displease the rest of the proportion.


Again, It is obvious that the government and societies capitalize on the international human rights to develop some regulations that protects the health status of their citizens, with the core issues triggering the formation of such rules including the maternal and prenatal health, drugs among other issues. Other than utilizing the measure like the national insurance plans, disease prevention plan and the generation of state funds to facilitate care to the citizens, other measures that the government utilizes includes the development of laws and regulations that outline the punitive measures that results in the event of breaking such policies and measures. Actually, the implementation of such regulations serve effective since they ensure that all its members adhere to the regulations as a means of adapting a good path towards improving their health status. However, some regulations and measures developed by the government may create danger to the health of its citizens, thus making some to practice some acts secretly, with the exposure to more harm.


More often, many regulations come with punitive measures such as fines, the withdrawals of operating licenses as well as the criminalization of actions such as rape, abortion or incest. In reality, the government formulates and implements such regulations with the intent of correcting the behaviors of some individuals as well as guides them towards the rehabilitation processes as well as creating lasting solutions to the victims. It is true that the majority of the government created health regulations and policies work best in improving the welfare of people as well as uphold the human rights. More often, some like those associated with rehabilitation as well as those that create punitive measure on issues such as excessive drug consumption, have declined such acts and made of individuals to turn around and adopt constructive lives.
On the other hand, some, such as the illegalization or legalization of abortion contravene basic human rights, hence the need for the consent before criminalizing or prohibiting such issues. In most societies, some conflicts have emerged due to the development of some regulations and policies, which differ, with different opinions of individuals. Among the nations such as Ireland, they have developed polices that criminalize the act of abortion.


According to this nation, their regulations, which affirm that life begins right from conception tend to defend and uphold the life of the embryo and the fetus, but tend to neglect the dangers facing the mother, in this case the woman carrying the pregnancy. In the United States a controversial debate has merged amongst the citizens with some groups supporting abortion while other opposing towards the act. The public division over abortion arises from clashing agendas on individual freedom, the right to religious or moral convictions engulfing the perception that life commences at conception or not during the birth period. In general, about 40% of the Americans support abortion terming that it gives an individual the freedom to make choice on whether to carry the pregnancy or terminate it. On the other hand, about 53% of the Americans believe that abortion is ethically wrong. In such situations, it becomes quite complicated for the government or society to formulate polices that give guidance on the issue. Within the US, the intensity of the Conflict of Interest has led to the emergence of two dominant groups namely the pro-life groups, which are against the abortion and the pro-choice groups, which accredit the legalization of abortion.


Other than the public conflict, the political conflict is also another factor that arises because of abortion. Actually, the abortion issue concerns the personal private rights. More often, most nations, with the inclusion of the US and the UK, develop a political conflict with two questions evolving. Among the questions is whether the women reserve the right to carry on with abortion, considering that they are the carriers of the fetus. Again, another question that brings about controversy includes the question whether the unborn child has the right to claim the rights of its own.
In some nations, human rights only apply to born but negates the fetus and the embryo. Nonetheless, those nations that believe that life begins at conception affirm that the unborn child should enjoy the same right with their born child. Still, what irritates most is the reality that some nations develop some policies without the consent of the individuals involved. In such case, the move is indeed unethical and it prejudices the human rights.
In America, the legalization of abortion has indeed caused some moral divide, with the pro-life supporters asserting that abortion is just like murder and the government should not legalize it. However, the pro-choice groups assert that abortion should be an individual decision and should undergo the legalization process. Further, some individuals argue that the legalization of abortion will welcome the save methods of undertaking the process as well as an ideal way of reserving the women with the right to control their bodies. However, the argument by the supporters of abortion has deviated from the right path, which dictates the observance of moral and ethical rights to both the child and the mother. Such direction is about observing the social ethics as well as matching with the universal direction about the issue. In general, the government should focus on developing the flexible regulations that could indeed match with the expectations of the majority in the society.


Lack of consent unethical:


Lack of consent, more so during the process of formulating abortion policy by the government and societies is indeed unethical and potential source for Conflict of Interest Challenges. Moreover, the UNESCO statements oblige that folks articulate their assent prior to every medical process. Under such grounds, the governments and societies have no mandate to formulate and implement policies regarding the crucial issues such as abortion, since they require the intervention of the individuals or the affected victims. When the government passes an abortion act with an intention to control the growing population, it negates the role and consents of the society, more so the parents. This is self-defeating because the universal aim is attained, but the outcome violates the individual interests. Statistics indicate that several countries have criminalized the act of abortion to some degree. Nevertheless, the regulations by such countries do not apply in the event of healthy regulation as a triggering factor in abortion. Other nations, more so those that operate under the influence of religion and other cultural backgrounds, allow the termination of the pregnancy arising due to rape, incest as wells as due to fetal malformation.
Various cases arise whereby the government takes the illegalization or legalization decision without informing the parents or the individuals whom the issue affects directly. More often, the illegalization of abortion can inspire individuals to seek unsafe abortion paths, which will eventually affect their future lives. On the other hand, the legalization of abortion is likely to cause more harm if not well administered. In this process, more individuals will embrace the act of abortion and take it as an alternative after the involvement of the unprotected sex. Under these circumstances, the consent of the parents together with the application of moral and ethical issues will play a big role in making the right decision concerning the move for abortion.

Conflict of Interest


In general, the Conflict of Interest surrounding abortion is an endless issue that is likely to cause more disagreement amongst the supporters as well as the opponents of the issue. It is apparent that any decision taken by the governments is likely to please some and displease the rest of the percentage.
Considering the much harm created by the issues, most individuals and societies have remained flexible when handling the issue. In this respect, the issue of abortion is partialy legalized in some nations while the rest of the nations have legalized the issue. Conversely, seeking the consent in the event of formulating such regulations and policies will serve effective in the event of developing the policies that can meet the societal demands as well as serve the interest of the majority. Above all, the move by the governments and the societies to develop the ideal regulations and policies should encompass the ethical and human rights as well as uphold the human dignity at all times.


Abortion for financial Benefits:


Despite the intensive debate that opposes or supports the acts of abortion, some issues emerging indicates that some people support the matter for the monetary gain purposes. Health practitioners with an objective to generate income sometimes engage themselves in abortion; the act create Conflict of Interest challenges, which is against ethically, accepted medical practices.
Further research indicates that the private medical facilities make more money from the abortion industry, with an average doctor getting the income of about $2 million in a single year. More often, such individuals emerge into the market with claims to offer sex education, while others claiming that they are offering family planning services. Additional research indicates that such practitioners ignore the human dignity and fail to uphold the human right of the fetus. In most cases, the government contributes much to these cruel activities by finding the efforts of these practitioners, the factor that gives them the upper hand to exploit the taxpayer’s money.


Further information indicates that some of the medical practitioners apply the deceptive counseling approaches to convince the women and girls alike to embrace the move for abortion, the factor that makes the majority to fall into their dirty trap. Same case apply in other developed countries such as the UK and Germany, with the abortion cases reaching about 36 and 42 percent respectively in a single year. More often, the minority fall victim of abortion, with the dominant races more so the whites minimizing the abortion cases in America. However, it is not obvious that all the medical practitioners crave for money as a benefit from abortion. Some medical institutions live alone the abortion mills, prefer abortion as the last alternative to save the life of the mother, after other alternatives have failed. It is apparent that such practitioners adhere to the ethic and human rights in the event of undertaking these services. Another point that proves that such individuals are genuine is the fact that they charge less money compared to the private medical facilities the factor that makes them appear genuine.
Finally, various governments and societies have developed tough legal regulations and measures to control the conduction of abortion by medical practitioners for monetary gains. In the US for instance, it is clear that any medical practitioner that appears to conduct the abortion for the purposes of monetary gains is likely to face a prison term of 5 years as well as pay the fine of up to $5000. Other nations also embrace the same policies, therefore an indication that nations and societies are facing such crimes with focus and are ensuring that the medical practitioners adhere to human ethics at all times. Despite the challenge arising in the process of fighting for the human rights by various societies, it is apparent that the core objective of most societies is to ensure that the human interest comes first and other issues follow afterwards.

Conclusion:


In conclusion, this chapter discusses the pivotal life issues of abortion and assisted death to indicate and resolve clinical Conflicts of Interest that can arise. It explores the nexuses between human dignity and pluralism and consent and financial incentives in abortion. And it explores types of assisted death with accompanying issues related to rights, law, and religion. These clinical issues can engender professional Conflicts of Interest, and these conflicts must be resolved via a balance between professional obligations, legal requirements, and patient interests, as discussed in the next chapter.

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