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Advanced Ethics End of Life Issue Topic
Advanced Ethics: End of Life Issue Topic
Justice: Allocation of Resources for the Terminally Ill in ICU Settings
Justice within the health care setting is a matter that requires a sensitive approach due to the intricacy with which decisions made by health care professionals and administrators have on the life of the patients. Among the most striking applications of justice within the healthcare setting is the allocation of resources of particularly for the terminally ill patients. On one hand, it is important to acknowledge the fact that the resources to save life, just as it is with most other vital resources in life, are limited in supply within a backdrop of an almost ever increasing demand. Justice as an ethical duty for the health care profession facilitates the making of the difficult decision on which individuals on the terminal illness patients’ list gets the allocation. As such, a clear ethical consideration basis must be formulated and followed to the latter to ensure that the most deserving patients are served by the profession on the merit of the appropriate considerations of making the waiting list.
To justify the importance of this topic to the health care industry, it is perhaps important to highlight the most critical areas of application of justice characterized by the allocation of organs for transplant. According to the healthcare professional ethics, justice should be employed in the allocation of transplant organs to the terminally ill patients based on a number of considerations (Giuliano, 1997). However, the following of the outlined code of the allocation has been a problem with cases of organ smuggling and buying cartels being reported in many instances. Alternatively, it is suspicious how celebrities and other high ranking members of the society climb up the waiting list in the allocation of organs.
As an illustration of the complexity of the distribution of transplant resources such as vital organs, there is a landmark episode in the American health care ethics history represented by contentious allocation of liver transplant to Todd Krampitz. In ethical considerations of the case, it is reported that Mr. Krampitz’s liver was fast deteriorating having suffered from a large tumor and waited for a well wisher to donate the organ. Krampitz and his family decided to design huge signboards, newspapers and television notices appealing for well wishers who would donate the organ to him. Eventually, a family emerged having lost a member to an accident and decided to donate the liver to Krampitz eventually saving his life through the transplant. Despite the ethical considerations binding doctors in the organ allocation system, his doctor went on to overlook the system where over 17,000 patients had been lined up ahead of him on the waiting list (Caplan, 2004).
As an ethical profession, it fails to be depicted in the case in the conduct of the doctor for circumventing the justice system of allocation of organs which are increasingly a rare resource against the rising number of patients in need of transplant. It has also been reported that politicians and superstars have severally been involved in arm-twisting the administrators of the system to allow them to be slotted ahead of other deserving patients on the waiting list. According to McCarrick (1995), the number of patients in need of organ transplants has steadily increased annually by about 20 per cent against an almost similar number of organ donors. To ensure that justice in the allocation of organs is adhered to, professional ethics needs to rise up to the occasion on an equitable basis. Treating every individual in need of an organ transplant will only be conducted in a just way if professionalism stands above the status considerations.
Just allocation of resources among the terminally ill patients has been a problem in many countries for a long time, with cases of an organ black market existing. As an illustration, it is reported that China had one of the most notorious illegal trade of organs where involuntary harvesting of organs from disadvantaged persons was going on for a while (Menikoff, 1999). Ethical acknowledgment of the need for justice in the healthcare profession particularly in taking care of the terminally ill patients is a milestone in the profession. However, adherence presents the biggest hurdle to the profession and enthusiasm observed in compliance to other professionalism duties and codes must be replicated on this end. While terminally ill persons may not actively take part in soliciting or even forcibly acquiring organs, influencing the system of organ allocation is a major setback to resource allocation in a just way.
Childress (1996) reckons that it is not enough to hold ethical opinion if application of the appropriate systems of allocation of resources such as organs cannot be followed. To this end, it is important to consider other channels of implementing ethical systems for instance by departing from the traditional principles altruism in dealing with organ allocation. Under altruism ethics, morality calls bind professionals to act in a manner that will ensure helping and benefiting others beyond their individual interests. Bearing in mind that most ethical codes of conduct in health care pay unmatched attention to altruism, it follows that the logic of circumventing the system would not hurt the professionals for having assisted someone in the end.
According to Krom (2005), it is perhaps time to make a departure from altruistic approaches in dealing with justice in allocation of resources to terminally ill persons and employing mutually assured assistance. In view of the author’s perspective, resource allocation would be better if the waiting list criteria are made with a more charity based approach across the donors and receivers. A different approach is argued by Menikoff (1999) who proposes a working organ swapping basis for the allocation of resources to work. The author argues that there is need for the receiver to avail an organ from his relatives to assist someone else on the waiting list and reduce the large numbers of people with organ needs. Organ swapping as recommended by Menikoff (1999) seems more logical than many other justice based organ allocation systems which can easily be circumvented exposing them to injustice.
In my view, it is very important for resource allocation systems for terminally ill patients to consider justice implications in advance of their implementation. While acknowledgment of a just allocation may be the driving force of adoption of a particular resource allocation system, such as the organ waiting list, it is important to interrogate its implications on implementation. Manipulation of the system by able persons through various influential inputs is perhaps one of the most difficult areas of implementation of resource allocation. It follows that the less advantaged persons in the terminally ill group of patients will be subjected to injustice following such systems’ incapacity to equitably handle their plight. A review of the system operating in the health care system must be conducted to highlight the incapacity of dealing with the manipulations. Health care provision should be accorded to all persons regardless of their state of condition provided the justice system avails an equal chance of treatment and care. As an illustration of the practicality of the need for equitableness, the current American allocation system dictates certain conditions that the patient must fulfill to qualify for a top priority in the allocation of organs. Among the criteria for first consideration is the severity of the condition and chances of survival in case a transplant occurred. Based on the fact that the organ being transplanted is not replaced, as recommended on the organ swap system, this will remain to be a retrogressive system that can be likened to a death license. An equitable chance in the organ swap system can raise confidence among patients which has been demonstrated to positively work in the healing and recovery process thereby making justice in resource allocation a reason for all patients to have hope for another day alive.
References
Caplan, A. (2010) “Cutting in Line for Organ Transplants.” Retrieved from: http://www.msnbc.msn.com/id/5810779/#.Tox3gGUrxkg
Childress, J. F. (1996) “Ethics and the Allocation of Organs for Transplantation” Kennedy Institute of Ethics Journal, 6, 397-401
Giuliano, K. K. (1997) “Organ Transplants: Tackling the Tough Ethical Questions.” Nursing, 27(5):34-38
Krom, R. A. (2005) “Earning Points for Moral Behavior: Organ Allocation Based on Reciprocity,” International Journal of Applied Philosophy, 19(1):73-83
McCarrick, M. (1995) “Organ Transplant Allocation,” Kennedy Institute of Ethics Journal, 5(4):365-384
Menikoff, J. (1999) “Organ Swapping.” The Hasting Center Report, 29(6):28-33
Advanced Accounting Advanced Tax Research and Jurisprudence
Advanced Accounting: Advanced Tax Research and Jurisprudence
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Ethics refers to conduct and how it can have a positive impact. Most times, the news focuses on issues that affect accountants. Accountants are being accused that they are not following the established codes of ethics (Dayson, 2010). Controllers, Chief accounting officers and Chief financial officers are the ones most likely to commit acts, which are unethical. In the United States, tax returns are filled by around 135 million people. More than half of this population obtains assistance from tax accountants. There are people, who might not want to pay and others want to pay it at an extremely low price. In turn, tax accountants are faced with challenges, which threaten their morality as well as ethics (Dayson, 2010).
This paper seeks to give an analysis of issues on Ethics, Morality and Legality in tax accounting. Also, it seeks to investigate the view provided by the scriptures in the Bible concerning matters related to tax.
Keywords: Tax, Ethical, Moral, Legal, Accounting
Issues involved in Tax Accounting
The case study is about tax accountants, who are often pressurized, to engage in acts considered to be immoral, unethical as well as illegal. Clients try and attempt to evade paying taxes or even trying to pay the least amount of tax. Accountants should be able to make decisions, which are morally accepted. This means that they should distinguish between what is bad and that which is right. Perfection standards should be followed when making decisions, which are unethical. The tax accountant should know about the implications of him committing the act. They should ensure that assessment of the situation at hand occurs (AICPA Professional Standards). This means that they should evaluate the impact of the act, which they are about to commit. Parties involved, should be thought off before any decisions are made. The results of the act should be compared as well as the responsibility involved. The tax accountant should make good judgment concerning this situation.
The Christian Bible (2011), KJV, has a lot of information regarding matters related to taxes. The book written by Mathew, in chapter 17 verses twenty four to twenty seven, provides information regarding taxes. Taxes were paid, even by Jesus and this means no one else has a right not to do so. It was during an incident at Capernaum that the matter on taxes was known. According to Jesus, any human being should be able to pay taxes. Those who do not, or try to evade it are committing a sin. Also, in the twenty second chapter of the same book, Jesus gave his sentiments concerning taxes. Some Pharisees wanted to trap Jesus, when they were asking if it is right to pay taxes. They wanted to know if paying taxes to Caesar was right or not. Jesus wanted people to pay taxes to whoever was in charge of providing money to them. This means that people should pay their taxes to the government as it is their obligation. Furthermore, those who do not pay taxes are meant to be punished by the existing authority. This is because they are evading their responsibilities, while other people suffer at their expense. The book of Romans also gives views that Paul gave concerning tax payment. People, who are moral, should be influenced by their conscience to pay taxes. Retribution exists for those who evade tax payment. God has given responsibility to authorities, thus it is mandatory to adhere to its set rules. Even if a person is not a Christian, they should know that it is required that they pay taxes. It is not fair for people to enjoy services provided by the government and they do not contribute anything towards it.
Tax accountants should be well trained, to face problems relating to their work. Integrity must be present while working. This means that they should not accept any form of gift, which might be presented to them. This is because they risk their career being sabotaged and later on, might lose their jobs. The policies, which exist in the organization, should be followed (Burton, 1972). In turn, it will be easy to solve the matter in a legal manner. One can chose to advise the client on the negative impact of what the client is requesting. The client should be aware of the implications of their intentions. If this fails, then more action needs to be taken, to ensure that the client does not commit this act in another firm. The tax accountant’s seniors should be made aware of what is taking place (Burton, 1972). They will then decide the best action to solve the matter. For example, they can sue the client whereby, the matter will be solved in court. This method is tough, but the results are rewarding. People who refuse to pay their taxes should be ashamed, so that they will think twice, in case they do not want to pay their taxes. Those who want to pay low taxes and want tax accountants to help them are committing a crime known as corruption. Corruption is crime, which carries a punishment that is extremely serious. Tax accountants have an ethics and conduct code, which they should follow. Those who violate the ethics code should be punished accordingly due to the crime that has been committed by them. Often, it might lead to loss of clients but one should be happy that they have made a decision, which is morally accepted. In conclusion, ethics is a vital issue, which should be addressed well by tax accountants. People should know that it is mandatory to pay taxes to any existing government (Accounting and Auditing Enforcement Release). Taxes, which people pay, are used by various governments to come up with projects that will benefit its citizens. People are in need of services of high quality in the sectors of health, education, among others. If they do not pay taxes, they should not expect to benefit from such services. This is the reason why tax accountants as well as their clients, should not become involved in unethical practices, concerning tax issues.
References
Accounting and Auditing Enforcement Release No. 923
AICPA Professional Standards, vol. 1, “U.S. Auditing Standards,” sec. 316
Bible. (2011). King James Version. Oxford: Oxford University Press.
Burton, John. (1972) .Corporate Financial Reporting: Ethical and Other Problems .New York: AICPA. 7, 51–52.
Dayson, J. (2010). Accounting for Non-Accountants. London: Pitman.
Advance Directive and ANA Code of Ethics
Advance Directive and ANA Code of Ethics
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An advance directive describes a document through which an individual makes a provision for health care decisions in case, in the future, the individual becomes incapacitated in making a decision regarding his treatment wishes. The advance directive constitutes the durable power of attorney for health and the living will (Guinn, 2008). A living will tells the type of treatment that an individual desires in case he is permanently unconscious or dying; an individual can refuse or accept medical care depending on his wishes as spelt in the living will. On the other hand, the durable power of attorney for health care is an advance directive that gives an individual’s health care proxy. The advance directive is a vital document since it serves the function of permitting an individual to make his health care choices, in the future. Without the advance directive, an individual will not have the capacity of expressing his health care desires to be pursued in the future, when he is not capable of making the health care decision (Guinn, 2008).
In carrying out health care practices, nurses need to follow the code of ethics. The code of ethics provides an outline of the rules, values, responsibilities and duties that nurses must follow in giving quality health care to individuals. The American Nurses association code of ethics outlines such guidelines and responsibilities that nurses need to adhere to in order to ensure ethical standards are followed in the provision of health care services. Therefore, the chief purpose of American Nurses Association code of ethics is to provide ethical standards that nurses should follow in order to ensure that they provide quality health care services to individuals. It provides the nurse with a guideline of what to do and what not to, when providing health care services. In addition, the American Nurses association code of ethics serves the purpose of aiding nurses in making ethical decisions, when providing health care services (Masters, 2013).
A nurse is trained to professionally handle patients under the guidance of the code of ethics. Through the American Nurses Association code of ethics, a nurse is capable of providing health care services to individuals through making the best ethical decision (Council of Europe, 2011). In case, a person does not have a living will or even a power of attorney for health, the nurse providing medical services to such an individual will follow the American Nurses Association code of ethics in providing treatment to the individual. The American Nurses Association code of ethics provides that a nurse must always intend to serve the good to others in order to impact the health lives of others positively. Because of this provision, the nurse will make the best ethical decision regarding the treatment of the individual, who does not have a living will or a power of attorney for health.
Besides, the American Nurses Association code of ethics provides that the primary commitment of a nurse is to a patient (Masters, 2013). Therefore, a nurse will always be committed to a patient. In case, an individual is in a coma but does not possess a power of attorney for health or a living will, a nurse is going to use this provision in providing the best health care service to the individual; the nurse will become committed to the patient in ensuring that the decision that he makes will be for the benefit of the patient.
References
Guinn, K. (2008). Physicians’ Perspectives on Discussing Patient Advance Directives. New York: ProQuest.
Council of Europe. (2011). Principles concerning continuing powers of attorney and advance directives for incapacity: Recommendation CM/Rec (2009)11 adopted by the Committee of Ministers of the Council of Europe on 9 December 2009 and explanatory memorandum. Strasbourg: Council of Europe.
Masters, K. (2013). Role development in professional nursing practice. Burlington, MA: Jones & Bartlett Learning.