Justice as Fairness

Table of Contents

1. Palliative care improves the quality of life and diminishes symptoms for individuals diagnosed with a serious illness. Also, it assists patients to understand all of their choices for medical treatment. It is useful at any stage of the illness, but is most effective if provided from the point of diagnosis. It can be provided to the patient along with curative treatment; therefore, it is not a requirement of the patient to stop any treatment that might cure the serious illness. Over time, if the treatment for the illness is no longer helping the individual, palliative care can continue to focus on increasing comfort or the patient can transition to hospice care (National Institute on Aging, 2017). Hospice care differs from palliative care as it is chosen at end of life, typically for symptom relief when the patient’s doctor believes they have six months or less to live. Hospice care is designed for the time when it may not be possible to cure a serious illness. All treatments to cure the individual’s illness are stopped and hospice care provides comfort care and support for the family. A team of nurses, doctors, social workers, spiritual advisors and trained volunteers are brought together to work with the patient and the family to provide the medical, emotional and spiritual support the patient needs. If hospice care is being provided at home to the patient, the hospice team coaches the family how to care for their loved one. Lastly, respite care is provided if the family needs a break from caring for the patient (National Institute on Aging, 2017). 2. Many Canadians in their last year of life could benefit from palliative care, but only 15% are receiving it. It is revealed by the Canadian Institute of Health Information that those who receive palliative care obtain it too late and too many patients are subject to multiple transitions of care as they are repeatedly moved around from their home, hospital and nursing home in their final days of life. Many individuals wish to die at home, but if they are not provided access to palliative care at home or are constantly being shuffled around, it is rare for their request to occur. Only one in four terminally ill patients who are hospitalized receive palliative care and half of them die while waiting to be discharged to a more suitable setting. The majority of Canadians die in hospitals where a peaceful and dignified death is rarely possible. The primary problem of palliative care in Canada is the lack of timely access and the distress caused by the lack of coordination between different parts of the health care system. Basic planning is the key to efficient palliative care. For example, cancer, cardiovascular disease, chronic obstructive pulmonary disease and diabetes account for majority of deaths and they all have predictable courses in the terminal phase; therefore, providing palliative care should be a priority. Moreover, Picard proposed a solution to easily resolve all the problems. Paramedics can provide palliative care which eliminates hospital transfers and doctors or nurses can be sent to the patients’ home or nursing home to have more hospital beds available. Overall, a change is required in the Canadian health care system of how palliative care is provided to support many patients at home, in nursing homes or in the hospital (Picard, 2018). 3. It is rare for Canadians to receive palliative care at home in their last year of life. Of the adults who died in 2016-2017 for Ontario and Alberta, 66% received some type of home care service in their last year of life and fewer than 1 in 6 people (15%) received palliative home care. It would be beneficial for the patients and the health care system if palliative care could be integrated earlier. Most individuals who had palliative care in the year of 2016, only received it in their last month of life. Access to palliative care in long term care homes in limited as, 24% of the residents who died in 2016-2017 were identified as having less than 6 months to live and of those residents, only 6% received palliative care in their last year of life. It is reported that patients who received palliative care earlier on were less likely to visit the emergency department as palliative care in long term care homes helps to prevent hospital transfers. Of the residents that received palliative care in long term care and died in 2016-2017, 97% of them died in their residence and 2% died in hospital. On the other hand, 77% of the residents who did not receive palliative care died in the long term care home and 18% died in hospital. Also, if patients could receive palliative care earlier on, it would decrease the amount of patients who are admitted to intensive care units for aggressive treatments. In 2016-2017, 25% of people who died in an acute care hospital received palliative care and 44% were initially admitted for an acute health issue, but once the problem worsened they were then designated palliative care. Majority of the time when patients received primarily palliative care in the hospital, it was unplanned or the patient was admitted through the emergency department. Following this, patients had to wait about 9 days to be discharged to a more appropriate setting for palliative care. Overall, palliative care is a current issue in Canada in terms of access and appropriate setting (CIHI, 2018). 4. Rawls theory of justice is constructed around the idea that all individuals are free and equal and that society should be fair. He views it as reconciling the tensions between the ideas of freedom and equality. His theory expresses the central idea that cooperation should be fair to all citizens considered as free and as equals. Rawls believes that citizens do not deserve to be less equal or at a disadvantage to another individual. All social goods are allocated equally to all citizens, unless an unequal distribution would be an advantage to everyone. Furthermore, any inequalities must benefit all individuals, including those who have the least. Rawls theory is not designed to address health issues as he assumed a healthy population that doesn’t experience negative effects from disease. Since Rawls classified the population as healthy, he was able to conclude fairness, equality and the same opportunities for all citizens (Wenar, 2017). 5. Norman Daniels considers health care special because it sustains normal function and allows opportunities for citizens. If people are kept close to normal functioning, it gives them the opportunity to participate in their society. Furthermore, the association between health care and opportunity proposes that the appropriate rule of distributive equity for directing the structure of a health care system is a standard protecting equality of opportunity. A fair process is required to set up the justification for resource distribution choices. This should be avoided by not biasing our designation for one phase of life and alternatively we should consider the age-relative opportunity range. Sparing assets from one phase of life for use at another doesn’t deliver inequalities across people in the manner that differential treatment by race or sexual orientation does. Equity between age groups in structuring a health care system is properly displayed by the possibility of inequality over a life expectancy. Rawls justice as fairness opportunity promotes “fair equality of opportunity”, as discrimination is not allowed and positive social measures are required to correct for the negative consequences. Lastly, our levels of well being should be evaluated by freely open measures which implies a list of essential primary social goods that incorporates rights and freedoms. Overall, justice as fairness greatly affects palliative care in Canada through protecting opportunity (Daniels, 2001).