When considering respect for autonomy in healthcare policy related to diabetes, the person with diabetes or pre-diabetes should have the ability to make his or her own decisions based on personal values and beliefs (Longest, 2010). Regardless of whether educational treatment options will reduce a person’s incidence of diabetes or reduce costs, respecting patients’ autonomy will require allowing them the choice to receive such education. Meaning, in no situation should an individual be forced to attend an educational program or receive a treatment for his or her diabetes or pre-diabetes.
Policy decision-making for diabetes must also apply the philosophical principle of justice; this can be a topic of debate related to the distribution of benefits and burdens on members of society in a fair way (Longest, 2010). We do not want to waste resources on those who are not in need, or take away from individuals who may have genuine needs. When determining our perspective on justice related to diabetes education, we must consider whom we would like the resources and burdens distributed to, and how these decisions will be made.
We should act with beneficence, to intentionally do good. Knowingly burdening some individuals for the benefit of others violates this principle (Longest, 2010). In health policies, a similar principle of nonmaleficence should be reflected in the quality and quantity of services, requiring that we “do no harm”. There can be significant consequences of the health policy-making process. All possible outcomes of policy implementation must be considered carefully to avoid negative ethical impacts.
Healthcare policies related to the coverage of diabetes and pre-diabetes education and treatment options have significant ethical impacts on Arizona residents. Healthcare policies can affect costs of services, preventing some residents from receiving services. If a patient is told that he or she needs to alter lifestyle choices to prevent diabetes, but the educational program ordered by the provider is not covered financially, the patient may decide to forego the program. In a few years, this patient could develop type 2 diabetes and the complications that can go along with it. Now, not only does this patient need frequent labwork, assessments by multiple providers, and daily medication to prevent complications, but still needs the education that was initially ordered by the provider.
In 2014, more money was spent on discharges for diabetes complications than any other emergency department visit or hospital stay in Arizona (Arizona Department of Health Services [AZDHS], 2018). Since the majority of type 2 diabetes care in the United States is paid for by government insurances, such as Medicare, Medicaid, and the military, wouldn’t we rather find a way to financially cover these preventative educational programs for patients with pre-diabetes and avoid the diagnoses of type 2 diabetes (American Diabetes Association [ADA], 2018)? Considering the cost of care for DM in the U.S. is $327 billion per year, covering these services could save billions of dollars (ADA, 2018). Perhaps, we could also find more innovative ways to expose the general population to educational tips to prevent type 2 diabetes.
Regardless of costs, diabetes can affect quality of life, result in amputation of extremities, and even result in death. We must tackle the difficult questions associated with justice in the care of patients with diabetes and pre-diabetes, in order to act with beneficence.
References
American Diabetes Association. (2018). The cost of diabetes. Retrieved from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html
Arizona Department of Health Services. (2018). Diabetes in Arizona: The 2018 burden report. Retrieved from https://www.azdhs.gov/documents/prevention/tobacco-chronic-disease/diabetes/reports-data/diabetes-burden-report-2018.pdf
Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.
Expanding Financial Coverage for Education and Treatment of Pre-diabetes 