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Keywords: Organ transplant,Health care,Surgery,Medical ethics,Transplantation medicine,Physician,Morality,Nick Cassavetes
The movie John Q, directed by Nick Cassavetes, explores the riveting story of the Archibald family. John Q Archibald, his wife Denise, and son Michael are an average family, but their lives drastically changed when one day Michael collapses while playing baseball. Rushing him to the hospital, John Q and Denise worry for their son. After several tests, they are informed by Dr. Turner and the hospital administrator, Rebecca Payne, that Michael has cardiomegaly and will need a heart transplant. Desperate to keep their son alive, John Q and Denise scramble to get the cash they need to keep their son in the hospital. John Q tries to talk to their insurance company but is told that their policy doesn’t cover the hospital bill. John Q becomes frustrated and baffled at the fact that he pays each month for health insurance but will not be able to use it to help his son.
The hospital does not wait for the Archibalds to acquire the $75,000 down payment, and decides to release Michael from the hospital, essentially telling John Q and Denise that their son will go home and pass away. Unwilling to give up on his son, John Q makes the bold decision to walk into the hospital with a handgun and gather hostages, one of which is Dr. Turner, in the Emergency Department. He demands that his son be put on the recipient list as soon as possible. As the day goes on, the police and SWAT try to make plans on how to get John Q out without hurting the hostages. However, John Q doesn’t want to hurt anyone, he simply wants to save his son, and eventually releases a few hostages in exchange for his son’s name to placed on the list. Finally, once Michael is brought back to the hospital, John Q reveals his intention to commit suicide so his heart can be used to save his son. He persuades Dr. Turner to perform the operation and the hostages to bear witness to his act. In a climactic plot twist, Denise learns that there is a heart from a donor that can be used to save Michael. She rushes to try to tell John Q, but he is shown pointing the gun to his head in the scene. In the nick of time, she stops John Q from ending his life, and miraculously, Michael receives his heart and is saved. However, John Q must now go to court and await his sentencing. The public have mixed feelings about this; some think that John Q should go to jail for his actions while others believe his actions were justified because of his intention to save his son. Throughout this storyline, viewers are given examples of ethical dilemmas in healthcare intertwined into the Archibald family’s life and navigation of healthcare for their son.
Ethical dilemmas are situations that occur when there are conflicting values and cause distress and controversy for those involved- in this case, healthcare professionals and patients (Potter et al., 2017). In healthcare, there are several important ethical issues that are closely studied due to their plentiful yet controversial nature. Issues that fall within these ethical principles are often found widely across the United States in hospitals, in which hospitals find themselves trying to reach a balance. These issues include autonomy, nonmaleficence, and justice (McDermott-Levy et al., 2018). Autonomy involves allowing the patient to be included in decision about all aspects of their care. Nonmaleficence is the concept of ethics in which the healthcare professional must try to balance the risks and benefits of care while doing no harm. Lastly, justice is fairness, especially regarding the fair distribution of healthcare resources.
One major ethical issue portrayed in this movie is the principle of maleficence. As previously mentioned, this principle involves the idea of “doing no harm,” which was contained in the original Hippocratic oath taken by healthcare workers like doctors. When the hospital decides to let Michael go because they are tired of waiting for John Q to come up with the down payment, “do no harm” might be said to be forgotten because they have discharged Michael from the hospital when he is not in a stable condition. With the condition of cardiomegaly, the heart becomes enlarged. This can be due to an underlying illness, such as a heart valve disease. In the movie, they do not mention what caused Michael’s cardiomegaly, and only mention that he needs a heart transplant. His condition and treatment are not focused on much in the movie, so it is not made aware what the doctors were doing to treat Michael. By sending Michael home, the family must essentially wait for Michael to pass away. This is harmful because the family does not want this option and would like to save their son, but the hospital insists on discharging Michael. Help is supposed to be offered to those in need, yet because insurance won’t cover the surgery, they send him home to die. More research of this ethical topic needs to be implemented so that new strategies can be developed to help nurses, physicians, and other healthcare workers collaborate to resolve these dilemmas and reduce patient harm. This will help patients, such as a patient like Michael, get better treatment focused on patient safety and care while reducing harm.
Another major ethical issue presented in the movie is the issue of justice, the fair distribution of resources to the population. Because John Q and his family do not have enough money to pay for the surgery, the hospital requires the Archibalds to make a cash payment. This seems rather counterintuitive because the family cannot afford the surgery yet are required to pay thirty percent of the cost just to have their son’s name placed on the organ transplant recipient list. When it comes to the allocation of resources, dilemmas are often found plentiful. As seen in the movie, regarding organ donation, organs must match with the recipient and it is often a list system. This can create several challenges for organ transplantation, including how to allocate the organs when the number of possible organ recipients is higher than organ donors. This is difficult because many families and patients find themselves in similar situations to the Archibalds. The organ recipient list can often be long and the process to be placed on the organ recipient list is not always guaranteed. A patient must be referred by a physician, and other factors, such as insurance, must be considered. In addition, decisions made in the healthcare setting are often impacted by a person’s financial status. For example, in a study focusing on the relationship between a patients’ insurance status and access to care, the researchers found higher odds for uninsured patients to be transferred to another hospital despite hospital capabilities. This creates an ethical dilemma relating to justice because this does not allow for proper, just care for all, but rather just for those who can afford it, and patients may be sent home without enough care, as demonstrated with Michael’s care. This ethics concept can be explored more through the examination of other questions of justice, such as if healthcare resources should be available to as many people as possible or ensuring that all people receive resources equally, or specifically the examination of who should or should not receive a transplant. Using the example from John Q, a consideration might be to not make organ transplantation an elective surgery, as described in the movie, and place it under something that can be covered by health insurance, that way families do not have to try to obtain cash to pay for care they need or not even have the option to possibly receive this type of care.
The movie John Q presents ethical dilemmas that are found in the healthcare setting that need to be studied and furthered investigated. The viewer connects to the characters, especially the young boy Michael who has so much life left to live. The sense of anger the movie is able to provoke about the state of the healthcare organization and how it turned away people in need persuades viewers to perceive John Q and his family as people with good intentions and the hospital as the wrong-doers. Because this was a film, the producers were able to create a happy ending for the Archibald family, but that is not always a guaranteed promise in real life. Again, these ethical issues, such as justice and nonmaleficence, impact the relationship between people and the healthcare system, so it is important to think about these ethical principles and how healthcare can change to help take care of all patients.
I had to watch John Q for another class and saw that the movie embraced a huge ethical dilemma. For those who aren’t familiar with the movie. It’s the story of aworking class family (The The Archibalds) whose life is about to change with an unexpected health tragedy. The son of the Archibalds is about 9 whiles old and while playing baseball one day he collapsed. He was taken to the sanitorium and the family was told that he wanted a heart transplant but his insurance wasn’t going to coverit. The heart transplant would go but in order to place the son on the list to take a heart the family would have to pay cash. The son didn’t have long to live and after coming up short on the deposit, the sanitorium decided to release the son.
Situations like this happen everyday in the United States. Families aren’t qualified to payfor health care and they’re placed in situations resembling as this. Ethics is questioned when asking a family to make a cash payment to save the life of a child. This was aworking class family who didn’t have the to pay for the heart transplant deposit. They vended fair everything they had and still wasn’t good to come up with the moneybags. To add to the uneasiness the sanitarium tried to release the child knowing he wasn’t near good condition and would not live much longer without the transplant. The hospice should have had more options for the family besides telling them to make a cash payment. I feel it’s the responsibility of the hospice to help everyone especially those who need life saving treatment.
One of the principles of ethics is beneficience which stands for the act of doing good. In this case, the hospital wasn’t acting on this principle of ethics. In my opinion, asking a family topays and trying to release a dying child isn’t beneficience. The principle of mortal rank was also questioned in this dilemma. Mortal life is very significant and shooting someone home to die doesn’t constitute the right of human life. The hospice took out the child’s right to live by refusing to place himon the list to enter a heart and trying to release him to go home. However, imagine what would havehappened if he’d have went home without any medical treatment or support, If the child only had a short time to live with the help of the hospital.
The sanitorium didn’t consider this because taking plutocrat sounded to be most important. In the movie, the Archibalds had an HMO and one of the workers said that HMOreceive stimuli for not offering treatments to cases which raises another ethical dilemma. The father said that the child receives a check up every date and no croaker every said that he was healthy and had no conditions. The dilemma here is clear, if the croakers would have ran tests previous to the incident, they could have seen that the child didn’t have a healthy heart and could have perhaps treated him. There have been numerous ventures that HMOs don’t offer treatments and in return take provocations at the end of the spell. This is unethical because the job ofthe croaker is to maintain the health of the case.
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