The Ethical Right to Healthcare in the Affordable Care Act

471 Pages·2017·2.67 MB·English

Duquesne University
Duquesne Scholarship Collection
Electronic Theses and Dissertations
Spring 1-1-2017
The Ethical Right to Healthcare in the Affordable
Care Act
Stella Morden
Follow this and additional works at:https://dsc.duq.edu/etd
Recommended Citation
Morden, S. (2017). The Ethical Right to Healthcare in the Affordable Care Act (Doctoral dissertation, Duquesne University).
Retrieved fromhttps://dsc.duq.edu/etd/141
This Worldwide Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic
Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact
[email protected].
THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT

A Dissertation
Submitted to the McAnulty College and Graduate School of Liberal Arts

Duquesne University

In partial fulfillment of the requirements for
the degree of Doctor of Philosophy

By
Stella Morden, MSN, NP-C

May 2017
Copyright by
Stella Morden

2017
THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT

By

Stella Morden, MSN, NP-C

Approved on March 28, 2017

_________________________ ___________________________
Gerard Magill, PhD Henk ten Have, MD, PhD
Vernon F. Gallagher Chair Professor, Center for Healthcare Ethics
Professor, Center for Healthcare Ethics (Committee Member)
(Dissertation Chair)

_________________________ ___________________________
Joris Gielen, PhD Henk ten Have, MD, PhD
Assistant Professor Director, Center for Healthcare Ethics
Center for Healthcare Ethics (Center Director)
(Committee Member)

_________________________
James Swindal, PhD
Professor and Dean, McAnulty College and
Graduate School of Liberal Arts

iii
ABSTRACT

THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT

By
Stella Morden, MSN, NP-C
May 2017

Dissertation supervised by Dr. Gerard Magill
Since the passage of the Affordable Care Act, It has been questioned whether the right to
healthcare in it can be ethically justified. The objection to a right to healthcare in general has
been prominent over many decades in the U.S. The concern over higher personal taxes, quality
care, and national debt steered the opposition. Responding to these concerns has a direct effect
on each individual in society. In particular, the lack of healthcare is very significant.
The idea of a comprehensive national healthcare in the United States caught the attention
of the public in the 1970s. It was inspired by the positive results of the Medicare and Medicaid
programs which were passed and signed into law in the 1960s. The public would see the benefit
of access to healthcare, which led to acquiring the expansion of it. Most people were wiling to
accept and agree on providing free healthcare to the elderly and the poor. There was, however, a
iv
strong opposition to a system of a national healthcare. The opposition did not dishearten
proponents to advocate for the right to healthcare in subsequent decades. After a vigorous
congressional debate, the Affordable Care Act (ACA) was passed and signed into law in 2010.
This dissertation engages the four standard ethical principles (known as principlism) to justify
the right to healthcare that is provided in the Affordable Care Act. In addition, theories of
distributive justice and normal functioning are used to argue and justify the provision of
Affordable Care Act.

v
ACKNOWLEDGEMENT

I thank God for the initial inspiration to enter the PhD program.
I dedicated my dissertation defense to my father. My father, and he alone, called me by a
masculine name at birth. The name carried the meaning of “to be a scholar”. Sadly, he did not
live to see me receive my PhD degree. He was an example of a scholar.
I thank my mother for always being supportive and encouraging. She has always allowed
me to choose my path and take on new challenges. Her love is amazing!
I thank my husband, John, for his understanding and support during the entire academic
process. His love and patience were noted in his tireless help.
I thank my children (Joshua, Jannah, Jonathan, Justin, Jesselyn, Jedidiah, Joanna-Praise,
and Jamie-Ophelia) for always demonstrating their support and excitement about my pursuit of a
doctorate degree. Their laughter and loving teasing have always warmed my heart. Their love for
me is seen in their understanding of the time I needed for school work.
I thank Dr. Gerard Magill, my chair, for his guidance and teaching. He taught me to be a
better writer, thinker, and researcher. His help during the writing process demonstrated the
meaning of humanity and a Christian. I could not have reached my academic goal without his
teaching and insight. I deeply appreciate his help.
I thank the department of Healthcare Ethics for understanding my situations during
difficult life events. The department has always been loving and caring.

vi
TABLE OF CONTENTS

Chapter One:
Section One. Introduction
Section Two. The Affordable Care Act (ACA): Patients, Populations, &
Organizations
1. ACA Overview: Key Features of Affordable Care Act
a. Ten Titles of the Affordable Care Act
b. Expanding Insurance Coverage
i. Setting the Priority
ii. Removing Obstacles to Obtain Health Insurance
2. Patients and Populations
a. Emphasis on Preventive Care for All
i. Free Preventive Services.
ii. Three Levels of Preventive Care.
b. Increased Benefit for Target Populations
i. The Poor and the Uninsured.
ii. The Old and the Weak
3. Organizations and New Mandates
a. Insurance Provision with Inclusion of Contraception
i. Making Health Insurance a Priority
ii. Women’s Preventive Services Including Contraception.
b. Quality of Care
i. Taking Care of the Vulnerable Populations
ii. Improving Quality of Patient Care
Section Three. Patients: Autonomy and the Right to Health Care
1. Autonomy & Human Rights
a. Human Dignity & Sanctity
i. The Intrinsic Value of Every Human Being
ii. Life is Sacred
b. Personal Autonomy
i. The Right to Make Choices.
ii. Self-governance
2. Beneficence & Non-Maleficence
a. Right to Treatment
i. The Obligatory Action to Give Benefit
ii. Health Services for All Americans
b. Right to Forgo Treatment
i. Medical Wishes
ii. ACA Includes End-of-Life Services
3. Patient Protection and Affordable Care Act
a. Right to Basic Health Care
vii
i. The Right to Health
ii. Minimum Coverage for Evidence-based-Services
b. Balancing Right and Responsibility
i. Benefiting from Health Care
ii. Changing Practice
Section Four. Population Health: Vulnerability, Justice, & Entitlement Programs
in the ACA
1. Vulnerability
a. Physical Limitation
i. Disease
ii. Physical and Mental Disability
b. Financial Limitation
i. Unemployment and Health
ii. Poverty and Beyond Working Years
2. Justice
a. Theories of Justice
i. Distribution of Health Care as Social Goods
ii. Two Positions on Justice
b. Needs & Fairness
i. The Principle of Need
ii. Justice as Fairness in Health Care
3. Entitlement Programs in the ACA
a. Medicare
i. Opportunity for Every Stage of Life
ii. Medicare for the Elderly
b. Medicaid
i. Equal Resources for the Disadvantaged Population
ii. Medicaid for the Low Income
Section Five. Organizations: The HHS Contraceptive Mandate in the ACA
1. Right to Preventive Care
a. The Conflict between Government Mandate and Religious Conviction
i. Health and Human Services (HHS) Announcement
ii. A Compromise
b. Needing More Provision of Women’s Health Services
i. IOM Recommendations
ii. Women’s Health Concerns
2. Protecting the Religious Identity of Organizations.
a. The Reaction Regarding the Contraceptives Mandate
i. Contraceptives Mandate Violates Religious Liberty
ii. Upholding the Catholic Faith
b. Permitting Abortion
i. Catholic Faith in the Secular World
ii. Voting for Laws that Support Forbidden Practices
3. The Principle of Cooperation
viii
a. Categories of the Principle of Cooperation
i. Settling the Conflict
ii. Distinctions of Cooperation
b. Cooperation Justifies Health Policies that Provide Forbidden Services
i. Support without Violation
ii. Considering the Greater Good
Section Six. Conclusion

Chapter Two
Section One. Introduction
Section Two. ACA Overview: Key Features of Affordable Care Act
a. Ten Titles of the Affordable Care Act
b. Expanding Insurance Coverage
i. Setting the Priority
1. Extending Health Coverage to Young Adults
2. Medicaid Expansion
3. Improve Medicare Benefits
ii. Removing Obstacles to Obtain Health Insurance
1. A Chance to Get Care
2. “I can’t afford health insurance.”
3. Coverage for Pre-existing Condition
Section Three. Patients and Populations
a. Emphasis on Preventive Care for All
i. Free Preventive Services.
1. Emphasis on Prevention
2. Wellness Programs
3. Lifestyle Modification
ii. Three Levels of Preventive Care.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
b. Increased Benefit for Target Populations
i. The Poor and the Uninsured.
1. Low-income Population
2. Minority Groups
3. Uninsured Population
ii. The Old and the Weak
1. Medicare Recipients
2. Improving Quality in Hospital and Skilled Facility
Section Four. Organizations and New Mandates
a. Insurance Provision with Inclusion of Contraception
i. Making Health Insurance a Priority
1. Working but no Health Insurance
2. Employers’ Responsibility Under ACA
ix