Is Neutral Ethical? Alice Boos, Ileana Mendoza, Ellie Condie, Drew Herbert, Anjuli Munjal

It is the beginning of the day, New Nurse Nancy is getting report on the three patients she will be caring for today.

Sarah Secure is a 27 year old female who has been admitted to the labor and delivery floor to deliver her first child. She is financially secure with an annual income of $70,000 and is privately insured through her employer. She currently pays 0.009% of her salary to her health care coverage. Her entire labor and delivery costs are covered.

Sarah: I have worked really hard to be able to pay my medical bills and have the best care possible for my baby and me, but it seems like I am getting the same quality care as people who are uninsured. I don’t want to pay for lazy people’s insurance. Don’t you think I deserve better care?

Nurse: We strive to give every patient the same quality care regardless of their insurance coverage.

Nurse [thinking]: With Sarah’s paid maternity leave, doula support, and ability to pay for childcare it seems like she is going to be fine no matter what type of delivery she has.

Maria Marketplace is a 27 year old female who has been admitted to the labor and delivery floor to deliver her first child. She is financially insecure with an annual income of $23,000 and is insured through the Affordable Care Act. She currently pays 6% of her salary to her health care coverage. She currently pays a copay for her labor and delivery.

Maria: I have worked really hard to be able to pay my medical bills and have the best care possible for my baby and me, but it seems that I am still struggling to afford everything. Don’t you think that is unfair?

Nurse: We strive to give every patient the same quality care regardless of their insurance coverage.

Nurse [thinking]: It sounds like Maria is going to return to work soon. I wonder if she will be able to afford a breast-pump and supplies if her insurance doesn’t cover it.

Ursula Uninsured is a 27 year old female who has been admitted to the labor and delivery floor to deliver her first child. She is financially insecure with an annual income of $23,000 and is uninsured. None of her labor and delivery costs are covered, so she has to pay for everything out of pocket.

Ursula: I have worked multiple jobs to be able to support myself and this baby throughout this pregnancy, but I can’t even afford health insurance. How am I going to pay all of these bills?

Nurse: We strive to give every patient the same quality care regardless of their insurance coverage.

Nurse [thinking]: I hope that she doesn't have any complications because I don't think she will be able to afford them.

Nurses final thoughts: At the beginning of the day I wanted to respond neutrally to all of my patients, but after hearing about their three different situations I realized that it is not possible. Sarah, Maria, and Ursula all work really hard. I can’t remain neutral because it is unfair that they don’t have the same access to health care.

Now that I understand the bigger picture, I realize that nursing is not a neutral field.

Every human being has the fundamental right to the highest attainable standard of health, and I need to proactively provide this to my patients. It is my responsibility to work with my colleagues to find resolution to inequities in health insurance coverage. It is part of my job to be actively engaged in political decision making around health care disparities.

ANA Code of Ethics: 8.1, 8.3, & 9.3

Credits:

Created with images by Presidencia de la República Mexicana - "Inauguración del Hospital Municipal de Chiconcuac" • Greyerbaby - "girl face portrait" • Pezibear - "squint eyes face" • jarmoluk - "photographer camera photo" • Gabriel F, SE - "Blue" • roland - "Orange" • Muffet - "ancient stone"

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