Read: Prior to beginning this discussion, read Chapter 1 and Chapter 3 of your textbook along with the article "Physical health inequities in people with people with severe mental illness: Identifying initiatives for practice change."

Reflect: Health Care Reform has, for a long time, been a hot topic. Costs of Medicare, loss of jobs, increased costs of doing business, are all part of the problem/need. Consider the two citations below:

We have invented more health care than we can afford to deliver....We already ration. The United States denies more health care to more people than any other developed country in the world. We did that by leaving 50 million people out of the system (before the Affordable Care Act).

[For example] I don't believe you should give any extensive operations to anybody over 85. You should make sure that they're clean, they're loved, they're comfortable, they're pain-free, but we shouldn't be doing high-technology medicine on people over 85. (Lamm, 2015)

A rising proportion of medical expenditure is now devoted to prolonging the lives of the very old and the terminally ill. The costs of this are potentially unlimited. 

We should pause to ask ourselves the questions raised by the surgeon Atul Gawande in his book, Being Mortal. Perhaps the greatest challenges in modern healthcare are not those of meeting the spiraling cost of advanced medical technologies. They lie in accepting that we are all going to die, and learning to do so with dignity.

Efforts at cost containment and the rationing of medical services are impinging deeply on the elderly and placing physicians in roles that may interfere with the covenant of faithfulness that exists between physician and patient. Physicians must examine negative societal images that may influence the care of the elderly and hold firm to the commitment to respond to the needs, values, and best interests of the elderly in the face of changing health care policies and constraints of one kind or another. Further, a major ethical imperative for physicians relates to making themselves available for the treatment of the elderly in the context of an appreciation of these patients' tasks in the final stage of development.

Write: As an assistant in arranging discharge planning with a social worker and a multi-disciplinary team,  you are asked for your professional input as an elderly woman living alone is being discharged to a long term facility. A high risk procedure and expensive procedure is being suggested for this 87 year old woman. The issue of cost for such procedures for the elderly has surfaced among the team. The team is discussing the decision of the procedure and social services is consulted for a full consideration of the patient in her context.

Utilizing what you have learned in the program and including extra resources, address the following:

• Evaluate the value assumptions that influence your recommendation.
• Describe how you would respond to these values as you self-reflect.
• Describe how much cost of the procedure would influence your recommendation.
• Should you consider what your client wants? How does this weight against professional values and opinions?
• Explain your recommendations to the team.