Legal Environment Research Paper Example

Analysis and Synthesis of Prior Research – Legal, Ethical, and Cultural Environment Impacts on the Healthcare System of Africa

Patient healthcare has for years been a source of debate for international communities. Social science has been aiming to make healthcare accessible to all; however, several legal, ethical, and cultural factors may still be limiting the provision of healthcare in some countries. A long wait before receiving the services, high costs of treatment, or inadequately compensated healthcare workers, may limit the number of patients who receive the desired level of medical attention and treatment. The number of factors affecting the provision of healthcare is enormous but each setting has its own set of issues, the most common one being economic. Economic issues at times become a setback in one’s understanding of reasons for healthcare limitations. Not all patients are unable to receive healthcare due to solely economic reasons. Often, misguidedly, the inaccessibility of healthcare services is equated with the inability to pay for these (Facione & Facione, 1997). The case of healthcare provision in Africa, which is the focus of this paper, is also an accumulation of several factors beyond economics.

Impact of non-Economic Factors on Healthcare Systems

According to Rowe & Moodley (2013), the South African healthcare system has been evolving and the transitions in its healthcare system, along with the imposition and modification of various laws, has rendered many aspects of the healthcare spectrum under scrutiny. Whether these legal, ethical, and cultural transformations have a positive impact on healthcare access is studied by them. Aniebue & Onyeka (2014) describe that although Western medicine has become the mainstream healthcare facility in Africa, the local spiritualist medicine still plays an important role. Such cultural factors and the ethics that entail have a huge implication for the healthcare standard in the country. The following is an evaluation of how legal, cultural, and ethical factors have shaped the healthcare system of the country and how changing times are helping it to meet international standards.

Mayer & Jabe (2010) in the context of multinational companies, point out the very important impact of the legal environment a company operates in when doing business internationally. In the case of healthcare provision in Africa, the same becomes applicable as Western medicine is a foreign product in the country. Such medical treatments are faced with legal issues at several levels: home country laws, host country laws, regional regulations, and international standards and certifications. Breach of any one of these can result in severe consequences for the practitioner and the institute with which he/she is affiliated. Oosthuizen & Verschoor (2008) point out that medical practitioners even in developing countries like Africa need to be well-aware of medical law. Today, many principles that were previously regarded as good ethics have been turned into legal statutes and have become a part of medical law. Healthcare practitioners should not just be well-equipped with medical knowledge but also with the rights of their patients and the way medical treatment should be rendered. In the United States the healthcare industry is one of the most heavily regulated, and so is now becoming the case with developing countries as Western medicine is beginning to takeover.
However, Facione & Facione (1997) suggest that social and political statuses at times become hindering in provision of healthcare. For example, citizenship, immigration status, or HMO membership are used as reasons for denying healthcare to certain patients. Therefore, it would be wrong to conclude that economic factors are the only hindrances in the provision of healthcare in Africa.
Bushy (2009) brings to attention another legal issue whereby, community values and interactions interfere with privacy and confidentiality issues when the professional and personal roles of the healthcare practitioner overlap. Small isolated societies are indicative of developing countries; in such a situation the healthcare practitioner may well be a relative or family member. Patient-doctor confidentiality may become a legal issue especially when stigmatized healthcare issues such as sexually transmitted diseases, mental illnesses, substance abuse, and domestic violence may be involved.
Lastly, Marshall & Batten (2004) point out an important concern in medical research conducted in developing countries like Africa. In such multi-cultural research environments, the researcher holds power in the form of money, knowledge, and expertise over his human subjects. Misuse of such power can be a tempting option in a country where money can buy participants and law enforcers are busy with issues of greater importance. In such a case, the medical research society suggests community-based partnership projects to carry out researches with open communication and consent of subjects.

Cultural Environment

Culture, defined as traditional behaviors that are characteristic of a society, has a huge influence on the extent of medical care a patient in Africa can access. Often diseases like cancer and AIDS are considered a taboo and the patient willingly keeps his/her sufferings a secret, thus seeking no medical attention. Women see it unfit to discuss symptoms and treatments and are also not allowed to take decisions regarding their health, resulting in a lot of patients going without treatment (Aniebue & Onyeka, 2014). Culture in these countries is often a healthcare barrier for women as approaching a doctor may mean having to reveal some body parts which the husbands may not allow; also using any financial resources for personal work by a female is considered wrong as she is meant to serve the family rather than use up its resources. Using Western bio-medical practices is also seen as culturally misfit by many African societies, where spiritual treatments are still considered to be better (Facione & Facione, 1997).
Bushy (2009) further discusses that every aspect of diagnosis, treatment and decision making is affected by culture. Symptoms of mental illness, depression, or any other terminal disease are kept a secret by patients in collectivist societies, as the disease of one may reflect badly on all family members. In such families the decisions for treatments are not taken by the individual alone, rather extended family members are consulted and a decision is reached. Similarly, the level of discretion with the doctor may also be defined by cultural norms. Some cultures expect the doctor to have a paternalistic approach where options are not discussed with the patients but rather a single chosen option is defined and the patient is ordered to follow.
Differences in culture can act as a barrier in several African societies, whereas, in others it forms the source of varying expectations from the health practitioner.

Ethical Environment

According to Beauchamp & Childress (2001), ethics is a question that goes beyond laws, as it requires the person to decide for him/herself what the best action in a situation should be? Ethics are dependent on the basal senses of right and wrong. In medical the ethical questions come down to five major values –

Respect for Autonomy – The patient’s right to choose, once he has been informed, should be respected.

Beneficence – The actions and decisions of the doctor should be in the patient’s best interest.
No Malfeasance – The healthcare provider should not perform any actions that may harm the patient
Justice – Healthcare practitioners make fair decisions.
Dignity – Patients should be treated with respect.
Based on these ethical values several legal issues have developed – informed consent, patient confidentiality, and patient autonomy. Healthcare should be made available to all, however, given limited medical resources, these end up in the hands of the affording.
Oosthuizen & Verschoor (2008) disturbingly point out that the law requires that patients should be considered customers. This law affects patient-doctor relationships in Africa, where usually patients consider a doctor’s word as next to God’s. This gives patients complete autonomy and the healthcare providers are strictly liable for any harm caused by a treatment or a medicine. The biggest ethical dilemma that now stands is that the legalization of several ethical stances in Africa may result in difficulties for the medical practitioners.
Thus developing a framework for ethical decision-making can help to ensure that no laws and no ethical standards are violated. The decision making usually follows a pre-defined pattern and the one defined by the Canadian Patient Safety Institute (2011) involves teams of multi-disciplinary health practitioners who are responsible for project implementation, Continuous Quality Improvement (CQI) and healthcare management. The decisions made by the team rely on strong team psychological linkages (Communication, collaboration, cohesion, leadership, and participation), processes, and social and policy context.
With such teams in place healthcare practitioners can remain well-coordinated in their approaches and yet provide medical care in Africa while abiding by the recently implemented law.

Conclusion

The African society is deeply affected by the legal, ethical, and cultural environment in which Western medicine has been adopted. The stark differences in values and beliefs result in the African society being closed to and skeptic of the American Medical system. Developing a healthcare system in the country has not been easy and a multi-disciplinary medical team is required to ensure that appropriate awareness is created, patient trust is generated, and the culture opens up to accept the wonders of Western medicine. Collaborative effort with sound management and leadership skills will be required to establish medical teams that help increase the numbers of those treated in rural areas of Africa, while greater awareness through Continuous Quality Improvement (CQI) and awareness generation will improve the health of the population at large.

References

Aniebue, U. & Onyeka, T. (2014). Ethical, Socioeconomic, and Cultural Considerations in Gynecologic Cancer Care in Developing Countries. International Journal of Palliative Care
Volume 2014 (2014).
Beauchamp, T. & Childress, J. (2001). Principles of Biomedical Ethics (5th ed.). Oxford, UK: Oxford University Press.
Bushy, A. (2009). A Landscape View of Life and Health Care in Rural Settings. University Press of New England.
Canadian Patient Safety Institute. (2011). Teamwork and Communication in Healthcare. Canada: CPSI.
Facione, N. & Facione, P. (1997). Who Gets Seen? Issues in Ethics, Vol. 08, No. 2. Spring 1997.
Marshall, A. & Batten, S. (2004). Researching Across Cultures: Issues of Ethics and Power. Forum: Qualitative Social Research, 5(3), Art. 39.
Mayer, D. & Jabe, R. (2010). The Legal and Ethical Environment for Multinational Corporations. Retrieved February 10, 2015 from http://www.enterpriseethics.org/Portals/0/PDFs/good_business_chapter_13.pdf
Oosthuizen, H. & Verschoor, T. (2008). Ethical principles becoming statutory requirements. South African Family Practice, 50:5, 36-40
Rowey, K. & Moodley, K. (2013). Patients as consumers of health care in South Africa: the ethical and legal implications. BMC Medical Ethics 2013, 14:15.