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Both the pro and con sides of gatekeeping take advantage of the doctors de facto role as the gatekeeper for patient access to services. However, the objectives are not mainly in the patients best interests. The moral dilemmas come into play when these other interests compromise the patients faith in the doctor as his principal agent. The unchangeable measure of self-interest that has always existed in the physician-patient connection is complicated and amplified by the self-interest motives on which the emerging gatekeeping duties depend. The essay discusses the ethical dilemmas in gatekeeping in managed healthcare systems and the lessons learned when it is included in other domains.
Cost-cutting measures are not unethical and, when they are in the patients best interests, are morally required. According to Tomson (2018), when physicians refuse to offer necessary treatments or coerce a patient into asking for or forcing a doctor to perform unnecessary care for any reason, they are infringing on those interests. As a result, the economic disincentives and incentives that alter the physicians freedom to act on behalf of the patient give rise to the ethical dilemmas associated with gatekeeping. Before implementing policies, the doctor was mainly in charge of determining what treatment was essential and what was not.
In addition to the intrinsic difficulties of gatekeeping, the physicians judgments are beclouded by various pressures and motives adverse to the patients interests. There is, first of all, the tendency toward underutilization since this rewards the physician or hospital. The temptation, therefore, is excellent to cut corners, declare as frills what might otherwise be a necessity, or be less sensitive to patients subtler but equally important needs for psycho-social support (Tomson, 2018). Further, the primary care physician is encouraged to temporize his work-up and delay expensive tests, treatments, or consultations. One may even stretch their competence dangerously to do specific procedures to contain costs.
The moral dilemmas in the constructive form of gatekeeping are more overt and obvious. Here, maximizing profit is the primary goal. A commodities transaction is created between the doctor and the patient. The doctor turns into an independent businessperson or the employed representative of investors and businesspeople who have no link to the customs of medical ethics. According to Spencer et al. (2021), the doctor starts acting per market ethics and starts to view his connection with the patient not as a trust but as an enterprise and a contractual one. Ethics shifts from being a question of duties or virtue to one of law. Ethics is replaced by analogies from the corporate and legal worlds. The doctors may sell medical knowledge to anyone they want at whatever cost and under whatever terms; it becomes private property.
Due to social discrepancies in the 21st century, gatekeeping in other domains would induce civil revolutions. Domains like college admission officers and welfare caseworkers are known to educate and unite society members through fair and equitable treatments. However, gatekeeping has its benefits in college admissions. The officers can verify students as per the schools rules and policies, eliminating the chances of any moral dilemmas. Consequently, for welfare caseworkers, negative gatekeeping might rise as most of their roles are business oriented hence transactional which leads to moral dilemmas on most occasions.
From the perspective of the patients interests, this article provides an overview of the ethical problems with gatekeeping. It concludes that society must protect the integrity of the physicians first duty to their patients. The current gatekeeping system must be examined to promote and build sustainable gatekeeping in the healthcare system and reinforce fundamental societal roles.
References
Tomson, A. (2018). Gender-affirming care in the context of medical ethicsgatekeeping v. informed consent. South African Journal of Bioethics and Law, 11(1), 24-28. Web.
Spencer, K. L., Mrig, E. H., & Bouchard, E. G. (2021). Unpacking gatekeeping in medical institutions: A case study of access to end-of-life patients. Qualitative Research, 14687941211034975. Web.
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