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Ethical decision-making in healthcare is necessary to address uncertainty or a conflict regarding competing values, such as societal, professional, and personal values. Decision makers in healthcare need to consider ethical codes and standards (Rosenzweig, 2006). A number of factors have contributed to an increased concern in health care settings, especially with regards to ethical issues, such as cost reduction pressure and issues of affordability and accessibility of various health services. It is unethical for the Cape Fear Endocrinology and Metabolic Associates to reject Medicaid patients for reasons of controlling cost.

Healthcare sector was once relatively protected from the pursuance of the profit that controls the rest of the economy. For a long period, healthcare institution has been non-profit and charitable organizations that exist mainly to offer services to the public. This has ultimately changed the goal of health professional education and socialization (Tong, 2007). The cape fears policy is unacceptable with regards to the virtue ethics theory, which explains the highest good for humans. According to the virtue ethics theory, physician needs to portray professional codes and traits that are virtues. The act of denying services to Medicaid patients is contrary to the principles of medical ethics, which outlines the standards of conducts that define the appropriate behaviors of the physician, the appropriate character traits or virtues for a physician (Tong, 2007).

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The cape fear policy shows how the healthcare system has become a profit-driven enterprise that makes health professionals compromise health professional ethics. The numbers of profit-oriented healthcare facilities, which range from local dialysis centers to those associated with leading academic institutions, have increased enormously. According to the principle of bioethics, healthcare professionals need to put the interests of the patient before their own ones. Healthcare professional needs to uphold the value, norms, and virtue of altruism (Tong, 2007).

Those supporting commercialization of healthcare sector argues that the tendency towards healthcare for profit increases the competition in delivery of healthcare, thus, results to more effective and efficient healthcare system. However, from an ethical perspective, the pursuit of profits is purely adversative to the principles of central medicine.

With regards to the principle of bioethics, it is against the concept of justice and equity for the Cape Fear Endocrinology and Metabolic Associates to turn off the Medicaid patient. According to the distributive justice, the burden and benefits need to be shared properly, as in Medicaid system. The society possesses the moral responsibility of meeting the basic needsof its members. Therefore, all Americans whether rich or poor, should have access to healthcare services without discrimination, regardless of his/her social background. The rising costs of healthcare and the increasing unwillingness of insurance firms to provide cover, alongside with current government budget cutbacks, have restricted healthcare accessibility, especially for the poor, aged, and those with chronic degenerative health issues (Morrison & Monagle, 2009).

The Cape fear’s policy is unethical because denying patients Medicaid access to health services is contrary to the deontology ethic theory. The theory emphasizes on the rights, duties, and respects to individual. The theory places a high priority on the absolute adherence to rights, obligations, and duties, which is viewed as acting ethically. The Cape Fear Endocrinology and Metabolic Associates have a moral duty to contribute their fair share to society. This is because of the benefits it derive from society, and it is unfair for the associate to refuse to serve Medicaid patients who cannot afford costly health service (Morrison & Monagle, 2009). All medical institutions including Cape Fear Endocrinology and Metabolic Associates normally benefit form subsidized government programs, such as Medicaid. In addition, they also gain from medical education and medical research funded through the taxpayers’ money. Therefore, from an ethical perspective, Cape Fear Endocrinology and Metabolic Associates have an obligation of providing healthcare services to society. All investor-owned health facilities turn off patient who cannot afford normally fail to discharge this obligation.

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Cape Fear Metabolic Associates and Endocrinology are the only endocrine specialists in their country. Due to the reasons of cost control, they do not accept Medicaid and Medicare patients. This policy does not only adversely affect the chronically ill patients, but it also puts employees through various predicaments. Some employees working under this policy feel that their morals do not approve it (Tong, 2007). They are, thus, faced with a predicament of either accepting this policy as it is, or reject it, and in so doing, lose their jobs. They can, thus, find an alternative way to articulate their concerns.

Employees working under this policy are at times confronted with death and life choices. They are expected to make testing or challenging decisions. They have an option of letting Medicare and Medicaid patients continue dying from chronic diseases, such as diabetes, hyperthyroidism, and gout. On the other hand, they have an option of helping such patients, and as a result, lose their employment (Tong, 2007). Such a predicament may make employees under this policy live with a guilty conscience.

In determining the best course of action, employees working under this policy can let their conscience be their guide in choosing the best method of addressing their predicament. Several years back, it was believed that Medicaid was a voluntary program, but lately, this has not been the case. The Cape Fear policy denies some services to Medicaid and Medicare patients. This has resulted in healthcare costs being out of control. Medical services available to patients under these two programs have become inadequate (Rosenzweig, 2006). This makes many people fail to receive the precise healthcare service, when urgently needed at a particular time. Employees working under this policy can help improve their predicaments, while at the same time help increase the availability of the medical services denied to many Medicare and Medicaid patients (Rosenzweig, 2006).

For employees, who oppose to this policy in order to keep their job, the best thing to do is a combination protesting against this policy and tying to reason with the administration by exercising some degree of intellectual sympathy. In this case, conscience can be termed as an independent norm of morality. It can essentially involve a process of committing, and applying their moral values and principals in judging this particular policy that denies Medicare and Medicaid some services because of their financial abilities (Morrison & Monagle, 2009). They should, thus, listen to their innermost still small voice, and try to find some means of compelling it. The employees should be in a position to identify the cause of such a policy being implemented. They need to realize that even if such patients are allowed to have access to the services denied by this program, the administration cannot support it financially, and it will eventually collapse. This will lead endocrinology service to being unavailable to even those patients who are not in the Medicare or Medicaid program (Morrison & Monagle, 2009).

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In protesting against this policy, the employees should not protest on a personal capacity. They can consider having a workers’ union. An employees’ union will increase their bargaining power. It will further ensure that there is no victimization by the authority. While protesting, employees can consider forming a partnership with other unions or employees who feel that denying Medicare and Medicaid chronically ill patients some medical services is unjustified (Tong, 2007). This can make authorities responsible for the implementation of this policy to consider amending it. As employees working under this policy let their conscience dictate the course of their action, they should follow the rules and regulations that are supposed to be observed when protesting. Finally, employees can decide to remain silent and let this policy be implemented, as it is in the current situation (Rosenzweig, 2006).

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