The Ethics of Free Clinics
The rising cost of healthcare and medications is both problematic and chronic. There is nothing ethical about price-gouging essential drugs or treatments, no matter the stance of the U.S. Food and Drug Administration or pharmaceutical companies that these are needed to promote research and development. Yet student-run free clinics may not be the perfect solution either.
Encouraging medical students to provide essential medical services to patients who are already struggling with accessing proper healthcare should be questioned. While patients theoretically have autonomy to seek primary care services from emergency rooms, in practice their options may be limited by heistance to take on medical debt, lack of insurance coverage, fear of mandatory reporting by healthcare professionals, mistrust of physicians, or cultural or language barriers. Patients with limited options juggle urgent and chronic concerns with the risks of student-provided care and its potential for poor clinical outcomes if critical details are missed due to inexperience.
In regards to virtue, there can be no doubt that the altruistic intentions and attentive enthusiasm of the involved medical students, faculty, preceptors, and medical school administrators are beneficiary; yet the actual outcomes may be less so. The question then arises of justice. Is it fair for students with less experience to provide ill patients with medical treatment? The patients who typically visit free clinics are often those in need of more continuous follow-up and in-depth care - options that student-run free clinics may not be able to provide or organize due to busy student schedules. Even with the oversight of a preceptor, faculty oversight is limited; some details may be missed that could negatively impact or otherwise compromise the quality of patient care [1]. While such instances may be far and few between, their possibility is unsettling when considering that there may be a pivotal prioritization of student experience over quality of provided care.
Of course, student-run free clinics are not the perpetuator, merely the symptom of a for-profit healthcare system. The U.S. is equipped with possibly the most advanced medical technology in the world, yet the most life-saving therapies and modern surgical interventions are out of reach for too many patients. I strongly believe that health inequity in our country represents a miscarriage of justice on the most fundamental level. I still do. I understand the power and privilege of being able to act on these challenges, to provide high standards of education and opportunities. I entered medical school hopeful: if patients are denied care due to socioeconomic limitations, then my role as a healthcare provider was to help patients ascend those tiers and access the highest quality of care available. This is less so a specific medical than it is a far-reaching social dilemma - yet the two are intrinsically tied together for the patients. In the 21st century, what does it mean to be a country that advocates for cutting-edge cures while at the same time failing to fund solutions for the most pressing and malignant illness in our society: poverty itself? The ethics of what it means to be pursuing care in a free clinic are complex and multi-faceted; far from limited, they are all-encompassing in the questions they raise.
[1] Buchanan, D., & Witlen, R. (2006). Balancing Service and Education: Ethical Management of Student-run Clinics. Journal of Health Care for the Poor and Underserved 17(3), 477-485. doi:10.1353/hpu.2006.0101.
