With there being a drastic increase in the number of cases of type 1 diabetes, there is a serious impact on the ethical and social issues regarding this disease. Diabetes is a hidden disease, one that is not always visible or recognizable. Diabetic patients are often not given the necessary attention and or assistance that is needed; there are often questions as to whether they have a disability. This raises many issues when it comes to perceptions, laws, discrimination, and treatment.
The stigma of poor diet and exercise is linked to both types of diabetes; however, that is not always the case. Many people don’t know that type one diabetes is a condition in which the individual's pancreas produces little to no insulin due to the immune system attacking and destroying its insulin-producing cells, the beta cells. Diabetics, therefore, have to monitor their blood glucose levels and administer insulin when needed.
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A normal daily regimen for a type one diabetic is very complex, but added stress and chaos occur when the public eye and society are involved. There is a constant worry about whether they will be able to bring their diabetic supplies into public places including; theaters, stadiums, courthouses, airport security, and various other places. Not only do their supplies entail medical devices such as pumps, insulin syringes, insulin vials, etc, but this also requires juice or another carbohydrate to treat hypoglycemia.
Diabetics should not have to sacrifice or risk their medical safety to participate in society. That is why there are laws set in place that pertain to diabetics in order to help them continue to monitor their disease while engaging and participating in life. The Americans with Disabilities Act (ADA) is a law that “prohibits discrimination against qualified individuals on the basis of disability” (Fact Sheet, 2015). Title II, of the ADA, ensures that the government provides the same services for people with a disability, and not excluding them because of their condition. This ensures that places modify their rules and policies in order to accommodate the disabled. For example, the airport security should authorize the diabetic to carry their supplies with them- modifying the policy against food, drinks, and sharp objects.
The ADA also protects children and their admission into camps, recreational programs, daycare centers, etc., due to title III. Title III states that “providers of public accommodations must provide you with services that are not any different from those they provide people without a disability” (Fact Sheet, 2015). These laws enforce that public and private entities make reasonable accommodations, however limiting these modifications so they don’t put a burden on the program and/or organization.
There have been raised concerns with driving safety and diabetics. Some people feel that there is an ethical issue with diabetics driving; diabetes and driving are both complex tasks and some feel that the two tasks should not have coincided. Driving demands multitasking, with full use of cognitive, visual, and motor skills. There are people who believe that both acute and chronic effects of diabetes cause danger to both the patient and the general public. For example, acute complications include hypoglycemia and hyperglycemia. These would impair judgment, awareness, motor, and perceptual ability. The ADA has released a statement in regards to the legal and ethical issues that have arisen. They feel that “people with diabetes should be assessed individually, taking into account each individual’s medical history as well as the potential related risks associated with driving” (Gupta, & Arora., 2014). It is also a responsibility of the individual's health care physician to notice warning signs and act if they become a risk for themselves and bystanders. The physicians should educate the patient on driving safety.
Cultural values also have a great impact on diabetes. A big concern is the medication needed in order to attain glycemic control and its restrictions on certain cultural values and/or norms. Some cultures, don’t believe that insulin should be incorporated in the treatment or control. There are various reasons as to why some culture's beliefs inhibit them from using insulin. Some of the reasons are due to religion, social factors, language barriers, and the perceptions of insulin safety. For example, Hispanics believe that insulin will cause more complications and/or be harmful, that it implies failure, and they have a fear of insulin injections (Rebolledo, J. A., & Arellano, R., 2016, August).
The Korean culture also feels that insulin as a treatment plan should be inhibited. They believe that people diagnosed with diabetes should entirely cut out carbohydrates. They feel that the administration of insulin is not safe and that cutting carbohydrates will eliminate the need for insulin. This is not a safe treatment for diabetics, as individuals' blood glucose levels don’t only rise with the intake of carbohydrates, there are other factors that play a role. Some examples of other factors that affect blood sugar include stress, hormones, exercise, etc.
Culture plays a big role in all aspects of health care. A physician works with a diverse population, culture sometimes being a barrier between the treatment plan and the patient. The only way to overcome these barriers is to observe and understand the barrier, providing individualized care for each patient. Often times the issues revolve around disparity, the inability to pay for appropriate care. In order to overcome this, “President Clinton announced a new initiative that sets a national goal of eliminating by 2010 longstanding disparities in health status that affect racial and ethnic groups” (Tripp-Reimer, et al, 2001). This means that all American's health goals are the same, not having lower goals set for minority groups. The issues that will need to be attended to are the quality of health services provided, poverty, and environmental hazards. For example, Mexican Americans' income raises obstacles for the treatment and management of diabetes. It is often a struggle for them to afford payments, often having no health insurance. This creates restrictions on the ability to control and manage diabetes, as it is impossible for them to afford the expenses of medicines, supplies, physician visits, and etc. Another disparity is financed, prohibiting the consumption of healthy foods.
There was a study conducted to display the effects of poverty on hospital admissions for ketoacidosis. They interviewed approximately 40 patients that had been admitted to the hospital due to lack and/or stop of insulin administration. 20 of the patients explained that they stopped administering insulin because they couldn’t afford the medication. Many of the individuals interviewed were uneducated about diabetic management. The study showed that a majority of the ketoacidosis cases could have been prevented if the patient was educated and had access to affordable care (Tripp-Reimer, et al, 2001).
In conclusion, cultural and ethical perspectives have a great effect on diabetes and its treatment plan. In order to overcome the barrier set due to ethical and cultural perspectives, there should be various diabetes educational courses carried out worldwide for all races and ethnic groups. It would be spreading awareness and knowledge on diabetes and its appropriate treatment plan. The intention of these courses should be to encourage diabetic patients to control and manage their condition, providing them with the knowledge they need to live with this disease. A wide variety of diabetics lack knowledge of the disease due to cost, distance, and the lack of educators. This lack of knowledge and understanding of the disease is one of the main reasons for complications associated with diabetes. Education will allow these individuals to be actively responsible for the daily management of their situation. These educational programs, being easy to access, will have a positive effect and attract the public. Better education and knowledge on diabetes will reduce complications minimizing the mortality rate in diabetics.
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