PHIL 434 Medical Ethics
Short answers 3 point seach
What is medical tourism?
Medical tourism is “where patients travel overseas for operations and various invasive therapies.” (Connell 2006, p. 1093).
What are 3 reasons people choose surgeries/procedures in other countries?
1. Economics – Even with health insurance, many procedures can be performed
for a fraction of the cost overseas.
2. Quality of care – quality of care is increasing around the world to the
near equivalent of Western countries.
3. More options- Even with health insurance, many patients find their health insurance companies limit the kinds of procedures they are able to receive.
What is the commoditization of care?
Turning health care into a commodity that is undifferentiated from other competing commodities and whose sole objective is to be bought and sold in the marketplace.
What is the Joint Commission International?
Joint Comission International is an international accredidation agency for hospitals that provides a means to ensure a global standard quality of care for all who are approved.
What are some of the benefits of medical tourism?
Medical tourism can be affordable and accessible. Accessible may apply moreso
for procedures are long.
What are some of the dangers of medical tourism?
Many countries have weak malpractice laws which prevent a patient from seeking recourse in the event of a complication. The surgeon or practitioner who originally did the procedure will not be available months down the road in your home country to provide ongoing follow ups or treat a complication.((Al-Lamki 2011) There is also the problem of internal brain drain on the host country, where the best doctors end up working in private medical tourism facilities instead of servicing their own people.(Al-Lamki 2011)
List 5 countries that people travel to for medical tourism.
Thailand, Singapore, Brazil, India, Malaysia (Al-Lamki 2011)
What are the 5 types of parenthood?
Genetic parenthood is defined where men and women are the cause of the pregnancy directly. Gestational parenthood refers only to women made pregnant by a fertilized ovary. Social parenthood is where parenting is separated from sex or whether the mother or father "created" the fetus. The custodial conception of parenthood - Individuals who are the caretakers of the child and provide love and care the child needs are the parents. (Austin 2007). The consent conception of parenthood - The intentional decision to procreate incurs upon the parent the obligation to care for the child. (Austin 2007)
What is surrogate parenthood?
A gestational surrogate is one "who agrees to carry [a] fetus to term and then transfer custody over to [a] contracting couple." The fetus is the donation of the sperm and egg from the contracting couple and it is them implanted into the surrogate. (Austin 2007, p. 4)
What are some answers to when personhood begins?
Some scientists believe life begins at fertilization, while others argue that life
begins when brain activity takes place and can be recorded by an electroencephalogram. Other biologists contend that it is only at birth when we are visible as distinct human beings.
In your opinion, which answer makes most sense scientifically?
Scientifically, I think the answer that life begins when brain activity occurs makes
the most ses.
In your opinion, which answer makes the most sense morally?
Morally, I think the idea that life begins at fertilization makes the most sense.
What is procreative liberty?
The freedom to make your own choices regarding procreation.
What are the 4 principles of biomedical ethics?
The four principles are a) autonomy, b) beneficence, c) non-malfeasance and d) justice.
What are some common misconceptions about who has abortions?
Abortions are not available all over the country. In fact, there are no abortion providers in 88 percent of United States counties (King 2010). Women do not typically replace birth control with abortions. Over 52 percent of women who get abortions have not had an abortion before (King 2010). Having an abortion is not scientifically proven to be dangerous to a woman's long-term mental health, despite what some people claim (King 2010).
1) immunizations, 2) declines in death from stroke and heart disease, 3) fluorrination of drinking water, 4) controlling infectious diseases. (CDC 2016)
What is Public Health?
Public Health “ is defined as the science of protecting the safety and improving the health of communities through education, policy making and research for disease and injury prevention.”(“Careers in Public Health” 2016)
What are the 6 theories of distributive justice?
The 6 theorries of distributive justice are: 1. Strict Egalitarianism; 2. Loose Egalitarianism; 3. Luck Egalitarianism; 4. Welfare-Based; 5. Desert-Based ; 6. Libertarian-Based (Lamont & Favor 2013)
What are the 6 reasons health care reform is necessary?
1) There are increasing numbers of people without insurance; 2) Medical costs are causing growth in personal debt; 3) Medical costs are directly attributed to many bankruptcies, which are growing; 3) The cost of health care is always increasing; 4) Corporations are raising costs and increasing their own profits at the expense of the public; 5) The national debt is increasing and this is related to health care; 6) The deficit is increasing and this is partly caused by health care. (“Health Care Facts” 2016)
How do you justify or reject health care is a human right and should be free?
I justify the fact that health care is a human right and should be free according to the U.N. Declaration of human rights,
21-30
1. What should be done now for Janet and her parents, and on what grounds?
I believe that Janet and her parents should consult with a medical ethics expert and an attorney in order to gain legal representation for their case. This is a situation which involves the state potentially requring her parents to keep Janet on life support. The medical personnel cite necessary compliance with the Kansas statute which nullifies a mother's advance directive in the case that she is pregnant. While the Kansas legislature may want life support if Janet as a mother is pregnant, there is strong potential that if she is brain dead, this would make the law not apply.
2. What values underlie the statute making a pregnant woman’s healthcare treatment declarations of “no effect” while pregnant?
Underlying this statute to making a pregnany woman's healthcare treatment declarations of “no effect” is a moral defense of the rights of the unborn fetus. There is a want to protect against the moral rights of the unborn child by excluding the ability to apply advance directive principles in the case that the mother is pregnant.
3. Do you agree or disagree with this statute, and on what grounds?
It seems wrong to keep a woman's body functioning against her will or against the wishes of her designated surrogate. While the fetus has moral rights according to the state, there is also the issue of the surviving famliy and their own moral rights, as well as the law compelling them to provide care for the unborn child. I also believe it is unfair that the legal rights of the unborn child should be able to outweigh the legal rights of the surrogate family acting on behalf of the mother.
.4. What decision would you be making as Janet’s parental surrogate, and why?
As Janet's parental surrogate, I would make the decision to follow in line with Janet's request. I would also take note that it appears she is brain dead. In some states the fact that she is brain dead actually results in a case where the pregnancy exclusion clause for advance directives does not apply, since brain death is considered equivalent to death.
5. Ought someone to be a surrogate for Janet’s fetus, or not? And why or why not? I do not believe someone should be a surrogate for Janet's fetus in this case, because the fetus is not actually a living being up to this point. This reflects the discussion amongst biologists and other scientists regarding what consitutes a human life. A legal framework should protect the rights of only living things, I believe.
31-40 .
1. As the administrator of the hospital, what do you do? Do you require that Dr. Contadina apologize to the patient’s family and explain to them what went wrong? What are the risks to doing so?
As administrator of the hospital, I do not require that Dr. Contadina apologize to the patient's family. I would ask that Dr. Contadina and a support staff of medical social workers or other experts on patient grieving provide a clear overview in a non-rushed meeting with the patient's family and also provide a chaplain on site at the hospital as well as psychological services if needed to the family.
2. Does Dr. Contadina have an ethical obligation to admit error?
No. In this case it appears that the cut which later became septic and was the reason for the patient's death was on the opposite leg which he initially sought treatment for. As a physician, the fact that the patient died is a tragedy but this case does not indicate malpractice rather than an very tragic event.
4. What are the possible benefits to admitting fault?
There is a chance the family may drop a potential lawsuit.
5. What could the hospital and/or Dr. Contadina (or any physician) have done differently? Was this a preventable mistake?
This does not appear to have been a preventable mistake. There are also legal liabilities that may be increased if the Dr. apologizes which could cost both the doctor as well as the hospital very large sums of money if they admit fault and are sued. In general, admitting things openly where money is inovlved in health care can only increase the risk of having a huge lawsuit thrown agaist you. The physician may have prevented this mistake by paying close attention to the cuts and open wounds on both legs and their reasons for swelling. In this case it seems that she alerted to his complaints of pain and may have misdiagnosed blood poisoning from cellulitis with a sprained ankle. Yet, the fact that the swollen ankle was on the opposite side of the leg with the cut indicates that the Doctor did not necessarily overlook this case. Also, there was no indication that the patient was suffering from pre-septic infection at the time of the visit.
41-50
1. Is the patient’s autonomy being respected by involving her in the decision-making process?
The patient's autonomy is not being respected because she is not involved in the decision making process.
2. How could a meeting of all parties involved have been more effective and/or ethical than piecemeal decision making?
A meeting of all parties, including the patient, to review treatment objectives, goals and standards would have been more effective because it would allow for a clear and concise plan to be arrived at by all interested parties. This would also allow for interested parties to raise objectiions with another and clarify disagreements or points of confusion regarding the patient's status.
3. Are the pain treatment policies of the facility meeting the standards set by regulators?
The pain treatment policies of the facility do not appear to be meeting the standards set by regulators. In this case it is unclear why the facility cannot simply provide the patient with adequate opiate medication but carefully monitor it so she is not doped up. Furthermore, it seems preferable that she would be doped up and at least pleasant-feeling rather than suffering terribly in pain and only given tylenol. As an 85 year old woman, she bears little risk of actual abuse or distribution so the motivation for the conservative approach is unclear and seems assinine.
3. Does the nurse have a moral responsibility to be more assertive in advocating for the patient’s relief?
The nurse does have a moral responsibility if she witnesses maltreatment against the patient, such as the patient experiencing undue pain which could be readily relieved by analgesics. This would seem to be a case of medical neglect.
4. Given that the doctor is likely to see the resident only every two months, what role should the doctor take in assessing and monitoring the pain and its treatment?
The doctor should take a secondary role to the support staff, primarily the managing nurse. He should also make himself available for calls from either the patient or the patient's next of kin when necessary, in case the doctor should need to tend to the patient's progress more frequrently than every two months.
5. What ethical theory or principle can function as a basis for good pain management? Kant's conception of the dignitiy of the human person corresponds with our need to provide pain relief and pain management to persons suffering. In doing so we uphold the dignitiy of the person and the dinginity of a human life.
5. What other issues do you think this case explores? This case explores the issue of drug prohibition in an indirect fashion. It eschews the woman being “doped up” while encouraging use of medications that will provide no relief. There is not reason why an older woman should sit in pain when medication is available.
51-60
1. Why do you think a person would volunteer to test an AIDS vaccine?
A person living in a community where AIDS is high amongst the population, and or they make active lifestyle choices which puts them at greater risk may both be reasons why a person would volunteer to test an AIDS vaccine.
2. In the AIDSVAX trials, some people were given a placebo instead of the vaccine. All the recipients had been told of this possibility ahead of time, but they did not know which substance they were receiving. Is it ethical to give some of the trial participants only a placebo?
I believe having a control group in a medical trial would be necessary in order for it to be considered a true trial with scientific results. So in this case, as long as the population has full knowledge they may be given a placebo, this would be routine.
3. If a vaccine being tested works for some ethnic minorities but not others, do you think it should be given to just those races or to everyone?
I think the vaccine should be given to the populations which it tested to be effective
4. Since the antibodies produced in AIDSVAX recipients were insufficient to protect them against infection, what might scientists try next?
Scientists may try a new vaccine with different or stronger antibodies.
5. If a private company develops an AIDS vaccine, it will spend a large amount of money on development and testing. Should it offer the vaccine free of charge to people who cannot afford it, especially those in very poor countries? How can private companies afford to develop vaccines if they do not charge for them.
I think that national health systems can find a way to contract with a private company in order to get the medications their populations need, using the populations' tax dollars. This would compensate the private company for their research. Federal subsidies for research into these vaccines are also ideal as a way to incentivize more companies towards research and development.
References
Al-Lamki, L. (2011). Medical Tourism: Beneficence or maleficence?. Sultan Qaboos University medical journal, 11(4), 444.
Austin, M. W. (2007). Conceptions of parenthood: ethics and the family. Ashgate
Publishing, Ltd..
“Careers in Public Health” (2016). University of Pennsylvania. Retrieved from http://www.publichealth.pitt.edu/careers/what-is-public-health
Centers for Disease Control (2016). Ten great achievements for public health in the 20th century. Retrieved from http://www.cdc.gov/about/history/tengpha.htm
Connell, J. (2006). Medical tourism: Sea, sun, sand and surgery. Tourism management, 27(6), 1093-1100.
“Health Care Facts”(2016) Obamacare Facts. Retrieved from http://obamacarefacts.com/healthcare-facts/
King, Carol. (2010). 10 Worst Abortion Myths and How to Refute Them. Ms. Magazine.
Retrieved from http://msmagazine.com/blog/2010/04/23/10-worst-abortion- myths-and-how-to-refute-them/
Lamont, J. & Favor, C. (2013). Distributive Justice. Stanford Encyclopedia of Philosophy. Retrieved from http://plato.stanford.edu/entries/justice-distributive/
