1. Define and discuss the roles and responsibilities of an ethics committee in a hospital setting.
The ethics committee is a multidisciplinary group that is made up of both hospital staff members and members of the local community. This committee, then, serves several different roles, or has multiple responsibilities, related to their position. The first responsibility of an ethics committee is providing education for the public in the community. In doing so, the committee has to communicate both positive and negative elements of the current healthcare systems, so that the public understands the state of healthcare in their area. The committee’s second responsibility is writing policies. These policies, like the public education program described above, are designed to improve customer experience, by improving the efficiency and transparency of operations at the local healthcare institution. These policies can be categorized into directive, confidentiality, medically futile treatment, and generic screening policies. All of these policies are very important because they define the institution’s mission and vision as it relates to the delivery of care. Closely related to this development of policy, is the ongoing critique of ethics-related practices of the institution. The ethics committee is thus responsible for making sure all of their existing and planned policies are being enforced from an ethical perspective, and with the best interest of the client at heart. Finally, the ethics committee acts as a watchdog to oversee the medical institutions day-to-day operation. This includes not only the coordination and application of the policies mentioned above, but also the organizations function, financial health, decision making processes, and other features that directly impact the quality of care within the institution. I believe that maintaining oversight of the ethical behavior of staff members, and communicating in a way that increases transparency between patients and medical staff is essential to the integrity, and ultimately to the business operation of any medical facility. Further, it is my opinion that creating an ethics committee that represents the community well, as well as including members of the medical staff, ultimately ensures hat a healthy relationship is built between the hospital and the people they serve. This is critical to the longevity of the involved medical practice, or practices.
2. Describe and discuss the AMA council on Ethical and Judicial Affairs’ stand on omitting treatment.
The American Medical Association strongly believes that there is a need to recognize when it is appropriate to shift from life sustaining to palliative care, in patients who are terminally ill. However, they also strongly recognize every patient’s right to appropriate care, and distinguish between suspending treatment and suspending care. A patient is well within their life to forego treatment for a terminal condition, but that does not negate their need for appropriate medical care. Patients can and should continue to receive care, for as long as they are living, and in need, regardless of the decisions they make regarding treatment for their condition. Likewise, in patients who are terminal, but for whom death is not imminent, it should not be considered unethical to suspend all life sustaining treatment, if it is done in accordance with the will of the patient. There is no medical benefit in prolonging life, when it is only prolonging the process of dying. As such, what is ethical with regard to omitting treatment is based on the will of the patient, and the perceived judgement of treatment effectiveness on a case by case basis. I strongly believe that there is a time to fight for a person’s life, and provide ongoing and aggressive treatment; however, it is equally important to recognize when compassionate care, and comfort which afford an individual a better quality of life in their final days is more important than fighting a disease, which will ultimately kill the patient, no matter what is done. It is then key, in my opinion, to understand the very fine line between omitting treatment and omitting care. I agree completely with the AMA in that an individual has a right to stop treating their disease, but that high quality medical care should be continued for the remainder of their life, in order to provide comfort, of palliative care.
3. Identify and discuss the obligation of the healthcare provider in discontinuing treatment.
There are several assertions that can be proven valid as far as the obligation of a healthcare provider in the discontinuation of a treatment is concerned. The first assertion suggests that the health care provider has no obligation to prolong the patient’s suffering before dying merely for the sake of prolonging life. There are cases in which prolonging life is simply prolonging the dying process, which may deteriorate the individual’s quality of life and increase suffering. In these cases there is a strong indication that it may be best to discontinue care, and it is ethical of the physician to recommend termination of care to the patient, and to help them understand the implications of their decision and the availability of medical options. Second, the health care provider is obligated to adhere to the patient’s wishes regarding treatment and care. When the patient wants to continue seeking treatment, treatment is pursued, in contrast, if a patient has requested the discontinuation of treatment, the healthcare provider is obligated to abide by these wishes and provide care without providing treatment. I think that it is a person’s right to decide when they are done fighting, and when they are ready to let go, and it is the responsibility, or obligation, of medical staff to give them the information they need to make that decision in an educated way, and to respond compassionately to their wishes as they work through that process.
4. Compare and contrast the issues involved with the selling of organs.
Some have made the argument, according to our textbook, that if it is ethical to donate an organ then it should also be ethical to sell an organ. However, this robs society of the social benefit, including an increased sense of community and interest in welfare, which comes from the organ donation concept. However, while these are purely theoretical approaches to the question, there are a number of more tangible reasons for legally banning the sale of organs. Most prominently, the ability to sell organs necessarily places the burden of organ donation on the poor. Those without money would be more willing to give up all or a part of an organ in order to financially benefit. Further, selling organs would increase the number of people having donations that can survive without them, and poor individuals who desperately need them would be excluded from having necessary procedures because the rich could afford the organ and the poo could not. I believe it is critical not to sell organs, because of the potential for creating a black market, or to encourage people to give organs at risk to their own health and wellbeing. I agree, as well, that the current system ensures that organs consistently go to those who have the highest level of need, according to a system decided by UNOS, however if organs could be bought and sold, organs could go to the highest bigger, rather than the individual with the highest level of need.
5. Discuss the ethics of the user of research results from a health care prospective.
It is key that research results be used in such a way that patient information remains confidential. Further in biomedical research it is key that subjects be fully informed about the nature of the study and reis factors, or other factors that could affect their consent in advance of the study. Care must also be taken to avoid accidental or intentional exploitation of those who might be compromised from making clear decision. Finally, research results can be protected by setting up a double blind experiment to protect the data outcome from skew or bias. I believe that research is critical to developing new treatments and better levels of care, however, I also believe that patients need to be protected from possible harm that could come from the study, and that their privacy must be protected to the highest degress. As such, care should be taken during the research process, and as it relates to research results in order to make patient protection the highest priority.
6. PAs are expected to behave both legally and morally. Professionalism is a fundamental part of the profession. Identify and describe the five areas that reflect Individual Professionalism of the PA.
The five areas of concern are conflict of interest, professional identity, competency, sexual relationships, and gender discrimination and harassment. Conflict of interest occurs when an opportunity arises which could benefit the PA above and beyond the benefits relate to the job. Any time that a person is in a position to put their personal benefit in front of the care of the patient, they are suffering from a conflict of interest. As such, accepting gifts, trips or other incentives is discouraged because it could be seen as a bribe to provide services which are not ordinarily provided, or to care for the patient that is giving the gift above and beyond the normal level of care, while simultaneously underserving the needs of other patients. PA’s should always ask themselves what others would say or think if they knew about the arrangement as a measure of its appropriateness. This is closely related to the honesty that is key to a PA’s professional identity. Professional identity means that PAs should represent themselves and their skill level honestly, rather than trying to misrepresent their skills, by claiming they are something they are not. Misrepresentation can occur both directly, for example if a PA claims they are a nurse, or indirectly, if a patient assumes that they have more authority than they actually do, and the PA does not correct them. This includes performing procedures or elements of care which were not included in their training, misrepresenting their professional credentials, and other similar activities. Relatedly, PAs should have a high level of competency for any procedure they perform. Competency relates to skill and ability to complete the task at hand. A competent PA will provide a high level of care, and ensure that the quality of healthcare is constantly upgraded, by continuing their education and focusing on executing every skill well while providing patient care. Additionally, PAs must avoid entering into a sexual relationship with those they encounter as a result of their position. These sexual relationships are defined and any personal relationships that occur between the PA and key persons in the case, like family members. Closely related to sexuality in the workplace is sexual discrimination. Gender discrimination and sexual harassment involve engaging in inappropriate activities and saying inappropriate gender related things while on duty. Gender discrimination is any type of action or behavior that will affect an individual’s treatment. Sexual harassment may refer to any form of sexual advances, verbal or physical conduct of the sexual nature, and sexual favors. It is very unethical for a physician assistant to engage in any form of gender discrimination or sexual harassment, and it must be avoided at all cost. I believe that professionalism is closely related to ethics, and providing an ethical workplace, and level of care for patients. As such, it is key that policies be established in order to support and protect the professionalism of all PAs. Implementation of such a set of policies is ultimately key to solving moral and ethical problems that arise out of a lack of professionalism.
References:
Baillie, Harold M. (2013). Health Care Ethics. 6th Edition. Pearson Education: Upper Saddle River, NJ.
