40 questions answered from two different books.
Health Care Ethics Principles and Problems (Medical Ethics)
Chapter 1
Briefly describe the differences among ethics, professional ethics and health care ethics.
Ethics is concerned with the way people ought to live their lives. It must not be confused with religion even though they may tend to advocate the same values. However, ethics are distinct interrelations among human which can be considered acceptable or unacceptable.
Professional ethics embody regulations pertaining to how persons function within a discipline. It specifies right and wrong actions based on morality. It does encompass principles of being, but the authors of this text wished to alternatively view ethics as beyond principle since health care focuses on people, bodies, minds, hopes for both. Precisely, it is about how people can interact with each other as living beings, not merely principle.
Here is where professional ethics become distinct from health care ethics. Healthcare ethics impinges on moral law. Thereby, professionals while operating within a framework of ethics emerging from society’s definition is caught in the middle of health care and social ethical interpretations of right and wrong conduct. Health care ethics forming the upward thrust into a greater meaning of what is morally correct or unjust
Chapter 2:- Case 1
According to medical ethics while a nurse/medical practitioner can make decisions in their best interest of a patient one the patient is fully conscious and if when conscious has elected a surrogate to make that this decision the medical profession cannot make that choice.
Chapter 2: - Case 4
The physician cannot overrule this patient’s decision because due to her religious convictions she has all right to choices. In this case the physician/obstetrician can offer alternative treatment in case the individual really needs additional blood. One such alternative is encouraging prenatal iron, administering intravenous iron proper to delivery or using blood substitute.
Chapter 2:- Case 5
Definitely, the physician ought to inform a parent and not the child because of him/her being a minor. There are no exceptions to the rule of informed consent whether it is a medication or procedure. Therapeutic privilege is only valid if the patient is unconscious; incapable of making a decision and does not have anyone to make such decisions.
Chapter 3:- Case 1
The medical indication form this patient is that he could benefit from stem cell implant questions are at his age and mental condition would it be worth it. Would it improve his mental capacity to make a valuable contribution of enhancing his life? A bone transplant could be considered if his mental capacity improves, which is highly unlikely.
Chapter 3:- Case 5
The situation could be helped through a court appointed guardian, but the difficulty in this case is established evidence of Father Eicher’s testimony of what he thinks Brother Fox’s wishes are ought to be validated by some written document agreed upon by both parties. In the absence of this document the difficulty escalates.
Chapter 4:- Case 2
Turing away uninsured patients can be considered unethical from a moral standpoint. There could be other ways in which health care could be paid for beside personal insurance. Many patients over 65 have Medicare coverage. Those not eligible for Medicare can access Medicaid. Patients whom have none of these can pay out of pocket. Subsequently, there is no justification for Dr. Williams’ method of turning way uninsured patients. Before making such a decision he needs to find out whether these people are eligible for Medicaid and have them sign up or offer them a payment plan for their care.
If Dr. Williams has no children then he may have to pay many taxes from his annual income. However, if there are children he could tender the care of uninsured as benevolence and receive a return just as when claiming form his children. It is understood that malpractice insurance, student loans and overhead office expenses must financial pressures, but his income can cover these expenses with adequate budgeting and tax declarations.
Chapter 4:- Case 3
Once there are alternatives the decision could be considered ethical. The hospital still provides services up a certain time of day. It has not closed completely. Members in the community know ahead of time where to access services after 10 o’clock at nights. An alternative to this decision was to increase health care costs, which is already high. Perhaps a poll could have been held to before to find out whether the community was willing to carry the extra cost during these hours.
Chapter 4:- Case 4
The decision to treat non complaint clients embraces social ethical considerations. If they are not treated the social repercussion would be great because HIV/AIDS is a social disease that could destroy the population of America. Drug resistant strains possibility could be alleviated through education. Program evaluation techniques will detect the extent of noncompliance to determine whether it is significant for an education intervention.
Funding will be affected depending on the protocol for execution of the program. Most programs have a consensus to provide care for a designated amount of clients. There are certain objectives to be achieved at the send of a particular execution period. If objectives are not achieved certainly this could affect further funding. Obviously, one objective should be to treat everyone who appears at the clinic regardless whether are compliant or not.
Chapter 5:- Case 1
In this case Mary’s father is indirectly a patient/client because he was actively participating in the donor program. The confidentiality lies in disclosure of information pertaining to a patient’s health to a third party without consent. For the surgeon to disclose this information Mary’s father consent had to be obtained. He did not provide this authority.
Therefore, confidentiality was maintained. The other issue was truthfulness, which now poses an ethical dilemma. As such in protecting the secret it can be said that Mary’s father requested not to disclose these results since he did not give permission to do so.
Chapter 5:- Case 2
It is a situation of moral ethics. This family has been involved in an accident. Each member is hospitalized. In the best interest of their psychological safety there is no need to add tensions by relating death to anyone, be it the dying or relatives. Morally the physician was correct in withholding that information and remaining silent on the issue because none of them were capable of receiving that information without serious repercussions to their health at the time.
When the children asked about their father they should be told that he is intensive care and doctors are working to keep him alive. More importantly, the patient did not tell the physician he wanted to know the information his wife was communicating. Consequently, the physician had no obligation to passing this information to the patient.
Chapter 5:- Case 9
Again this is an ethical dilemma as it relates to truthfulness. Testing and treating Mrs. Smallwood without her consent is both illegal and unethical on the part of the physician. Truthfulness is compromised by not disclosing the nature of the test and treatment while preserving Mr. Smallwood’s confidentiality. Lying technically relates to fabrication information. Definitely, if this were AIDS the physician would have to decide that this cannot be hidden due to its seriousness and repercussion. However, both situations are equally dangerous and the physician should have devised some way of telling the truth maybe by allowing the intervention of a social worker.
Chapter 5:- Case 10
There are no ethical implications if Dr. Timorous remains silent on the issue. This would be preserving confidentiality. He should not disclose any of this information to the client’s brothers either because he was not directed to do so. After tests were conducted it is none of his business to disclose these findings with a third party without the appropriate consent even those they are friends.
Chapter 6:- Case 1
Yes, Nurse Lewis acted in accordance to the abuse law covering domestic violence as well. She needed to contact the welfare department or police, which she correctly did. Whistle –blowers can protect themselves through their unions or nursing associations. Intimidation of any sort is unprofessional practice, which warrants thorough investigation because it is a violation of patients’ rights to safe care. Power is an appropriate consideration in health care ethics when it is used to advocate for patients’’ right and not for abuse.
Chapter 6:- Case 2
If nursing directors do not address this issue adequately by having this obstetrician either removed or rehabilitated then nurses can take this to the association level. Nurses associations are organizations that are expected to represent nurses as well as advocate for patients’’ rights. Unsafe practices are a violation of patients’ right which must be appropriately recorded and subsequently reported.
Records ought to form the basis of complaints while protecting the safety of patients. Once there are records in nurse notes to support irregular judgments by this obstetrician an investigation into these practices ought to be imitated and disciplinary measures taken.
Chapter 6:- Case 3.
Patients, nurses, doctors and members of the community ought to sign a petition and have a politician intervene if members of the medical profession are ignoring this practice. Reporting to the police maybe unprofessional unethically because members of the public could begin disrespecting doctors either at that health care institution or altogether.
Chapter 7:- Case 1
Chapter 7:- Case 3
Chapter 7:- Case 4
The neurologist’s recommendations can be considered unethical since it is contributing to suicide by violating a patient’s right to care. Withholding pneumonia treatment is initiating suicide. Hence, it is illegal as well as unethical. As the attending physician I would continue care.
Chapter 7:- Case 5
In realizing that assisted suicide is unethical it would be my responsibility to collaborate with social services in seeking help for my client and his family. This patient can now be considered suicidal. He would not receive any cooperation from me and eventually seek other alternatives. As such, this matter ought to be reported to the relevant authorities.
Chapter 8:- Case 1
Cystic Fibrosis is a serious development in this case. Abortion is legal in America and at 16 years old Jean can initiate an abortion after speaking with a designated social worker on the issue. From this point she and her daughter could be referred to the appropriate agencies for counseling and help. Morally, their family priest could intervene and offer some advice on the issue.
Chapter 8:- Case 2
Yes, it is medically indicated since there is fetal abnormality and possible danger to the mother’s health. With an already low income and one Downs syndrome child in the family this could become burdensome to the family. As such, their desires are ethically correct based on these criteria.
Chapter 8:- Case 5
This couple in my opinion has no valid reasons for abortion because it is based on career opportunities. Here is where the value for career opportunities supersedes the morality of destroying an unborn fetus. They can be further advised on taking contraceptives to prevent a pregnancy. Since there are no issues pertaining to becoming pregnant then adoption should not be considered at this point. Instead planning the pregnancy is most important.
Chapter 8:- Case 6
Yes, it is medially indicted because the pregnancy threatens the life of the mother. The ethicalness of abortion is complicated by the situation because even though facing death Desiree wants to leave a memory for her husband in a child
Chapter 9:- Case 2
Ethically the family is desperate to save the life of the older child. Making the sacrifice to have another one with a match seems reasonable and morally correct. If the child is not a match the fetus would be discarded then the motive becomes morally unsound when the fetus is considered a life in itself.
Chapter 9:- Case 4
The appropriate controls of surrogate motherhood lie in drafting legislation that would protect both surrogate mother as well as gestational one. It could involve limiting the amount of money paid during pregnancy to expenses directly related to it. It has been discovered that women who enroll in surrogate programs are in dire need of money.
Subsequently, qualifications should be placed limiting the amounts of money surrogates receive during a transaction. In the case scenario offered with Rosha surely this match should not have been considered due to alcoholism, mental illness and non-compliance with reducing alcohol and smoking. Linking these irregularities to the dysfunction with the John family ethically signing the contract can be considered unsound.
Chapter 10:- Case 1
Predictions state that there are merely a few more years with some serious complications. The interest society may have lies in whether an organ transplant would benefit the client by prolonging life for more than just a few years. Already the professor has made a significant contribution to the world and has a family history of heart disease. Hence, it may not be worth the while. This organ could be reserved for someone with more potential to life.
Chapter 10:- Case 2
Both dialysis and kidney transplant are medically indicated in Robert’s case. Robert’s father’s belief regarding his reaction to dialysis may not be relevant because Robert has not communicated this to the health care team. As such, he ought to be consulted for clarifications. It is ethical for the father to donate his kidneys because he does not have diabetes or any threatening kidney condition, which would mutilate the decision. At age 25 yrs. old and blind a kidney transplant or dialysis can bring some hope to improving quality of life even though the ensuing years may not be many.
Chapter 10:- Case 5
While relevance to the patients’ social profile should not take precedence it is important to rule out who could benefit most from the transplant. In the case of the alcoholic with associating medical conditions priority should be given to a person whose condition offers more success towards the intervention. Obviously, the lawyer showed more promise from a medical standpoint excluding his social status, which is not a considerable criterion in this case.
Chapter 10:- Case 6
Yes, laws should be designed to ensure fairness in donor recipient relationships and decisions regarding who gets an organ transplanted. This law could be enforceable once it contains penalties for violation. If there are no penalties then it would be a law written on paper. The law ought to address all random factors entwined in the practice of organ transplants. Parents of the Mary Lindsey were quite ethically in asking the public’s support. John’s relatives remained dormant on the issue. As such, there were no resources available to this client.
Chapter 11:- Case 4
It would appear that health in some countries is a business. Therefore, advertising has become ethical for any business. So far there are no laws prohibit such practices. Consequently, it is legal and ethical. However, in health care patients do not select what drugs they want to use. These are prescribed based on their particular diagnoses.
Chapter 11:- Case 5
Once prostate cancer is not an infectious disease that could wipe out nations or the entire world then there is no need for subjecting men to tests or mandatory screening. Also the money spent on such screening is not worthwhile. This could be expended on finding cures for cancers other than the use of chemotherapy which has very serious side effects.
Chapter 12:- Case 3
It is useless admitting John at this stage. Experimenters ought to tell John the truth of the drug being ineffective.
Chapter 12:- Case 4
There is no validity from a professional perspective of this research because the practice is conducted outside the discipline. Perhaps Bill Riley could have linked up with a licensed psychologist in conducting the study. Besides withholding the intention is unethical research practice. These have to be confirmed and enforced as acceptable by professions within the psychology discipline.
Understanding Health Policy: A Clinical Approach
4th Edition
Thomas S. Bodenheimer
Chapter 2:- Question 1
How does each person pay when receiving care? Do people contribute small amounts in advance so that their care will be paid for when they need it?
There are four options available to pay for health care in America. It includes, Medicaid, Medicare, private insurances and out of pocket. There are ways in which people can contribute in small amounts for their care in advance. This is through Medicare and private insurances. Monthly payments are deducted which account for advance payment for health care.
Chapter 2:- Question 2
When a person contributes in advance, might the contribution be used for care given to someone else? If so, who should pay how much?
There could be a possibility that that money could be used for another if that person does not become ill. However, it does not mean that when the person paying in money becomes ill there will be no funds for their care. Health care administration will have enough funds to finance that persons’ care through Medicaid benefits. Everyone should pay for their care based on their income.
Chapter 3:- Question 1
- People lack insurance because they feel that they cannot afford the high cost especially, if they are not employed. Some people who can afford insurance do not think it is a priority in their life since emergency Medicaid can always cover some of the cost. Also some insurance companies do not cover people with certain types of illness.
Who Are the Uninsured?
- The uninsured are section of the population without health insurance coverage. Studies revealed that 24% of people with an annual income of less than $25,000 per year were uninsured.
Does Health Insurance Make a Difference?
- Yes, it does make a difference because people insured people can guarantee prompt effect and quality healthcare. People who are not insured may receive no care or pay large sums out of pocket if they are not eligible for Medicaid.
Chapter 4:- Question 1
- With traditional fee for service the physician was reimbursed by the patient/client directly for diagnostic procedures.
- Fee for service the physician and organization will be paid for the MRI test individually and not as a bundle through health insurance either from Medicare, Medicaid or private.
- Under Independent Practice Association (IPA) the physician receives a capitation payment as well as a yearend bonus for MRI and similar procedures.
Chapter 4:- Question 2
Ordering more diagnostic tests would enhance profits. First depending on the accounting system payment for these tests can be immediate and re-imbursements for certain tests are very high such as MRI. If these services are bundled there would definite increases in profits.
Chapter 5:- Question 4
A gate keeper provider such s HMOs or primary care physician help guide clients towards available health care providers within that particular network. The limitation is that it does not give the client options to choose for him/her until a period of time has elapsed since it is a locked-in system. This is a technique in managed care to keep cost under control
Chapter 5:- Question 5
A primary based health care system is structured so that the client first sees a physician who is not a specialist. Costs of a primary care attention are far less than that of a specialist. As such, the advantage is controlling costs and allowing more re-imbursements to be fueled into primary care services.
Chapter 6:- Question 1
Two generations of HMOs are regional and dispersed. Regional is more associated with traditional model whereby healthcare is managed from within a district to district framework. This is typical of the British Healthcare system. A disperse HMO seeks to arrange care based on the three levels, primary secondary and tertiary. United States of America has adapted this system.
Chapter 6:- Question 2
Vertical integration is management of healthcare systems using a top down typology. It is using the ascending/ descending model as in primary, secondary tertiary. Virtual has to do with integration of skills creating an interdisciplinary management approach by way of contracts linking services such as hospitalization, ambulances and laboratory. This can be either ascending as in teamwork or horizontal.
Chapter 6:- Question 3
Independent Practice Association is an organization of health care practitioners which contracts with different companies in providing care. For example an HMO or managed care plan can contract with an IPA then subsequently with an independent physician. An integrated medical group provides a series of services when a particular plan is executed. These include pharmacy, laboratory and transportation to name a few. Independent practice association could provide integrated medical services also.
Chapter 7:-Question I
In the past every order had to written by a physician and handed to the nurse then transferred to a pharmacy for either pick up or delivered. Modern middle-level practice nurses merely see orders written, but prescriptions are directly sent to pharmacies, which either deliver or patients pick up their medication. Future trend point towards illuminating paper prescription altogether and patients are told about the orders which are picked up or delivered. Clinical information systems are replacing paper trails.
Chapter 8:- Question 1
One intervention suggested to in reducing painless cost as depicted in the steeper curve points towards reducing the number of Cesarean births performed daily as well as improving prenatal care, which is less costly and limits complications. Reducing immunizations was also considered a painless cost reduction approach. Flatter portions show where prolonging life in cases of anencephaly or vegetative conditions could reduce costs.
Chapter 8:- Discussion question 2
Women’s health has always created controversies in health care. Interestingly, while women with breast cancer ought to be addressed and given priority at the same time of equal importance are women without breast cancer. There are many cheaper ways of testing for breast lumps besides using a mammogram tests. It has been proven that quite a few of these patients continually prove negative. So why is this money being expended on mammograms when it is needed treatment of an existing condition.
Chapter 9:- Question 2
This could be accomplished by asking insurances to contribute more towards the re-imbursement project to reduce costs. Costs still could increase if there are fluctuations in the additional amounts offered by insurances.
Chapter 9:- Question 3
The better method is requesting authorization prior to ordering tests, with prior authorization patients do not have to pay for their tests and the waiting period is greatly reduced.
Chapter 10:- Question 3
A cost conscious HMO would not have admitted Nina Brown because he would have contemplated the long-term cost to the client. Fee for service physicians might be more concerned about how much revenue could be accrued from the case.
Chapter 10:- Question 4
Careful record keeping is very important. If a clinical information system is installed this should be re-evaluated for system errors. In cases where there is none the transfer of all documents from one department to the other must be recorded and signed. In this way administration can trace the responsible party. As office manager who did not receive the X-ray report it would be necessary to attach a timeframe for x-rays reaching the office. When that time has elapsed inform x-ray department of the irregularity.
Chapter 10:- Question 5
The medical malpractice system was inactive. As such, there needs to be re-evaluation of the existing system with a view of designing a new malpractice model consistent with new developments in the work industry.
Chapter 11:- Question 1
Tuberculosis declined prior to identification of the bacteria because the causative organism developed a different strain, human bodies became adaptable to the original strain and there were marked improvement in sanitation. Likewise polio morbidity and mortality declined due to the discovery of a vaccine. Subsequently, there was wide spread prophylactic vaccination of the population. Hodgkin’s disease mortality declined as well due to the discovery of chemotherapy treatment.
Chapter 11:- Question 2
First and epidemiology revolution relates to discovery of the environment as a source of disease and not an act of the wicked Gods or evil people. Within the environment were bacteria, viruses and organisms termed germs. In the second epidemiology revolution environmentalists, scientists and public health began identifying causes of diseases by germs found in the environment, researching ways to isolate and destroy their activity in the human body and other animal species.
Chapter 11:- Discussion Question 2
Heart disease is highly associated with life style and diet and not just cholesterol levels. It could be explained that people, in Japan eat healthier diet low in trans fats and organic food. Many Americans live a stressful life style. A large proportion of the population is uninsured and cannot afford health care. Health insurance determines the quality of care accessible to individuals in America unlike Japan. The implication for research in coronary heart disease comparing Japan to United State of America is establishing how stress and accessible to quality health care affects the life expectancy in the two countries.
Chapter 12:- Question 2
Medicaid finances 43% ; Medicare 17% ; out of pocket spending accounts for 23% and 7% by private insurances.
Chapter 12:- Question 3
Medicaid essentially covers about 90% of care in nursing homes and assisted living facilities. Medicare does not pay for nursing homes in the long term setting. It pays only for medically necessary skilled nursing facilities or home health care for a limited time as prescribed by a doctor.
Chapter 12:- Discussion Question 1
Private insurance companies do not want to undertake that burden since long term care could be both costly and extensive. Also, governments do not subsidize private insurance long term care plans. Hence, they are often not available.
It is difficult to predict how long would be long term and the elderly are unable to pay for this because they are the largest groups requiring this service. Usually they are on social security or pensions, which cannot afford the cost of a regular health insurance much more long term insurance care costs
Chapter 13:- Question 2
Rationing is limiting healthcare resources to cut costs. Precisely, it is distribution of these resources in a fair manner so that there will be enough for most persons.
Chapter 13:- Question 3
The person who has a better prognosis after being transplanted ought to receive the heart first. On some occasions agencies work on a first come first serve basis.
Chapter 13:- Question 4
I would proceed with the committee’s recommendation. Beneficence versus distributive Justice is the ethical dilemma because as a physician I am faced with the issue of making a decision in the best interest of patient, society and relatives.
Chapter 13:- Question 7
Physicians seem to serve two masters in their practice as roles are shifted from time to time. In the case of Lakeberg the surgeon had to serve society as well as patients. Both children died as was predicted. The hospital wrote off part of the costs, which was borne by society. Again in Dr Intenviso’s case he had to deal with society’s rationing and the patients’ need for intensive care.
In Mr. Rodolfo’s case the committee’s decision had to be honored in spite of the differences in opinions between wife and daughter. Donor transplants makes it even more difficult ethically in the presence of shortages and decisions are made on first come first serve basis without really evaluating the outcome when a transplant is executed.
Chapter14: Question 1
In Germany healthcare is paid through employers’ insurance along with a merge between social insurance and public funds. Canada provides universal/comprehensive tax funded healthcare coverage for all its citizens or permanent residents. In United States of America residents/citizens are obligated to carry private insurance if they are not disabled or under 65 years old. Otherwise health care is subsidized through Medicaid and Medicare coverage. British health insurance system is similar to Germany. They have established the National Health Service (NHS), which is funded by taxes.
Chapter 14:- Question 4
In Germany cost are controlled through merging social with public funds; United States of America it is public funds and private insurances inclusive of employer insurances. In Canada amount of taxes received control spending on health care. Similarly, in Great Britain there is a balance between taxes and social service input.
Chapter 15:- Question 1
The difference among government financed insurance, employer mandatory and individual mandate is the way in which these plans are funded. There could be a mixture in dispensation. Examples of government financed are Medicaid, Medicare, or comprehensive insurance as in Canada. Employer mandate are usually subsided by government and individual mandate are for residents over 65 with a mandatory eligibility due to their age.
Chapter 15:- Question 2
Medicare is social insurance because it caters to a particular population and is mandatory for that age group. Medicaid is government financed insurance for all those in the eligible uninsured in the society.
Chapter 16:- Question 1
The power was increased during 1945 and 1995 through the development of four categories of actors known as purchaser, suppliers, providers and insurers. The necessity of health insurance grew. Consequently, providers of care and suppliers of services gained momentum and a revolution emerged in the industry.
Chapter 16:- Question 2
Changes realized the development of insurance companies using a team of doctors in providing care for insured clients. This meant that once a client was insured in a certain plan that plan decides who the health care provider will be. Hence, health care provider relationship with insurance companies became a system of co-dependence.
Chapter 16: Question 3
The backlash against managed care between 1995 and 2000 emerged as purchasers and insurer’s sought to do business with providers who could keep cost down since managed care costs escalated. At the same time managed care was considered quality care for the affluent in society with just a few being able to afford it due to high cost in contacting these services.
Chapter 16: Discussion Question 1
- The likelihood is that he/she could encourage more surgeries applying the benevolence strategy.
- The primary care could order tests, which are unnecessary as a package to be paid for such services.
- Using the profit motive there could be an exceptionally high billing of insurances for MRIs for non- predisposing conditions.
- If for profit motive is the indication even if no patients are admitted using the money on some equipment which may not be used is likely since money is the driving force. However, with more sensible thinking this equipment should not be bought because it would not accrue any substantial profit.
- In a for profit organization Medicaid patients are beneficial to the system because it is public funds and often careless expenditures are bypassed.
