Question

Sarah Brandywine hurried into Dr. Kline’s inner office. Dr. Kline was transplant coordinator at Mid-western General Hospital, and he was expecting her. She had called him for an appointment as soon as she had realized the dimension of the problem with Mr. Wardell.

"So tell me about Mr. Wardell," Dr.Kine said, nodding toward the chair beside his desk.

"He’s fifty-one-year-old man who came to the hospital two days ago because he was frightened by the jaundice and ascites he developed over the course of the last week," Dr. Brandywine said. "He have been experiencing fatigue and loss of appetite several weeks prior to the jaundice. His liver is swollen and lumpy."

"Sounds like cirrhosis," Dr. Kline said. "I’m sure you did liver function tests, but what about a biopsy?"

"We did both yesterday. And I called you right after the final results. There’s so much scarring that Mr. Wardell has little liver function left." She shook her head. "I want to put him on the transplant list."

"What’s the cause of his disease?"

"It’s alcohol induced."

"No way." Dr. Kline shook his head. "No livers for alcoholics. No ifs, ands, or buts about it."

"This is a man with two kids." Dr. Brandywine tried to keep her voice level. "One’s twelve, and the other is eight. Their mother died two years ago, and their dad is all they’ve got left."

"Oh, God, the kids make it particularly sad." Dr. Kline’s voice took on a pained expression. "But look, thirty thousand people a year from alcoholic cirrhosis, and we can’t treat them at all."

"I know we can’t, but can’t we treat some?" Dr. Brandy wine leaned forward. "Is being an alcoholic enough for an automatic turndown?"

"I’m afraid so." Dr. Kline nodded. "These are people who created their own problem. There are far being enough livers to go around, so it’s only fair for us to put folks with problems not of their own making on the list and to leave others off."

"But, look, this guy’s got two kids depending on him." Sarah squeezed her hands into fists. "If I can get him into a rehab program, can we promise him the chance at a liver then?" She quickly added. "Not a guaranteed liver, but a chance at one."

"The answer’s still no." Dr. Kline paused. "I’m not saying alcoholics can’t be reformed, but I am saying they’re bad risks. If we give a transplant to somebody whose liver was destroyed by biliary cirrhosis, we’re likely to get a good, long-term survival. But if we transplant somebody who’s been drinking for the last ten or twenty years, we’re not likely to get food, long term results. The guy may promise to stop drinking and maybe he’ll do it for a while. But chances are good that, within a few years, he’s going to be back in the hospital with liver failure again, and alcohol is going to be the cause."

"I admit the numbers are against me." Dr. Brandywine inhaled deeply, then let her breath out in a long whoosh. "There’s nothing I can say to convince you?"

"We can’t afford to risk wasting a liver," Dr. Kline said. "That’s what I’ve got to convince you of." He shook his head. "It breaks my heart to think about Mr. Wardell’s children, but I’ve got to think about the parents with cirrhosis who aren’t alcoholics."

Critical Thinking

Should lifestyle factors be considered in the allocation of scarce life saving medical resources? Defend your position using ETHICAL principles.  Using the DIALECTICAL PROCESS state what your ethical position would be and why. You are to take a position and defend it. You should use some ethical principle to decide what you think is the morally correct thing to do. You must state those principles and explain how they have been applied to the situation. You should indicate that you have rejected alternative positions to your own and the reasons why you have done so. In so doing you need to enunciate clearly the values and ethical principle(s) you are using to both reject the alternative positions and to defend or support your own.

Use this template or form to make certain that you include each part of the process-parts a to e

Label your parts with the letters a to e to make very clear that you have done each part.

Dialectical thinking: the 5 parts

• a. Take a position on this question or issue Be as exact as you can be. Be precise in your use of language (ethical principles and values).
• b. Provide the reasons why you think this position is better defended by reason and evidence than are the alternative positions Position defended using reasoning (ethical principles and values) in support of the judgment (conclusion of the argument). You state the reasons why the position you take makes sense and has evidence and reasons (ethical principles and values) to support it other than your feelings or personal preference or your opinion or what you were brought up to believe or what just about everyone you know thinks or believes.   Philosophers have offered such reasons (ethical principles and values) and evidence for the positions they have taken and you should consider them and if you agree you can and should so state them in support of your own position.
• c. State the reasons why you found the other positions flawed or less defensible than the one you are defending
• d. State the criticisms of your position
• e.   Respond to the criticisms- rebuttal- how do you defend your position in light of those criticisms

Answer 1

Ans:-

a)- the position of the Academy of Nutrition and Dietetics that older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake.

# Food security directives mainly focus on producing and consuming enough calories.

# There are key ethical issues in making societal decisions about nutrition.

# Ethical trade-offs exist between environmental sustainability and nutrition goals.

# Without tractable debate on the ethics of nutrition, inequities will persist.

Delineating the ethical issues for human nutrition :-

The nutrition aspects of the debate about feeding the world well and sustainably are deeply rooted in ethics. This paper does not focus on just one ethical issue in addressing nutrition in the context of achieving food security and more broadly within the sustainable development agenda. Instead, it provides a review of some of the pressing ethical concerns that shape policy, action and accountability in the nutrition field. The paper attempts to highlight disagreements about what values should be taken into account, what trade-offs between values are justifiable, and what strategies are ethically acceptable. While not intended to bring about concrete answers to these issues, it is hoped that tangible progress on ethical issues and disagreements is possible even in the absence of consensus about agreed values.

Ethical issue 1: the ethical implication of traditional views of food security: nutrition inclusivity

food should be considered an exceptionalism in our society. Food is an essential aspect of human function, existence and experience and often, diverse and distinct social problems come together around food.Our food choices are often intertwined in our beliefs and values, our relationship to where the food comes from, and our larger connection with an increasingly globalized world.

In order to understand the importance of food in the context of improving nutrition outcomes, one can begin with the well-established framework of food security. This section outlines three ethical challenges that prohibit the inclusivity of nutrition within the food security directive.

- The first challenge is how the definition, although well intentioned to ensure all citizens have access to nutritious food, does not match the reality of what is researched, funded and implemented within the food system.

- The second challenge is that while the definition of food security is, in theory, inclusive of ensuring nutrition as part of its goal, it is not enough to achieve nutrition outcomes because of the multi-faceted complexity of nutrition. It takes more.

- The third challenge is the moral significance and implications of how food security is measured which is limited from a nutritional perspective and provides an inaccurate picture.

b)  nutrition therapy is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention.The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions. This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process.

The Need to Justify Own Position [TOP]

Several authors argue that challengers are in general in a more vulnerable position than defenders . Such a vulnerable and exposed position should also imply an increased need to justify or defend one’s position, for example by undermining the position of one’s opponents. Although there are no studies investigating challengers’ perceptions of their attitude allies and opponents, there are indications that challengers do display increased intergroup biases. For example, in their comparative study on conflict resolution in symmetrical and asymmetrical dyad conflict structures, De Dreu and colleagues found that in asymmetrical structures (where one party wants to change and one party wants to keep the status quo), challengers of the status quo perceived defenders as less friendly and more dominant than defenders perceived challengers. Thus, we expected challengers to display stronger intergroup biases by ascribing more negative reasons for opponents’ than allies’ attitude position than defenders, and that the need to justify one’s position is one potential explanation to this asymmetry.

c) the other positions flawed or less defensible than are :

• Argument to moderation (false compromise, middle ground, fallacy of the mean, argumentum ad temperantiam) – assuming that the compromise between two positions is always correct.
• Continuum fallacy (fallacy of the beard, line-drawing fallacy, sorites fallacy, fallacy of the heap, bald man fallacy) – improperly rejecting a claim for being imprecise.
• Correlative-based fallacies
  • Suppressed correlative – a correlative is redefined so that one alternative is made impossible (e.g., "I'm not fat because I'm thinner than him").
• Definist fallacy – defining a term used in an argument in a biased manner. The person making the argument expects the listener will accept the provided definition, making the argument difficult to refute.
• Divine fallacy (argument from incredulity) – arguing that, because something is so incredible or amazing, it must be the result of superior, divine, alien or paranormal agency.
• Double counting – counting events or occurrences more than once in probabilistic reasoning, which leads to the sum of the probabilities of all cases exceeding unity.
• Equivocation – using a term with more than one meaning in a statement without specifying which meaning is intended.

d) Criticism is an evaluative or corrective exercise that can occur in any area of human life. Criticism can therefore take many different forms.

To criticize does not necessarily imply "to find fault", but the word is often taken to mean the simple expression of an object against prejudice, no matter positive or negative. Often criticism involves active disagreement, but it may only mean "taking sides". Constructive criticism will often involve an exploration of the different sides of an issue.Criticism is often presented as something unpleasant, but there are friendly criticism. Criticism is also the study, evaluation, and interpretation of literature, artwork, film, and social trends . The goal is to understand the possible meanings of cultural phenomena, and the context in which they take shape. In so doing, it is often evaluated how cultural productions relate to other cultural productions, and what their place is within a particular genre, or a particular cultural tradition.

Negative arguments

Criticism may not be a positive response to an individual, action, or belief in all circumstances. There are two reasons that this might be the case:

• The recipient of the critique may be hurt by it. This is particularly true when the object of criticism is personal (a political or religious belief, for example) or when the critique is composed in a malicious way, rather than in an attempt to improve the recipient.
• The critique may not result in any positive change. If the critique is not written in a persuasive manner, if the recipient of the criticism isn't willing to acknowledge their faults, or if the recipient lacks the resources needed for change, then the critique will not have an impact.

Affirmative arguments

critique may be necessary or desirable in particular situations.

• Diagnosis and error correction: critiques identify the limitations of the object of criticism. A film critic, for example, might discuss the extent to which a particular film was able to communicate a theme. Criticisms also identify prejudices, biases, and hidden assumptions.
• Improvement: by evaluating the ability of an individual, action, or idea to accomplish a given objective, critiques identify possible improvement areas. Criticisms may also present alternative perspectives or suggestions, both of which facilitate improvement.
• Ethical implications: critiques of societal norms or public policies have the potential to affect a large number of people in a profound way and are thus ethically desirable.

e)

1) Make Communication a Habit :

Feedback isn't only for annual performance reviews. Don't let your only interaction with an employee occur when something is wrong. Establish a schedule for a regular pattern of communication, even if it's just a note on your calendar as a reminder to routinely touch base with each employee. Hearing positive feedback when warranted will lessen the blow when a negative critique is necessary.

2) Focus on Growth :

Strong leaders see their role as a coach and mentor. As supervisors, this means providing pointers to help others learn and grow in their careers. Create an environment where continued training and improvement are core values. When employees feel like you have their best interest at heart, they will be more receptive to your feedback and evaluations.

3) Balance Criticism With Positive Reinforcement

Starting off with a criticism will trigger a negative response and shut down the conversation. Make sure to convey your confidence in their overall work. Before pointing out a mistake, let your employee know you value them and appreciate their contributions.

4) Be Specific

Avoid giving vague, ambiguous or generalized advice. Detailed commentary helps people understand how they can do better. For example, instead of telling someone their presentation "needs work," give them specific suggestions for improving their delivery. Make a point of scheduling a follow-up conversation to discuss their progress. Offering as many details as possible helps your employee understand where they need to improve.

5) Avoid Finger-Pointing

To avoid the feeling of being criticized, focus on the behavior or the situation, instead of the individual. Rather than saying, "You always turn your expense reports in late," which will immediately put the employee on the defensive, focus on the facts. "Your expense reports need to be turned in within three business days. Otherwise, clients aren't billed on time, and it creates extra work for the accounting department. Please make sure they're on time."

6) Be Discreet

No one wants to be called out in front of others. Constructive criticism should be given in a private setting, not in the hallway where others can easily overhear your conversation. Timing is important. If you have a serious matter to address or you suspect the employee may not take it well, ask to meet at the end of the day. If it's a staff member with direct contact with clients, don't schedule a potentially upsetting conversation directly before an important meeting.