Question

Ethics Class

Chapter 14 Discussion questions:

Discuss bioethics? Discuss health care professionals and patients & their families-rights & obligations. Discuss truth telling and informed consent. Discuss intercultural bioethics. Discuss ethical issues in medicine. Discuss human experimentation.

Answer 1

1. Bioethics is the study of typically controversial ethics brought about by advances in biology and medicine. It is also moral discernment as it relates to medical policy, practice, and research.

Four commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress (2008), include the:

• Principle of respect for autonomy,
• Principle of nonmaleficence,
• Principle of beneficence, and.
• Principle of justice.

Examples of topic areas that have been the focus of bioethics for a long time are organ donation and transplantation, genetic research, death and dying, and environmental concerns.

2. Patients Rights and Responsibilities

A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.

A patient has the right to a prompt and reasonable response to questions and requests.

A patient has the right to know who is providing medical services and who is responsible for his or her care.

A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.

A patient has the right to know what rules and regulations apply to his or her conduct.

A patient has the right to be given by the healthcare provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.

A patient has the right to refuse any treatment, except as otherwise provided by law.

A patient has the right to be given, upon request, full information, and necessary counseling on the availability of known financial resources for his or her care.

A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate.

A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.

A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.

A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.

A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.

A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.

A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency.

A patient is responsible for providing to the healthcare provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.

A patient is responsible for reporting unexpected changes in his or her condition to the healthcare provider.

A patient is responsible for reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.

A patient is responsible for following the treatment plan recommended by the healthcare provider.

A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the healthcare provider or health care facility.

A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider's instructions.

A patient is responsible for assuring that the financial obligations of his or her healthcare are fulfilled as promptly as possible.

A patient is responsible for following healthcare facility rules and regulations affecting patient care and conduct.

Health professionals maintain health in humans through the application of the principles and procedures of evidence-based medicine and caring. Health professionals study, diagnose, treat and prevent human illness, injury and other physical and mental impairments in accordance with the needs of the populations they serve. They advise on or apply preventive and curative measures, and promote health with the ultimate goal of meeting the health needs and expectations of individuals and populations, and improving population health outcomes. They also conduct research and improve or develop concepts, theories and operational methods to advance evidence-based health care. Their duties may include the supervision of other health workers

Public health workers shall have the right to freely from, join or assist organizations or unions for purposes not contrary to law in order to defend and protect their mutual interests and to obtain redness of their grievances through peaceful concerned activities.

3. In the determination to promote and improve communications around person-centred care, there is growing professional interest in matching different communication functions or behaviours to good outcomes .

Informed consent is shorthand for two distinct duties in Westernized medicine. Firstly, the clinician’s duty to obtain consent before treatment, and secondly the duty to ensure that the person has been properly informed about a treatment’s risks and benefits . A particular issue in end-of-life care is that many individuals are unable to make their own medical decisions and are increasingly being asked to elect proxy/surrogate decision-makers. One study showed that families made approximately 75% of medical decisions for hospitalized persons with life-threatening diseases.

4. Culturally based moral conflicts are a reality in a large part of the globe. Different cultures give rise to medical or sanitary practices, or those related to the life sciences, that are also differentiated - which may lead to dissensus regarding their morality. It is extremely important that bioethics, as ethics applied to moral issues, concern itself with such questions, demonstrating its connection with the world of life and its role as a relevant instrument for ordering social life. Designed to make specific theoretical contributions for dealing with culturally based moral conflicts, the equality of cultures in intercultural dialog, as a precept orienting decision making and intercultural mediation, implies rejecting ethnocentrism and cultural relativism.

The theoretical-normative reference point for human rights as an ethical agenda which is both procedural and substantive, given its condition as an integral element of the culture of mankind, and its role in the defense of different cultures, especially those in a minority, is essential. Thus human rights, which are universal in that that all members of the human species are entitled to them, reveal themselves to be a unique instrument in the defense of vulnerable groups and the rejection of authoritarian governments and practices. This is expressed in the use of human rights by indigenous peoples to enforce their rights before the InterAmerican System of Human Rights, and by nongovernmental organizations in countries where there are harmful traditional practices, such as child weddings, female genital mutilation and honor killing of women.

It is by virtue of their universality in the defense of vulnerable groups that the construction of the IBP based on human rights, through which culturally based moral conflicts and intercultural mediation, procedurally grounded in the cultural rights, the right to participation, the right not to be discriminated against and the right to freedom of expression, was proposed. In the case of culturally based moral conflicts in which there has been violation of human rights, beyond the human rights that orient dialog and cultural mediation, it will be necessary to have recourse to the principle of prevalence of human rights, thus rejecting arguments of authority in terms of the predominance of the cultures over the rights of any human being not to be submitted to torture, cruel, inhuman or degrading treatment, and others of the same nature.

Finally, it should be noted that strategies for the resolution of culturally based moral conflicts, which, regardless of their nature, are anchored in human rights, start from the assumption that there is no hierarchy among cultures and that protection of the vulnerable, regardless of the cultural community of which they are members, is the inexorable duty of the State.

5. Medical ethics involves examining a specific problem, usually a clinical case, and using values, facts, and logic to decide what the best course of action should be.

Some ethical problems are fairly straightforward, such as determining right from wrong. But others can also be more perplexing, such as deciding between two "rights"—two values that are in conflict with each other—or deciding between two different value systems, such as the patient's versus the doctor's.

Doctors may deal with a great variety of perplexing ethical problems even in a small medical practice. Here are some common problems identified in a 2016 Medscape survey, where at least some physicians held different opinions :

Withholding treatment to meet an organization's budget, or because of insurance policies;

Accepting money from pharmaceutical or device manufacturers;

Upcoding to get treatment covered;

Getting romantically involved with a patient or family member;

Covering up a mistake;

Reporting an impaired colleague;

Cherry-picking patients;

Prescribing a placebo;

Practicing defensive medicine to avoid malpractice lawsuits;

Dropping insurers; and

Breaching patient confidentiality owing to a health risk.

Professional standards are a way to provide some guidance on ethical problems, but they cannot address every issue, and they may not address troubling nuances, such as reconciling two conflicting values.

6. Ethical issues in human research generally arise in relation to population groups that are vulnerable to abuse. For example, much of the ethically dubious research conducted in poor countries would not occur were the level of medical care not so limited. Similarly, the cruelty of the Tuskegee experiments clearly reflected racial prejudice. The NIH experiments on short children were motivated to counter a fundamentally social problem, the stigma of short stature, with a profitable pharmacologic solution. The unethical military experiments during the Cold War would have been impossible if GIs had had the right to abort assignments or raise complaints. As we address the ethical issues of human experimentation, we often find ourselves traversing complex ethical terrain. Vigilance is most essential when vulnerable populations are involved.