Up@dawn 2.0

Wednesday, January 25, 2017

Quiz Jan26

NOTE: a version of this quiz posted earlier has been modified, as of 2:55 pm Wednesday.

1. Chapter 3 begins by asking if our bioethical perspective ("vision") is skewed by _____... (a) cultural assumptions, (b) gender bias, (c) religious faith, (d) all of the above

2. What's the leading global cause of death among women of reproductive age?

3. (T/F) The "feminist critique" says bioethics has been dominated by culturally masculine thinking.

4. What ethical perspective did Nel Noddings (supported by Carol Gilligan's research) describe as the "feminine approach"?

5. What's a furor therapeuticus?

6. Does Campbell consider the outlawing of female genital mutilation culturally insensitive?

7. What's allegedly distinctive about "Asian bioethics"?

8. What western ethical preconception is "somewhat alien" in the eastern dharmic traditions?

9. What gives Buddhists and Hindus a "whole new perspective" on bioethical issues?

10. What does Campbell identify as a "tension in the Christian perspectives" on bioethics?

DQs:

  • How do you think your own attitudes and assumptions about gender, religion, etc. influence your Bioethical perspective?
  • What do Plato's Euthyphro and the Biblical story of Abraham & Isaac suggest to you about the place of religion in addressing biotethical issues? (61-2)
  • What is Buddhism's bioethical relevance? (69)
  • How should medical professionals treat and care for children whose parents object to medical intervention on religious grounds?
  • Is it best for caregivers to try and limit their personal knowledge of patients' particular perspectives, beliefs, identities (religious, political, cultural etc.) so as to avoid conscious or unconscious bias in treatment, or does this unduly sacrifice the humane dimension of medical practice?
  • Post your DQs

Bioethics today is about the ways our vision of issues and outcomes may be occluded, blurred, or otherwise compromised by our respective points of view or perspectives. Of course this is not unique to bioethics, all human comprehension is subject to bias by the attenuation of culture, gender, religion, ideology, experience, the absence of experience, greed, egoism, and on our list could go. It is in our nature to see what we've seen, to see what we want to see, to see through a glass darkly. Without corrected vision the people perish.

Our native tendency to frame experience incorrectly, conformable to our own pre-vision and hence occlusive of other ways of seeing and clinically intervening, is a constant challenge to the fair-minded ethicist. Bioethical philosophers across the perspectival spectrum presume to prescribe corrective frames, but inattention to the varieties of sight is a constant hazard. Here's a link to a good little essay on the subject, from esteemed bioethicist Arthur Caplan: "When Religion Trumps Medicine."

We should play with this metaphor. As a lifetime wearer of framed corrective lenses, I can attest to the temporary excitement of a new prescription, or even just a stylish new frame to house the old set of lenses. The trick is always to find frames that hold up through every season of wear, that don't grow tiresome, and that justify the expense of change. (My wife returned from Costco one day reporting that the same frames she'd found at the Eye Doc's were $100s cheaper there.) Sometimes new lenses in the old frame suffice, sometimes you just need a new look.

So, some of the perspectives we'll try to focus and reframe today: attitudes and assumptions around HIV/AIDS, especially as occluded by miseducation; violence as a public health issue; "feminist critiques" of contingently-drawn, historically-conditioned categories of masculinity and femininity, locked into patriarchal institutions and practices that discriminate against women; misogyny; marginalization; advocacy; embodiment; empowerment; relational autonomy; metaphysical dualism; care; furor therapeuticus; female genital mutilation; "Asian bioethics"; Plato's Euthyphro; Abraham & Isaac; Buddhism; and more.

How do you get that "new look"? I always like to suggest trying the John Rawls Original Position/Veil of Ignorance frames. Some of us can wear them.

One more indulgence, before discussion: the snarly TV doc Gregory House was suggested by a student last semester as a good example of how some practitioners seem driven less by the patient's best care than by their own egoism. But, getting the diagnosis and treatment right regardless of motive and ego still seems the most important thing. Doesn't it? Maybe you can find & share links to other YouTube moments illustrative of good and bad medical-ethical practice.

Also of interest:
HHS nominee skirts questions about impact of Drumpf’s executive order on ACA

President Drumpf’s choice for health secretary declined Tuesday to promise that no Americans would be worse off under Drumpf’s executive order to ease provisions of the Affordable Care Act — and distanced himself from the president’s claim to have an almost-
finished plan to replace the law.

At a testy Senate confirmation hearing on his nomination to lead the Department of Health and Human Services, Rep. Tom Price (R-Ga.) sought to play down the influence he would have on reshaping the health-care system along conservative lines, while attempting to deflect accusations from Democrats about his ethics.

He repeatedly flashed his long-standing distaste for federal insurance standards and other government strategies to guide medical care. And although he embraced certain policies popular within the GOP, such as special insurance pools for patients with preexisting medical conditions, he steered clear of other ideas he has supported, including the transformation of Medicaid from an entitlement program for lower-income people to a set of block grants to states.

By the time the hearing ended after four hours, the Senate Finance Committee’s partisan divisions appeared as bitter as they had at the beginning, with the Republicans aligned solidly behind the nominee despite sharp Democratic attacks on his investment and legislative practices.

Chairman Orrin G. Hatch (R-Utah) praised Price as a singularly qualified nominee and took broad swipes at Senate Democrats, saying they were tearing at the fabric of the chamber as an institution with their attempts to undercut Drumpf’s Cabinet ­choices.

The committee’s ranking Democrat, Sen. Ron Wyden (Ore.), countered that Price, if confirmed, would “take America back to the dark days when health care was for the healthy and the wealthy.” Focusing on the private investments in health-care companies that could have benefited from bills Price sponsored, Wyden said that “it is hard to see this as anything but a conflict of interest and an abuse of position.”

[Who is Tom Price?]

A fresh allegation Tuesday was that Price underreported to the committee and the Office of Government Ethics the value of shares he holds in an Australian company, Innate Immunotherapeutics. Price, who purchased some of that stock through a discounted, private offering, attributed the under­reporting to “a clerical error” and a misunderstanding of the question.

“The reality is that everything that I did was ethical, above­board, legal and transparent,” Price said — a message Republicans sought to reinforce throughout the hearing.


Democrats targeted most of their questioning on the direction that Price, if confirmed, would try to take the health-care system. Price demurred repeatedly.

For instance, he sidestepped a series of questions about the effects of the sweeping order Drumpf issued just hours after his ­swearing-in that directed agencies to lift or soften federal rules implementing aspects of the ACA. Price declined to commit that no one would be harmed, that no one would lose insurance coverage or that the regulations would be rewritten only after a plan exists to replace the 2010 health-care law.

He similarly deflected a question about whether the new administration would try to stop enforcement of the ACA’s individual insurance requirement prior to a replacement plan.

See how your coverage could be impacted by four prominent plans proposed by RepublicansVIEW GRAPHIC

“I commit to working with you,” Price finally told Wyden after reiterating that his goal is to ensure all Americans have an opportunity for access to health insurance. The ACA’s goal is universal coverage.

“We didn’t get an answer,” Wyden retorted.

Price also skirted questions by Sen. Sherrod Brown (D-Ohio) about Drumpf’s statements the weekend before his inauguration that the health-care plan he was completing would provide “insurance for everybody.”

Brown asked: “President Drumpf said he’s working with you on a replacement plan for the ACA, which is nearly finished and will be revealed after your confirmation. Is that true?”

Price replied: “It’s true that he said that, yes.”

The packed hearing room broke into laughter.

Brown persisted: “Did the president lie about this, that he’s not working with you?”

The nominee gave an oblique answer, saying, “I’ve had conversations with the president about health care.”

[HHS nominee’s mix of investments, donations, legislations keeps raising questions]

Tuesday’s hearing was the more significant of two appearances Price has made in the past week on Capitol Hill because the Finance Committee has jurisdiction to vote on his nomination. A date has not been set.

Democrats’ numerous attacks on Price in the past week prompted Sen. Johnny Isakson (R-Ga.), who officially introduced Price to his Finance Committee colleagues, to say, “I feel like I’ve been asked to be a character witness in a felony trial in the sentencing phase of a conviction.” WaPo
==
Faith-Based Decisions: Parents Who Refuse Appropriate Care for Their Children
Adam Lovell*, an active 2 ½ -year-old boy, was healthy until the day his parents took him to the local emergency department for vomiting and a suspected case of acute gastroenteritis. To the physicians, Adam appeared lethargic and was responsive only to painful stimulus. A blood culture was obtained, and other laboratory tests were performed. The blood culture later grew a meningococcus. Within hours "purple splotches" appeared on his face, legs, and trunk. Adam was diagnosed with meningococcemia and was started on appropriate antibiotics and steroids administered intravenously. Adam was intubated to stabilize his airway and transported to the County Memorial Hospital. On arrival, his perfusion was poor and blood pressure low. The tips of all his digits were dark blue; purpura (purple splotches) were present over most of his trunk, feet, and hands in a "stocking-glove" distribution. Intravenous fluid boluses and vasoactive drug infusions were administered. Adam's parents consented to multiple blood component therapy to treat a coagulopathy. Adam was also treated for respiratory failure related to meningococcal sepsis with both conventional and high frequency mechanical ventilation for the first 11 days of hospitalization.

At 10 days, Adam had well demarcated patches of dry, devitalized tissue (dry gangrene) on both of his feet, his left hand, and the fingers of his right hand. An eschar was present on the posterior surface of his right thigh. Ulcerated areas of skin were present in the perineal region. Consulting surgeons talked to his parents about the risks, benefits, and alternatives of amputation and debridement of portions of both of Adam's feet, his left hand, and the fingers of his right hand. The Lovells consented to the debridement and surgical treatment and signed the consent form. Shortly thereafter the family's minister came to the hospital and prayed with Adam's parents for God to restore life to the devitalized tissues. Soon afterward, the Lovells rescinded consent to surgical treatment and communicated that they wished to allow time to elapse so that God could heal Adam's dead and injured tissues. When the physician and the surgeon told Adam's parents that infection and sepsis would be inevitable without treatment, they agreed verbally that, in the event of sepsis, amputation should be performed.

Over the ensuing 2 ½ weeks, physicians met with the Lovells and vigorously attempted to persuade them to proceed with Adam's amputation and debridement of dead tissues. Mr. and Mrs. Lovell remained adamant that an expectant approach be maintained. During this time neither sepsis nor wet gangrene, which would have offered absolute indication for surgical intervention, occurred. Despite the best efforts of the family and staff, many hours elapsed where Adam remained quiet and alone in his bed. He would cry and appeared to be sad. At times he cried out "hand" while gazing at his outstretched and mummified hands. During visits, the Lovells read the Bible to Adam and assured him that God would direct his hands and feet to re-grow. The Lovells asserted to the staff that Jesus had arisen from the dead and shown himself to believers, and that God would revitalize Adam's dead tissues. Both family-associated and hospital-based clergy were regularly present to expand opportunities for mutual understanding of religious and medical issues. Adam's parents were repeatedly confronted with the ever-present and increasingly imminent reality that Adam needed amputations to prevent new onset of sepsis and to avoid possible death from sepsis.

After almost a month in the pediatric intensive care unit, Adam began to experience fevers and his white blood cell counts increased; both signs were indicative of developing infection. Therapy with topical and systemic antibiotics was continued and modified. His parents were informed of the changes and of the increasing need to consent to surgical therapy. In an effort to reinforce the inescapable need for surgical therapy, the physicians consulted with a burn surgeon at a neighboring institution by telemedicine. The surgeon confirmed that amputation was unavoidable. These communications were shared with the Lovells, who nevertheless, were not dissuaded from insisting upon further observation. Despite considerable effort to understand and support the parents by their own family members, by the medical staff, by social service, by psychology and by clergy (hospital and family), a clear impasse had been reached. The Division of Social Services (DSS) was engaged to evaluate the case for a possible claim of medical neglect against Adam's parents. With the possibility of the child's custody being assumed by DSS, the parents signed consent for amputation and debridement. The mother signed consent because "only death would take my baby from me." The family requested that a "hands-on" surgical evaluation be performed at another medical facility. This request was granted. Expedited transfer was made, surgical intervention was deemed necessary by the receiving surgeon and amputation and debridement followed within 2 days.
(continues)
==
Letting them die: parents refuse medical help for children in the name of Christ
The Followers of Christ is a religious sect that preaches faith healing in states such as Idaho, which offers a faith-based shield for felony crimes – despite alarming child mortality rates among these groups
Mariah Walton’s voice is quiet – her lungs have been wrecked by her illness, and her respirator doesn’t help. But her tone is resolute.

“Yes, I would like to see my parents prosecuted.”

Why?

“They deserve it.” She pauses. “And it might stop others.”

Mariah is 20 but she’s frail and permanently disabled. She has pulmonary hypertension and when she’s not bedridden, she has to carry an oxygen tank that allows her to breathe. At times, she has had screws in her bones to anchor her breathing device. She may soon have no option for a cure except a heart and lung transplant – an extremely risky procedure.

All this could have been prevented in her infancy by closing a small congenital hole in her heart. It could even have been successfully treated in later years, before irreversible damage was done. But Mariah’s parents were fundamentalist Mormons who went off the grid in northern Idaho in the 1990s and refused to take their children to doctors, believing that illnesses could be healed through faith and the power of prayer.

As she grew sicker and sicker, Mariah’s parents would pray over her and use alternative medicine. Until she finally left home two years ago, she did not have a social security number or a birth certificate.

Had they been in neighboring Oregon, her parents could have been booked for medical neglect. In Mariah’s case, as in scores of others of instances of preventible death among children in Idaho since the 1970s, laws exempt dogmatic faith healers from prosecution, and she and her sister recently took part in a panel discussion with lawmakers at the state capitol about the issue. Idaho is one of only six states that offer a faith-based shield for felony crimes such as manslaughter.

Some of those enjoying legal protection are fringe Mormon families like Mariah’s, many of whom live in the state’s north. But a large number of children have died in southern Idaho, near Boise, in families belonging to a reclusive, Pentecostal faith-healing sect called the Followers of Christ... (continues)

47 comments:

  1. Quiz Question:
    With a perspective on bioethics, what two reasons make Islam is so important?

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    Replies
    1. 1. it is the second largest and rapidly growing group of believers worldwide whose daily life is strongly influenced by their faith
      2. it insists that God's will is absolutely sovereign no matter how strange or difficult to understand and is needed to guide ethics

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  2. This is an article I discovered and I believe it really covers what chapter 3 focuses on with bioethics and how perspectives shape our ethics. This article is about abortion but that is not the aspect I would like to focus. The issue at hand in this article is gender based or ethnic based abortion. Gender based abortion is historically known due to the controversy that surrounds China. What do you think about the fact that now sex and raced based abortions are finding their way into the U.S. and what do you think about the ethics behind the professionals preforming the abortions based on these factors?

    http://www.lifenews.com/2015/12/15/naacp-loses-lawsuit-to-overturn-ban-on-abortions-targeting-black-unborn-babies/

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  3. Quiz Question: Many children were born with sever physical handicaps as a result of a sleeping pill in which scandal?

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  4. Why is it that women in 3rd world countries have less education about protecting themselves and have safer sex?

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  5. DQ: How do you think your own attitudes and assumptions about gender, religion, etc. influence your Bioethical perspective?

    Response: I personally feel that my attitudes and assumptions about gender, religion, etc. influence my Bioethical perspective (s) in way that allows me to think openly about various topics that may be vital to our society. Although my attitudes and assumptions may shift from time to time, I still feel that by keeping a non-biased view on these things, I am better able to learn more about the Bioethical perspective that I have.

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    Replies
    1. I belive that my raising and perspective on these subjects will help me relate to my patients and make them more comfortable. Hopefully, if I have patients one day, I can relate my similarities with them to gain their respect and trust. Thankfully I have a wide spectrum of knowledge and beliefs.

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  6. Quiz Question: Which 17th century philosopher is responsible for the birth of the "Dualism" philosophy?

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    Replies
    1. The French philosopher René Descartes is credited with creating "Dualism " and is also known as "the father of modern western philosophy."

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  7. This comment has been removed by the author.

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  8. Quiz Question: What term sums up "Asian Bioethics"?

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  9. Quiz Question:
    What Islamic tradition has great similarities to the Jewish tradition of "responsa"?

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  10. What do Plato's Euthyphro and the Biblical story of Abraham & Isaac suggest to you about the place of religion in addressing biotethical issues?

    So in my opinion and personal life, I believe that religion has a place in bioethics based upon Plato's second horn in Euthyphro that God's will is always synonymous with what is right. As health professionals and participants in the health care field in general, the very fact that we call ourselves "practitioners" of medicine shows and admits that that outside of knowing outcomes based on trial and error many things are out of our control. This is where religion or God comes in. "Rightness" in itself may be able to be achieved without God but in situations where rightness cannot be found by our finite ethical systems a greater knowledge source is needed. Therefore, listening to God's will only enhances our ability to act in an ethical manner especially in situations with factors that are out of our control or knowledge base. Drawing a parallel to Abraham and Issac, God's testing of Abraham's faith may not have initially seemed ethically sound, however as a result Abraham was assured of God's promise and Abraham's descendants (the Jews and Christians) can now share in that trust which proved God's test to be in line with "rightness".

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  11. Possible discussion topic:

    Do you believe it is important to address the "baggage" (assumptions made about ethnicities, religions, genders, etc) one brings when discussing ethics and ethical dilemmas? Do you believe all individuals should have their differences ignored to maintain an even playing field or should these differences be added into the conversation?

    Personally I believe that turning a blind eye to the differences in us does more harm than good. When discussing a matter, say race, it is important to recognize struggles that the race in question faces every day. For example, African American activists have been fighting for equality within the American societies for a LONG time and it is imperative to recognize this, but the solution to their struggles is not the statement "I don't see color." This statement discounts the entire race and treats a unique culture as unimportant. Not seeing race is discrediting years of struggle and the consequences that happened because of them (like social trauma, poor economic conditions with little help to rise from it, educational gaps, etc) These issues that certain groups still face today should be addressed and not ignored in conversations on ethics.

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    Replies
    1. I agree. The different elements of life (religion,gender,etc.) will always cause debate. But, in terms of the baggage, almost every human being thinks differently. Besides gender and race discrimination, we should allow everyone to believe and use their religious practices in their ethics. As long as well-being and assurance is obtained, there is no problem with it.

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  12. In response to the discussion about personal attitudes and their effect(s) on my personal bioethical perspectives, I would have to say that they definitely do "bleed" into how my perception on everyday issues are dealt with. I do, however, attempt to maintain a minimum level to which I allow my personal attitudes to interfere with matters that require a more clear-minded approach. Having said that, I feel as though an individual's bioethical perspectives should be less discriminatory when it comes to instances such as treatment in medicine or any other serious matters. Anyways, that's a little bit about how my personal attitudes and assumptions affect my bioethical perspective(s).

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  13. Here is a link to an interesting video with Carol Gilligan on "Resisting injustice: a feminist Ethics of care". What is your opinion on her views?
    https://www.youtube.com/watch?v=ahs0FNiNeos

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  14. Replies
    1. Marginalizing is regarding a group as being inferior and therefore not having a right to the same amount of liberty as everyone else.

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  15. http://www.eubios.info/ABC4/abc4232.htm

    This link leads to a brief article on familial communitarianism by Dr. Kam-por Yu in Hong Kong. It gives us a peek into the views on this term from a different perspective.

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  16. https://s-media-cache-ak0.pinimg.com/736x/71/37/30/71373009fe79d5f2f68351f0259adf3e.jpg

    An image outlining the levels and stages of the ethic of care. It's simple but rather profound and in the end is very similar to the hippocratic oath.

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  17. This is a short essay that highlights the marginalization of women in Sub-Saharan Africa. Is it culturally insensitive to try to end these horrible circumstances? No!

    http://www.du.edu/korbel/hrhw/researchdigest/africa/WomensRights.pdf

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  18. Quiz Question:
    How does Campbell think empowerment is achieved? What does it entail?

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  19. Quiz question: which ancient philosophy, originating in China, suggests that "morality is embeded in a way of life directed towards virtue and sustained by rituals or rites"?

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  20. Discussion Question:

    Do you believe that empowerment is achievable in today's society or is it only achievable in a society that resembles Utopia?

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  21. What is dharma in hinduism and buddhism?

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    Replies
    1. Dharma has two distinct meanings. The first is that Dharma means collective teachings of Buddha ("The teachings"). The second meaning translates into "the way things are.

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  22. On page 52, Campbell asserts, "it may be that women, who have strong reminders of their bodily existence through menstration, pregnancy, childbirth, and breast feeding, are less likely to be caught up in this dualist fallacy than are men." While this may be a contributing factor, I would also like to point out that the hyper-sexualization and objectification of our bodies would also act as a "strong reminder" of our "bodily existence."

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  23. Discussion Question

    What do you think of the "medical tourist hubs" in Asia and their effects on their local inhabitants? How would you propose to rectify the situation?

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  24. DQ:

    Do you believe that it is possible to wholly avoid causing harm to all forms of life in this current time period that we live in (21st Century) as proposed by the principle of ahimsa (pp. 65)?

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  25. discussion: Can religions be unified to enhance bioethical practices or will religion always divide people on the issue?

    Good article: http://www.thehastingscenter.org/BioethicsWire/Fellowship/Detail.aspx?id=6799

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  26. Quiz Question: Asian writers and politicians has seen the human rights movement as what form of imperialism?

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  27. Quiz Question:

    What does Campbell feel about apartheid?

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  28. Interesting viewpoint on how dying has changed.

    http://exopermaculture.com/2016/01/19/how-we-used-to-die-how-we-die-now/

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  29. http://childrenshealthcare.org/?page_id=24

    Here is a link about the laws regarding child endangerment, religious rights, and needed medical treatment

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  30. Phillip Shackelford, Nick Place, Darcy Tabotabo
    We further discussed the argument of saving a child's life although a parent does not consent due to religious beliefs. We concluded that the doctor should be proceed by law to save the child due to his obligations as a medical professional to preserve life.

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  31. Bell Doski, Kayleah Bradley, Shivan Berwari

    We discussed in depth about medical professional who recognize that they have implicit biases. We agreed that although one should not discriminate based on differences with patients, one should not pretend that these differences don't exist. Also we agreed that certain healthcare professionals shoudl not get closer to their patients whereas others can do that without emotional distress.

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  32. In Class Discussion: (Madison Toney, Shonda Clanton, & Dr. Oliver)

    We discussed the history and theories of modern day feminism and how extremists have really taken away from what we think it originally started as. We discussed the idea of needing to rename the group as something along the line of just general equality for all human beings. We also discussed some personal opinions about religion and how that it could contradict views of ethical decisions.

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  33. In class discussion: Sarah, heather, and Addison discussed how even though as medical professionals our goal is to help people, we can not go against a parents wishes. We can try to persuade, but we can't force.

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  34. This article is a bit extremist but has some good facts and statements about marginalization of women

    http://www.care2.com/causes/5-ways-women-are-still-marginalized-in-america-today.html

    Just copy and paste it because it will not hyperlink

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  35. A discussion question from the previous class:
    Do you believe that it is possible to wholly avoid causing harm to all forms of life in this current time period that we live in (21st Century) as proposed by the principle of ahimsa (pp. 65)

    I dont believe that it is ever possible, in contemporary or past times, to completely avoid all forms of harm to the world around you and with the lifeforms you interact with. Answering under the idea that "all forms of harm" include not only physical but also mental and emotional harm, it is virtually impossible, especially in a world so closely connected by instantaneous communication with a wide variety of culturally and personal mentalities, to not somehow injury someone because of one's words or own beliefs.

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  36. Discussion Questions
    1. Should our bodies be considered a prison or a temporary mechanism in which to navigate life?

    2.Do you think the idea of rebirth is possible? What do you think constitutes how you are reborn or what you are reborn as if you previously answered yes?

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