Up@dawn 2.0

Friday, January 27, 2017

Quizzes Jan31 & Feb 2

Quiz Jan 31, BB 4 - Clinical Ethics

1. (T/F) Dignity, respect, and confidentiality are among the aspects of the clinical relationship which emphasize the importance of trust. 

2. What (according to most recognized oaths and conventions) must always be the deciding factor guiding professional decisions? 

3. The idea that the doctor always knows best is called what? 

4. Is a diagnosis of mental illness grounds for establishing a patient's lack of capacity to render competent consent to treatment? 

5. What general principle allows breach of confidentiality? 

6. What term expresses the central ethical concern about "designer babies"? What poet implicitly expressed it?

7. Why have organizations like the WHO opposed any form of organ trading?

8. Besides the Kantian objection, what other major ethical issue currently affects regenerative medicine?

9. What does palliative medicine help recover?

10. What would most of us consider an unwelcome consequence of not retaining the acts/omissions distinction with respect to our response to famine (for example)?

DQ


  • How do you generally go about establishing trust in a new relationship? Do such general considerations apply equally to the clinical relationship? How does "professionalism" relate to trust?
  • Considering the "demented professor" (81) and other instances of patients whose expressed "best interests" may conflict with a clinician's therapeutic impulses: how important is the patient's present happiness, in influencing your clinical evaluation?
  • What's wrong, if in fact the doctor does possess more accurate information and more relevant experience, with treating the patient after the analogy of parent and child?
  • What would Dr. House do about patients who make (in his opinion) foolish decisions regarding their care? Would you hire him to work in your hospital?
  • Under what circumstances would you NOT violate confidentiality and inform a patient's partner that they were HIV positive?
  • What concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
  • What do you think of Thomson's violinist analogy (91-2)?
  • Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
  • Should surrogacy, organ trafficking, and transplant tourism be regulated? How, and by whom? 
  • Do you think our society has a healthy attitude towards mental illness? Is it possible to declare a politically and ideologically neutral standard of sanity?
  • How would you counsel patients who insist they no longer value their "quality of life" and refuse potentially effective treatment and medication?  
  • Can the medical profession ever fully embrace the concept of ars moriendi, the art of dying?
  • Can you imagine ever facilitating a suicide, professionaly or personally?
  • Is there anything wrong with displaying cadavers in a museum exhibit (as in "Bodies: The Exhibition")? What guidelines should be followed?

==
Also of interest:

Drug Shortages Forcing Hard Decisions on Rationing Treatments...In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.

The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview...
==
Scientists create a part-human, part-pig embryo — raising the possibility of interspecies organ transplants
http://wapo.st/2k85Wt3

http://www.nytimes.com/2017/01/26/science/chimera-stemcells-organs.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
Human stem cells could be implanted in an early pig embryo, making a chimera with human organs suitable for transplant.

http://www.nytimes.com/2017/01/26/opinion/mr-trumps-gag-rule-will-harm-global-health.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
The president has greatly expanded a policy restricting federal aid to health organizations abroad that talk to women about abortion.

==
Quiz Feb 2, BB 5 - Research.  Happy Groundhog Day! (It still casts a shadow...)

Today in Bioethics we'll talk "research." Things like clinical trials and research involving animals and their rights, and genetics, and epidemiology. We'll look at the funding gap between what we need to cure and where our research dollars are actually going, and at the moral imperative of genuine and informed consent. We'll look at disturbing instances of fraudulent and dishonest research. And we'll consider Peter Singer's claims about "speciesism."


The future of research is a daunting source of apprehension and speculation. Michael Sandel and Bill McKibben have aired serious concerns about genetic and other "enhancement" research as potentially catastrophic for our capacity to achieve or even recognize "meaningful" lives. Enhanced may not mean improved.

1. Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.

2. What decree states that consent must be gained in all experimentation with human beings?

3. Name one of four areas of research discussed in the book.

4. Which famous contemporary philosopher coined the term speciesism?

5. Name one of four R's used in international legislation pertaining to animal rights in research?

6. Dilemmas in epidemiological research illiustrate what general point?

7. What did Hwang Woo-suk do?

8. What is the term for altering the numbers in a calculation to make the hypothesis more convincing, with no justification form the research findings for such members?

9. What categories of human enhancement does Campbell enumerate, and what does he identify as its "extreme end"?

10. What is the "10/90 Gap"?

DQ:

  • Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?
  • Discuss: "Trials of pharmaceuticals may be driven as much by commercial considerations as by the likelihood of real therapeutic gain." 122
  • What concerns do you have about the use of animals in medical research? Is speciesism one of them? 10 medical breakthroughs due to animal testing... PETA... Touring an animal research facility
  • What limits, if any, would you like to see imposed on genetic research and the uses to which it may be put?
  • Were ethical improprieties committed in the case of Henrietta Lacks, whose cells (HELA cells) were harvested without her consent? (Rebecca Skloot... BBC...CBS...)
  • If "dreams of perfect health by the better-off will determine the research agenda" in the future, resulting in soaring health care costs and greater health "enhancement" opportunities for the wealthy, what should be done to insure adequate attention to "the health problems of most of the world's population"? 129
  • Should we be worried about a "Prozac revolution" and a "brave new world" of somatically-induced apathetic bliss? 130
  • Would you give special priority to any of Campbell's five enhancement categories (130)? Is "Transcendence"-style enhancement beyond the realm of reasonable concern (given the considerable monied interest of people like Larry Page)? 
  • Comment: "Why would we want such a 'posthuman' future? Are our lives better if we become physically stronger or more agile, or have an increased intelligence, or live for centuries?" 131
  • Is the outsourcing of clinical drug trials to developing countries ethically defensible? 132
  • How would you propose making research priorities "aligned to the needs of the majority"? 133
  • Is it likely that biobanks and other communitarian initiatives will in the future "prioritize health research according to need rather than profit," particularly in the U.S.? Would you support such a reprioritizing? How?
  • Have you seen Sicko? Care to share a review? Or of Michael Moore's latest doc'y?
==
Also of note:

To enhance our SuperBowl experience-
The New York Times (@nytimes)
N.F.L. Great Ken Stabler Had Brain Disease C.T.E. nyti.ms/1R1vYYw
==
It's the birthday of the first woman to graduate from medical school, Elizabeth Blackwell, born on this day in Bristol, England, in 1821. She wanted to become a doctor because she knew that many women would rather discuss their health problems with another woman. She read medical texts and studied with doctors, but she was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in upstate New York accepted her. The faculty wasn't sure what to do with such a qualified candidate, and so they turned the decision over to the students. The male students voted unanimously to accept her. Her classmates and even professors considered many medical subjects too delicate for a woman, and didn't think she should be allowed to attend lectures on the reproductive system. But she graduated, became a doctor, and opened the New York Infirmary for Women and Children. WA Feb3
==
IACUC - Institutional Animal Care and Use Committee

The Institutional Animal Care and Use Committee (IACUC) is a regulatory body comprising MTSU faculty who are appointed by the University's President through the recommendations from the Institution's Faculty Senate. The IACUC is responsible for reviewing the activities that involve the use of animals to enforce humane & ethical practices to be adopted by the University employees. MTSU adopts the following minimum requirement for the Committee's constitution thereby complying with the requirements of both USDA and PHS...
==
Neil Gorsuch wrote the book on assisted suicide. Here’s what he said.

Not since 2006 has the Supreme Court taken up a case involving “death with dignity” legislation — the handful of state laws that allow people to end their lives with the help of a physician. That year, the court handed a victory to death with dignity advocates, ruling that the attorney general could not bar doctors in Oregon — the first state to pass such a law — from giving terminally ill patients drugs to facilitate suicide.

It was only the third time the court had heard a case challenging such statutes, and the six-member majority tread lightly, recognizing the sensitivity of the issue.

“Americans are engaged in an earnest and profound debate,” the majority wrote, quoting from a previous opinion, “about the morality, legality, and practicality of physician-assisted suicide.”

That debate is far from resolved today — and it’s one Neil Gorsuch, President Trump’s nominee to the high court, will surely be eager to weigh in on, should he win confirmation.

Gorsuch, a 49-year-old federal appeals court judge from Colorado, was tapped by Trump on Tuesday to replace Justice Antonin Scalia, who died last year after three decades on the Supreme Court. Aside from his bona fides as a lawyer and a jurist — which may all but guarantee a favorable vote in the Senate — Gorsuch has cultivated something of an expertise in assisted suicide and euthanasia in his legal career.

[Trump picks Colo. appeals court judge Neil Gorsuch for Supreme Court]

In 2006, the year he was nominated to the federal bench, he released a heavily researched book on the subject titled “The Future of Assisted Suicide and Euthanasia.” The front cover looks almost like a Tom Clancy novel, with purple all-caps block text set against a black background. But the book itself is a deep, highly cerebral overview of the ethical and legal debate surrounding the practices... (continues)
==



49 comments:

  1. This comment has been removed by the author.

    ReplyDelete
  2. 1) What is the difference between (normal) medical care and palliative care? 104

    2) What are the three types of consent? 83

    3) What type of cell is valued in regenerative medicine? 99

    4) What code was drawn up after World War II and states, "The health of my patient will be my first consideration"? 80

    5) How can you obtain stem cells? 99

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    Replies
    1. 2) informed consent, voluntary consent, competent consent

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  3. This is an article that I found that pertains to medical paternalism. The specific issue is about who is the rightful owner of your medical records: you are the doctor? I think it earns some well-deserved thought because I know I haven't ever really thought about it until now.

    http://blogs.aafp.org/cfr/freshperspectives/entry/doctor_or_patient_who_owns

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  4. Quiz Question:

    What is a Somatic Cell Nuclear Transfer also known as and what famous animal was a product of a similar procedure?

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  5. Quiz Question: What was the name of George Bernard Shaw's play concerning the medical relationship?

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  6. Replies
    1. you need to reply to my actual post man lol

      Delete
  7. Quiz Question: What 1967 event became the first of its kind within transplantation and regenerative medicine? And whom is responsible for this success?

    ReplyDelete
    Replies
    1. The first human-to-human heart transplantation was performed by Christian Barnard in 1967.

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  8. DQ: What would Dr. House do about patients who make (in his opinion) foolish decisions regarding their care? Would you hire him to work in your hospital?

    Dr. House does what he wants and therefore would find some sort of way to cheat the system or coerce/ deceive the patient into abiding by his wishes. Dr. House is a medical genius but i would never hire him. First of all, the only thing retaining House's job are the writers in Hollywood. Not only has House broken medical and professional protocol on multiple occasions he has also broken civil laws such as DUI's and sexual harassment so he would be a walking lawsuit waiting to happen. Then again, the embodiment of house in real life would still somehow make a way to weasel out of legal trouble so sure, why not hire him! lol

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  9. Quiz Question: Where does the term "Natural Law" find its origins

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  10. DQ: Can you imagine ever facilitating a suicide, professionally or personally?

    Answer: The idea of ever facilitating a patient’s suicide (whether professionally of personally) is one that I feel many physician’s and other health professionals deal with at some point in their career. Likewise, I struggle mentally when thinking ethically about these types of situations because of the magnitude of such a decision and the emotional and psychological trauma that can be associated with my choice. Personally, I do not like the idea of euthanasia, but I do understand that if I was a health provider, the most ethical thing to do would be to separate my personal decision from my professional one and do what is in the best interest for the patient. However, I do not feel that I could ever facilitate in a suicide and then live out the remainder of my life with a clear conscience.

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    Replies
    1. I personally believe that I would be able to facilitate a suicide if the circumstances were correct. I can see where some patients would have less pain, and it would be more humane. This is something that I would be able to do mentally as well, but I realize that there are not many people who fill this way. There would more than likely be a select group of professionals that would perform this process.

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    2. I could not facilitate a suicide under any circumstances. I understand there are situations where the patient or others may believe that PAS is the best option, but personally I would never carry out such a procedure. I would simply make the patient as comfortable as possible for the remainder of their life.

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    3. I think I could facilitate a suicide - if the patient was clear on their decision. I would prefer PAS over euthanasia, of course. I think that if someone is in too much physical and emotional pain to keep going and they want to die in a dignified manner with as little as pain possible, then I should help them with their wish. That being said, if I was actually in the situation, I think it would be a lot harder to decide and be confident in my position.

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  11. This comment has been removed by the author.

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  12. Below is a link to a quick post that I found regarding a mother who refused to share pertinent information with her doctors that may have brought on greater trouble to the health professionals as well:

    http://www.chinadaily.com.cn/china/2014-05/06/content_17488383.htm

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  13. Here is a good Ted Talk that takes neither side on abortion. Instead, it advises a "provoice" approach. Check it out:

    https://www.ted.com/talks/aspen_baker_a_better_way_to_talk_about_abortion?language=en

    Discussion Question: Do you have to take a side in the discussion of abortion?

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  14. Quiz Question:

    Which movement paved the way for "death with dignity" through the introduction of Palliative Medicine?

    (pp. 104)

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    Replies
    1. The Hospice Movement introduced Palliative Medicine by dealing with the pain, breathlessness, and nausea associated with death from terminal diseases and by creating care environments that allow the patient to spend more time with family.

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  15. DQ(#1)

    I would have to say that trust in a new relationship is usually built upon a foundation that is supported by actions (I.E: Doing things that are earning of trust); Whereas, a clinical relationship demands a type of trust in which the patient is willing to put aside their biases and believe that the professional is fully equipped and capable to address the situation that they are specialized in. As found among all professional titles, this relationship is not so much "proved" as it is "expected".

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  16. DQ

    Do you think a person is more likely to "give up hope" once they know they are likely to die soon? Would you be likely to give up?

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  17. QQ

    What is the "rule of thumb" regarding informed consent?

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    Replies
    1. The rule of thumb is that all risks which a 'reasonable person' would wish to know about should be described, but such risks which are significant for that person must be mentioned.

      Delete
  18. Quiz Question:
    What are the three aspects that qualify someone to have valid consent? Why is it more difficult to determine one of these due to the internet?

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  19. Here is a link that describes a situation that shows the transition from paternalistic medical care to patient-centered medical care.

    http://www.forbes.com/sites/carolynmcclanahan/2013/02/19/dinosaur-doctors-and-the-death-of-paternalistic-medicine/#30e8e6e1fd50

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  20. DQ: What's wrong, if in fact the doctor does possess more accurate information and more relevant experience, with treating the patient after the analogy of parent and child?

    I think it is the duty of a physician to oppose patients' ill-advised and non-evidence based views clearly (but with compassion) when these views might not be in the best interest of the patient, just as a parent does to a child. However, this paternalism is not necessary in matters that are not life threatening; in such cases, the patient's views must be considered with an open mind.

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  21. Quiz Question: What does the absolutist prohibition encourage?

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    Replies
    1. It encourages some women to risk death for an unborn child, even though there may be other children dependent on her.

      Delete
  22. Quiz Question: How does the reading describe that a baby can have "five parents"?

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  23. This might not have anything to do with what we are talking about currently but his a link to a article about a person who had a twin growing in his stomach.
    https://m.youtube.com/watch?feature=youtu.be&v=O4ZmM8C5ykk
    My question is could that be considered a type of paratisim?

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  24. Quiz Question: What 3 oaths/conventions help shape the deciding factor in professional decisions?

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  25. Quiz Question:
    What is the name of the technique used to produce designer babies?

    ReplyDelete
  26. Quiz Question:
    What does the VE approach say about deciding the best interest of the patient?

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  27. In the USA, what is the estimate of people who die per day while waiting for an organ transplant?

    ReplyDelete
  28. http://www.antiessays.com/free-essays/The-Commodification-Of-Babies-385325.html

    An essay on the commodification of designer babies by May Bismuth

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  29. A video on YouTube on whether or not there is a place for paternalistic doctors anymore.
    http://youtu.be/xtu6mQbfS-U

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  30. http://www.ncbi.nlm.nih.gov/m/pubmed/18315998/
    An article on informed consent, you'll need to click on a link there but it offers full citations as well.

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  31. Do you think our society has a healthy attitude towards mental illness? Is it possible to declare a politically and ideologically neutral standard of sanity?

    I feel that as of right now, society doesn't understand mental illness and the reality of it. If one hasn't experienced it, there's no real way to understand how debilitating some illnesses can be.
    Although sanity can't be precisely defined, there are clear outliers of those who are out of the usual. Sanity has a broad definition.

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  32. Where is the public outrage over needless suffering at the end of life?

    I feel like this is caused by people being self-centered. If your family member is close to death and is in extreme pain and is obviously suffering needlessly, it would seem logical to find a way to end the needless suffering, but most people would not be able to do that, because they have an emotional attachment to the person and do not want to lose the person before they have to, even if they are suffering.

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  33. Nick Strukov, Jesse Brandon, Zach Davis

    We talked about the idea of assisted suicide. We agree that people should have the right to end their own lives if they deem it necessary without legal persecution.

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  34. Darcy Tabotabo, Shivan Berwari, Kayleah Bradley:

    We talked about assisted suicide and the different factors that affect a decision to do so. These include their state of consciousness, state of mind, ultimate prognosis, and severity of discomfort of the patient. It is a difficult thing to decide but ultimately in the hands of the one suffering.

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  35. Sarah, Addison, and Heather
    Today we talked about assisted suicide and how we would support it in terminal cases

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  36. In Class Discussion: Shonda Clanton and Madison Toney

    We discussed The Body Exhibit and our own opinions about the display. I have seen the display and I personally like that it gives the opportunity for people to learn about the body in the most accurate visual way possible outside of medical school. Shonda also agreed in the fact that she would love to see it and the idea of the display. We know there are controversies about how the bodies were obtained and if the people new that that was what their bodies were going for but all in all it is for science and learning. If the one rumor about people killing for bodies for the exhibit is true I believe it is due to the fact that there are multiple stages of embryos that might have been obtained through abortion.

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  37. In response to the DQ "Is the outsourcing of clinical drug trials to developing countries ethically defensible?":
    Personally, this topic walks hand-in-hand with the concept of "organ donation tourism" that was discussed early in the text. I think Kant gets it right with these cases - to exploit the economically oppressed in the name of personal (in the case of organ transplants) or even public (clinical trials) benefit would be morally reprehensible.

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  38. For the question, "Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?", I believe that it's not possible to fully inform a test subject involved in an experiment due to their knowledge affecting the way they react to elements of the experiment. Placebos, for example.

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