- We wrap up our reading and discussion of Bioethics: The Basics with ch.6 on justice. The vaccination/immunization issue is raised here. Also see Eula Biss's On Immunity, below.*
- But first, on "enhancement": awhile back I saw a chilling fictional representation of how future mental/cognitive enhancements might lead to dystopia. It was episode three of the British series "Black Mirror," in which everyone is equipped with an implant called a "grain" - it's kind of a subcutaneous Google Glass, with instant access to one's entire archival memory (and with f/forward and rewind). The late David Carr on Black Mirror, MicroSoft's HoloLens, and our dwindling experience of "actual unencumbered reality"...
- And if that's not chilling enough, check out "The World of Tomorrow"...
- 1. What are the two major spheres of justice discussed by Campbell?
- 2. (T/F) Vaccination/immunization and restricted mobility are two of the measures used by preventive medicine to counter the spread of disease.
- 3. Another name for the micro-allocation of health care, concerned with prioritizing access to given treatments, is what? (HINT: This was hotly debated and widely misrepresented ("death panels" etc.) in the early months of the Obama administration.)
- 4. What "perverse incentive" to health care practitioners and institutions do reimbursement systems foster, as illustrated by excessive use of MRIs?
- 5. What is the inverse care law?
- 6. What is meant by the term "heartsink patients"?
- 7. How are Quality Adjusted Life Years (QALYs) supposed to address and solve the problem of who should receive (for instance) a transplant?
- 8. Who propounded a theory of justice that invokes a "veil of ignorance," and what are its two fundamental principles?
- 9. Under what accounts of health might we describe a sick or dying person as healthy?
- 10. Name two of the "capabilities" Martha Nussbaum proposes as necessary to ensure respect for human dignity?
DQ:
1. Do you agree that health care providers are ethically obliged to promote a fair balance between the rights of the individual and the welfare of society as a whole, and a fair distribution of benefits and burdens in society? Would you say that ethos is widely shared among physicians?
2. Reflecting on the present measles outbreak and the ebola quarantines of last summer, how would you rate the current strength and effectiveness of vaccination and restricted mobility as tools of preventive medicine? How might they be improved? Do you agree that most anti-vaccers lack a degree of social conscience?
3. Are you aware of examples of unjust "queue jumping"? 150 (Does the name Mickey Mantle ring a bell?)
- 4. Are there better alternative payment systems than reimbursement? Is it possible to reign in excessive tests and costs while retaining a reimbursement system?
- 5. How would you resolve the Lifeboat Scenario? 153f.
6. Do you agree that justice requires us to remove the social disadvantages caused by ill health and disability, and support a universal right to those health care interventions that will allow everyone to pursue their "normal opportunity range"? Would you be more or less likely to agree, if you found yourself behind the "veil"? 159
7. Are there any "attainable human capabilities" on Martha Nussbaum's normative list you'd not include on yours? 163
8. Elaborate on how bioethics overlaps with environmental ethics. 165
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Eula Biss, On Immunity: An Innoculation
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Eula Biss, On Immunity: An Innoculation
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Bioethics articles... transhumanism articles... Dying while black: Perpetual gaps exist in health care for African-Americans...
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Dr. Victor Sidel, Public Health Champion, Is Dead at 86
Dr. Victor Sidel, a leading public health specialist whose concerns ranged from alleviating the effects of poverty in the Bronx, where he worked for many years, to raising alarms about the potential impact of nuclear war, died on Jan. 30 in Greenwood Village, Colo. He was 86.His son Mark confirmed the death.
As a founding member of Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985, Dr. Sidel voiced his apprehensions about nuclear proliferation as a public health issue for more than 50 years. He served as president of the former organization and co-president of the latter.
In a paper in The New England Journal of Medicine in 1962, Dr. Sidel, Dr. H. Jack Geiger and Dr. Bernard Lown painted a grim picture of fatalities and injuries in the Boston area from a nuclear attack and posed ethical questions for surviving doctors.
“Does the physician seek shelter?” they asked, adding, “If the physician finds himself in an area high in radiation, does he leave the injured to secure his own safety?”
And in speeches beginning in the mid-1980s, Dr. Sidel (pronounced sy-DELL) used a metronome to stress what he described as the imbalance between worldwide spending on arms and health care. With the metronome set at one beat a second, Dr. Sidel explained that with every beat, a child died or was permanently disabled by a preventable illness, while $25,000 was spent on weaponry... (continues)
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Dr. Victor Sidel, Public Health Champion, Is Dead at 86
Dr. Victor Sidel, a leading public health specialist whose concerns ranged from alleviating the effects of poverty in the Bronx, where he worked for many years, to raising alarms about the potential impact of nuclear war, died on Jan. 30 in Greenwood Village, Colo. He was 86.His son Mark confirmed the death.
As a founding member of Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985, Dr. Sidel voiced his apprehensions about nuclear proliferation as a public health issue for more than 50 years. He served as president of the former organization and co-president of the latter.
In a paper in The New England Journal of Medicine in 1962, Dr. Sidel, Dr. H. Jack Geiger and Dr. Bernard Lown painted a grim picture of fatalities and injuries in the Boston area from a nuclear attack and posed ethical questions for surviving doctors.
“Does the physician seek shelter?” they asked, adding, “If the physician finds himself in an area high in radiation, does he leave the injured to secure his own safety?”
And in speeches beginning in the mid-1980s, Dr. Sidel (pronounced sy-DELL) used a metronome to stress what he described as the imbalance between worldwide spending on arms and health care. With the metronome set at one beat a second, Dr. Sidel explained that with every beat, a child died or was permanently disabled by a preventable illness, while $25,000 was spent on weaponry... (continues)
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 | Mother Jones (@MotherJones) |
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We are this close to "designer babies" mojo.ly/1W5QtTe pic.twitter.com/KTO0VDpNHl
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 | New Republic (@NewRepublic) |
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What’s wrong with Craig Venter? bit.ly/1UWRU65 pic.twitter.com/F3b8scr06N
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The USDA abruptly removes animal welfare information from its website
http://wapo.st/2kBZkTy
Measuring the wonders of an empathetic ear in the doctor’s office
http://wapo.st/2k4JHTO
Turning the Tide Against Cholera
Two centuries ago, a global pandemic rose from the swamps of Bangladesh. Now researchers there may have found the tools to stop it.
CreditJenn Ackerman for The New York Times
Trump’s Travel Ban, Aimed at Terrorists, Has Blocked Doctors
Across the United States, over 15,000 physicians are from the seven affected countries. Many work in small towns, poor urban neighborhoods and V.A. hospitals.
Trump’s F.D.A. Pick Could Undo Decades of Drug Safeguards
A top candidate to head the agency, Jim O’Neill, advocates “progressive” approval, in which drugs proved safe could be sold to consumers even if not yet proved effective.
Discussion Question:
ReplyDeleteIs the rise in medial schools that accept students that show interest working/living in poverty areas enough to show signs of better health in those areas? Example: ETSU likes to accept students from the Appalachian area in hopes of providing future care for that area.
I think only time and records comparing the periods of time before and after the people receive help will tell if there's an improvement or not. Even though a student may come from a challenged area, they may not want to work there because there's not good pay or its dangerous or they have other aspirations.
DeleteI don't think that there would be any correlation between a medical student's origin and the medical success of their home region. Most students are most likely leaving the Appalachian era to make a name for themselves, and going back to a small mountain town is not necessarily the best opportunity to do so. It seems more than likely that the students that leave home to go to school do not intend to move back.
DeleteHere is a link to Australia's grim reaper campaign
ReplyDeletehttps://m.youtube.com/watch?v=U219eUIZ7Qo
Well, that is one way to send a message. I don't believe that commercial would be permitted today. Especially, the baby being knocked away to the ground. I wonder how successful these ads were at influencing the spread of AIDS in that community after the release of these commercials. What were the feelings in response to the ad?
DeleteAttached is a link to an educational video that visually explains the ideas and provides examples of both distributive justice and social justice.
ReplyDeletehttp://study.com/academy/lesson/distributive-justice-definition-theory-principles-examples.html
Quiz question: What two fundamental principles of justice does John Rawls argue is rational to ensuring that society is fair to everyone? (pp. 158)
ReplyDeleteQuiz Question:
ReplyDeleteWho stated "all shall count as one and none as more than one"?
(pp. 156)
This article is an interesting find that deals with social justice. It is about the more prominent appearance of DNA testing and the discrimination that is starting to come along with it. I think that this will definitely begin testing our society and its boundaries of what is socially just when it comes to genetics.
ReplyDeletehttp://www.wired.com/2016/02/schools-kicked-boy-based-dna/
Discussion Question:
ReplyDeleteDo you think the aid of posting on social media websites (i.e. Facebook, Instagram, Twitter, etc.) to gain the attention of the public and celebrities to help with or pay for medical expenditures is socially just? Do you think it is considered "queue jumping"?
EX: Ellen DeGeneres was somehow able to use her influence and TV show to get a boy (who was denied for a heart transplant twice) a new heart.
The boy would make a strong argument that it is acceptable, but I believe the fact is that some people get help and some people die. It is a hard fact of life, and if someone has the influence to help another and does, then it was meant to be. Does that mean someone did not recieve a hear and died in his place? Who knows, but at least one life was saved. This seems to be a slippery slope with the answer to one question asking several more.
DeleteI don't think that accessing attention and sponsorship using social media is unacceptable, and if it is used specifically to fund a transplant then it is definitely not queue jumping. What's the difference between this and raising money in your local community? I remember a few years ago in Murfreesboro, a high school kid named Baylor Bramble got a debilitating brain injury playing football. The community rallied behind him, and raised money for his treatment and to support his family. Using social media seems like the same premise to me, just in a digital format.
DeleteDQ: How would you resolve the Lifeboat Scenario?
ReplyDeleteIf I were placed in the lifeboat scenario, I would first double-check to make sure that the amount of rations available could in fact ensure survival for a few people. I would then explain the situation to each of the members. Hopefully, the crew will understand the situation, and a few members may offer their rations to the primary rowers. Asides from those few steps, I would not change the lifeboat scenario too much as explained within the text. However, I might have designated a few rations to the woman with child in the case that another ship or plane notices our lifeboat and rescues the crew earlier than the anticipated 10 days. As depressing as this situation appears, I feel this is the way that I would handle the situation.
QQ:
ReplyDeleteWhat does Lennart Nordenfeldt refer to as a set of goals which are necessary and together sufficient for minimal happiness?
(pg. 159)
DQ: How would you resolve the Lifeboat Scenario?
ReplyDeleteDesperate times call for desperate measures. It takes about five days for people to die from dehydration. Since the food/water will last five people for four days, then there is twenty days worth of food/water.
If they were heading to civilization, I would divide the resources so that the two young men and the middle aged man got about seven days's worth of food/water each. If they were not heading to civilization, I would divide the resources so that the two young men and the young woman got about seven days's worth of food/water each. All of the outcomes are harsh.
Quiz Question: Describe the six people in the Lifeboat Scenario.
ReplyDeleteThis is an informative video that explains the contribution of John Rawls in defining justice and its components.
ReplyDeletehttps://www.youtube.com/watch?v=5-JQ17X6VNg
3. Are you aware of examples of unjust "queue jumping"? 150 (Does the name Mickey Mantle ring a bell?)
ReplyDeleteI'm not aware that it is seen very often, but I do hope that it doesn't occur at all. It reminds me of the movie 2012. This movie set up the apocalypse and (spoilers) at the end there were multiple ships that could withstand the end of the world. They were supposedly filled with people that would make the correct genetic makeup, but they were rather filled with the richest people in the world who funded the project. I just hope the world never gets to that point.
Quiz Question:
ReplyDeleteWho stated that 'Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.'
What is: the U.N. Declaration of human rights
DeleteDQ: Are you aware of examples of unjust "queue jumping"? (Does the name Mickey Mantle ring a bell?)
ReplyDeleteAnswer: I am aware of the concept of unjust "queue jumping. However, the name, Mickey Mantle does not ring a bell. I do not find it fair that a patient can take priority over another patient next in line for a transplant due to the fact that the former can afford it sooner. This idea may be fair for patients that can afford it right away, but this is not the case for patients that come next in line.
This is an article about Steve Jobs and his organ transplant. Apparently, Steve Jobs lived in Northern California. He received an organ transplant in four months, because the waiting list in Tennessee was shorter than that in California.
ReplyDeletehttp://www.cnn.com/2009/HEALTH/06/24/liver.transplant.priority.lists/index.html?iref=24hours
Quiz question: What method of preventive medicine should be used optionally due to inaccuracy?
ReplyDeleteWhere does the U.S rank among other countries in life expectancy? pg145
ReplyDelete26th place of 36 candidates.
Delete1. Do you agree that health care providers are ethically obliged to promote a fair balance between the rights of the individual and the welfare of society as a whole, and a fair distribution of benefits and burdens in society? Would you say that ethos is widely shared among physicians?
ReplyDeleteIt must be a cooperative effort amongst us all. Instead of encouraging the competitive nature which ensures we exploit the weak and ignore the unintelligent, health care providers, branches of government, charities, and individuals belonging to both categories have a moral imperative to make a health a priority.
Darcy Tabotabo, Lee Gish, Phillip Shackelford
ReplyDeleteTalk and discussed immunization.
Alternative questions:
ReplyDelete1. What is the difference between equitable treatment and equal treatment? (143)
2. Who is the highest spender on health care across the world? (145)
3. What is another name for the inverse care law? (148)
4. Name two possible principles for how to allocate fairly. (155)
5. Who said "all shall count as one and none as more than one?" (156)
6. What three areas does WHO urge action in all the countries with poor health outcomes? (161)
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ReplyDelete1. What is an extreme example of health promotion used in the People's Republic of China?
ReplyDelete2. What is the term used for people in deprived areas with multiple problems?
3. What calculation is used to solve dilemmas such as "who gets the kidney"?
This comment has been removed by the author.
ReplyDeleteAlternative Quiz Questions
ReplyDelete1. What is the paradox of healthcare?
2.In your own words, what is the definition of macro level?
3. What is an example of the micro level?
4. What is "the most powerful causal factor in ill health?"
5. According to Rawls justices only requires what?
2. Reflecting on the present measles outbreak and the ebola quarantines of last summer, how would you rate the current strength and effectiveness of vaccination and restricted mobility as tools of preventive medicine? How might they be improved? Do you agree that most anti-vaccers lack a degree of social conscience?
ReplyDeleteI would rate the effectiveness of vaccines as high. These preventative measures have stamped out illnesses that once wrought havoc on generations of the past. I think so called anti-vaccers are ill informed, and maybe lack the intellectual capacity to conduct qualitative research on reputable sources.
A "chiropractor" saying he's a doctor (I mean...sorry guys, lezbe honest y'all, thats not a real doctor persay). Anyways, these are the types that anti-vaccers get their information from, and it's sad that the word of a chiropracter is taken over the word of a virologist who's studied viruses for a lifetime.
Alternate Quiz Questions:
ReplyDelete1.) What was the name of the physician that established Cholera was spread by contaminated drinking water?
2.) What term describes the reduction of diseases in whole communities?
3.) What system describes 1 year of remaining life being "full quality" and 0 being "no quality"?
1. John Snow
Delete2. Herd Immunity
3. Quality Adjusted Life Years
Alternate Quiz Questions:
ReplyDelete1. What was the true cause to the “bad air” or “noxious miasma” in London in the 19th Century?
2. How does “herd immunity” reduce the spread of infectious diseases?
3. At the macro-level, what is the name of how much of a country’s total financial resource devoted to health compared to other areas called?
4. What was the major dilemma in the village pub story?
5. Recite the “Serenity Prayer” of Alcoholics Anonymous.
Alternative Quiz Questions:
ReplyDelete1. What was the topic presented by Kimberly E., Kyle J., and Vincent L. ?
2. What is the capability approach?
3.To achieve good outcomes in health and life expectancy, government must do what?
4. What is "social justice"?
Alternate Quiz Questions
ReplyDelete1. What are the 4 spheres of justice and define them.
2. Describe how vaccinations work. Does this ensure absolute immunity?
3. What are the three levels of allocating healthcare resources?
4. What 2 principles does Campbell propose to allocate healthcare fairly?
5. Describe the Maximin Principle.
Alternative questions:
ReplyDelete1. What are two principles for just health care?
2. What is noxious miasma?
3. What is the "meso" level of health care?
4. Where does the majority of medical spending go in most countries?
5. What are the three areas of daily life where poor countries need to work on?
General Discussion Questions:
ReplyDeleteShould we put laws in place that require vaccinations/immunizations to help protect people from preventable diseases?
How far is to far in genetic testing/recombination therapies in embryos?
Material of bioethical concern:
https://www.bioedge.org/bioethics/france-opens-national-bioethics-debate/12570
http://www.standardnewswire.com/news/1354513540.html
http://medicalfuturist.com/bioethical-issues/
https://mobile.nytimes.com/2018/02/12/business/computer-science-ethics-courses.html?referer=https://www.google.com/
I am not against vaccinations, but I would like to play the devil's advocate for this discussion post. If the government passed a law that required everyone to be vaccinated, what would be expected if there was an adverse health outcome? Would the government be responsible for paying for the care of that individual as a result or the financial cost if by chance the person died? In either of these scenarios, there would be an outcry that the government is removing choice, required something that led to the harm of an individual and add to further skepticism about the dangers of vaccinations. When people are highly educated and then provided a choice, I believe that when adverse outcomes occur on a small scale, there is less of backlash when a single isolated adverse outcome occurs.
DeleteWeighing the risk of vaccinations (pro-vaccination):
https://www.youtube.com/watch?v=NaGndICPT8I
Vaccine resistance in California:
https://www.youtube.com/watch?v=qO5QOIIL_ZE
DQ: Is a healthy diet a way to prevent disease infection and a substitute for vaccination? If so, how much of the population has a healthy enough diet to use this as a substitution? What constitutes a "healthy diet"?
DeleteI don't think requiring national vaccines is ethical. I believe that it would be a great idea, and that mandated vaccinations would be good for the collective population, but I don't think it is our government's place to require us to take certain medicines. While vaccines are definitely helpful, I think making vaccines a federal requirement would be a very slippery slope towards a drugged up dystopia.
Delete1. What does herd immunity mean?
ReplyDelete2. Define QALY's.
3. What is the Liberty Principle?
1. Widespread vaccination reducing the prevalence of disease in whole populations which reduces infection in individuals who are not immunized.
Delete2. Quality Adjusted Life Years which is a calculation of the number of life years to be gained by the intervention multiplied by the fraction of quality of those years.
3. Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all.
Alt quiz questions!
ReplyDelete1. Name and describe a disease of affluence.
2. Regarding equality, Aristotle said...?
3. Explain the paradox of healthcare.
4.what was the WHO's initial "idealistic" conception of health?
5. The most powerful causal factor in ill health is?
6. According to this chapter, when is it beneficial to allow the death of a child?
7. Who said something along the lines of, "we need the resistance of facts to make our theories work"?
8. What Alastair Campbell book is shamelessly promoted in this chapter ;)?
9. What Royal Society report was mentioned in this chapter and what ethical dilemma does it reference?
10. Name the Australian governments advertising campaign mentioned in this chapter.
Reference numbers
Delete1. 151
2. 150
3. 131
4. 150
5. 153
6. 161
7. 171
8. 171
9. 172
10. 148
DQ 7.
ReplyDeleteAre there any "attainable human capabilities" on Martha Nussbaum's normative list you'd not include on yours? 163
I would not include number which states, "being able to use the senses..."
She does include imagination and thinking, which I think is both attainable and normative. I do not think using the term "normative" in conjunction with "senses" though, is well thought out. People are able to live full and happy lives lacking one "sense" or another. Having the ability to hear, see, or etc, or having a lack thereof, does not inable one to lead a fulfilled happy life. Also, having a lack of the aforementioned is admitably undesireable, but shouldn't be seen as abnormal. As in the case we covered of the deaf family and genetic engineering, it is not always clear whether having a certain ability is optimal.
Alternative quiz questions:
ReplyDelete1. What was the popular theory in London to explain the spread of cholera?
2. What sphere of justice pertains to ensuring fairness and impartiality in defining and dealing with crimes and punishing offenders?
3. Define Herd Immunity.
4. What are some examples of non-coercive methods of persuading individuals to pursue healthier lifestyles?
5. What is the difference between equal and "equitable" treatment?
6. What is the goal of the bill names "The Paradox of health care"?
7. What percent of GDP spent on health care in America according to Campbell?
8.In the "Village at the Cliff's edge" dilemma, what were the two solutions provided?
Extra Quiz Questions:
ReplyDelete1. What are the two 'diseases of affluence' that Campbell mentions?
2.Qhat is the more complex problem in health care intervention?
3.What is the problem at the 'micro' level?
4.What are some possible principles to be used to allocate hwalthcare fairly?
5. What does the alternative, deontological theory see?
6.What is John Rawls Maximin Principle?
7.What are some statistics on health inequalities that paint a grim picture?
8.What 3 areas does the WHO's report urge action to be taken in?
9.What is the most significant of all bioethical issues that we have to confront at the present?
1. Diabetes and heart disease
Delete2. How we make fair comparisons between one group of patients and another, whose needs may be different.
3. Who is to receive treatment when there are not enough resources for everyone.
Great to see these alternate quiz questions. Let's go over them in class, along with the main quiz. It might be helpful if you'd all include parenthetical page references, to expedite our review.
ReplyDeleteRegarding queue jumping I don't know much about Mickey Mantle other than he played baseball. However, it's not difficult to imagine certain individuals being able to buy a spot on the waiting list for urgent care patients. Cinematically I remember a movie, John Q, starring Denzel Washington where a man essentially holds an emergency room hostage for his son to receive a heart transplant. I wouldn't justify either of these but they are extremes of a conceptual reality.
ReplyDeleteAlternative quiz questions:
ReplyDelete1)What are the two field that help promote public health as well as discuss ethical aspects of the medical field? (pg. 145)
2)What are some concerns with screening? (pg. 146)
3)What are 'free-riders'? (pg 147)
4)How does Aristotle describe the idea of unequal fairness? (pg 150)
5)What is the WHO definition of health and how does it relate to Nordenfeldt's vital goals? (pgs. 150/166)
6)Why is queue jumping problematic? (pg.157)
7)What are some of the principles for just health care? (pg.162)
8)Regarding to the previous question what are the two principles we continue to look back on, in connection with theories we saw in chapter 2? (pg. 163)
9)The Liberty and Difference principle follow what order? What does that implicate? (pg.165)
10) What does the CH theory argue? (pg. 169)
1. Preventative Medicine and Health Promotion
Delete2. Accuracy of test and the occurrence of false negatives or positives
3. Parents who refuse to get their children vaccinated but rely on most parents agreeing so their child will be protected by herd immunity
4. We should treat equals equally and unequals unequally. Equitable treatment rather than equal treatment.
1. What resourced did Campbell mention if your are interested in the "health rationing debate"? (174)
ReplyDelete2. What issue does Campbell mention where Bioethics and Environmental ethics overlap? (171)
3. Who is the author of Health Justice? (168)
4. The ______ does not have the power to make governments and international and financial institutions change the policies that are causing such massive health problems for the majority of the world's population. (168)
5. There are ______ deaths per thousand births in Swaziland compared to _____ in Sweden. (167)
6. What did Norman Daniels claim? (165)
7. Why did Campbell mention The Theory of Justice? (164)
DQ1:
ReplyDeleteI think that it is absolutely the obligation of health care providers and professionals to care for both their individual patients, and the society as a whole. That being said, it has been statistically proven that there is not a fair distribution of benefits and burdens in society, specifically in the field of medicine. In addition, I believe that it is a handful of powerful doctors and physicians that perpetuate this behavior for the sole purpose of fattening their pockets. Outside of the excessively powerful, however, I feel like the call to care for both the specific and general is answered by most caretakers, but too much of it is out of their hands for them to have any significant impact.
DQ2:
I don’t think the proper way to value the effectiveness of vaccines is to look at what they have failed to prevent, but instead what diseases are no longer a problem. Vaccinations have been successful in mitigating and eliminating countless diseases; a lack of vaccines may instead be the reason of such outbreaks. In addition, the anti-vax movement has most likely brought some of these issues about, which is a senseless motive in my opinion. Those people absolutely are looking at their own benefit (which is delusional in the first place) and blatantly disregard the repercussions of their actions on their local population.