Clinical Ethics (Basics 4); Premonition 4
Basics
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)?
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)?
Premonition
1. What's the "real waste" in government?
2. What misdirected pandemic narrative did Bob Glass think Homeland Security got "wrapped up" in?
3. What hit Richard Hatchett light a lightning bolt or thunderclap?
4. What was the biggest difference between Expert and computer models of disease?
5. What in Rajeev's mind made Hatchett a "philosopher type"?
6. There's no better system for transmitting disease than what?
7. Who is least capable of original thought?
8. Why was the 1918 St. Louis death rate half of Philadelphia's?
9. What was the moment when the CDC accepted social distancing as a viable tool in a pandemic?
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?
Can you imagine ever facilitating a suicide, professionally or personally?
ReplyDeleteI feel like I could imagine facilitating both, depending on the situation. Just extending a persons life for the sake of them living longer seems like a disservice to that person. If it is clear (and it probably isn't always) that the person is competent, fully informed, and terminally ill (e.g. will die within a few months), I don't think that stopping their suffering would be unethical. If we think that it is unethical to cause suffering, then isn't it also unethical not to stop it? This goes back to the action of inaction. On the other hand, I can also think of a variety of situations where it would be unethical to perform a physician-assisted suicide (e.g. patient is incompetent, pressured due to monetary reasons or family, etc.). I do think there must be a distinction between suicidal thoughts and actions of a person who has a mental illness.
In terms of myself, I suppose there could be a set of circumstances where I wouldn’t want to continue my life. I think that quality over quantity of life is in many ways an individual experience. I don’t know if it’s fair to judge people in these decisions when it’s difficult if not impossible to fully grasp their experience.
I really like the question you asked about it also being unethical to not stop suffering. I think it's an important distinction to make, where does the line between causing suffering and allowing suffering lie? Is there even a difference between the two? Definitely some things to think about for those people looking for careers in healthcare, especially as the reality of this kind of situation becomes more and more likely.
DeleteTo gain trust within a relationship it usually involves being vulnerable with another individual. This can be difficult when thinking of a patient doctor relationship where professionalism would dictate vulnerability would be over the line. This often times leads to a master servant dichotomy between the patient and doctor. The doctor dictates and the patient listens, end of story. This is not how medicine should be practeiced, often times this form of dichotomy forces the patient to blindly trust the doctor, instead of taking a vested interest with his or her own health. That is why a physcian needs to walk a fine line, between a friendly caring relationship that builds trust, and a professional demeanor and attitude that relays confidence so the patient knows they will be well taken care of.
ReplyDeleteI see nothing wrong with displaying cadavars within the right environment. They are a helpful tool in understanding human anatomy and can be used to help foster a healthy respect for death. Great care should be given to the bodies to ensure they are not disrespected while still being used in a scientific and beneficial way.
ReplyDeleteThe simple guidelines should follow: respect the body, take special care of it so it won't needlessly decay before entombment, if it needs to be sliced open to show different anatomical pieces do so in a way that effectively shows the anatomy without being needlessly grutesque. Everything else can be handle by the judgement of the individual curating the museum.
I think you have a good argument for why cadavers should be displayed in a proper environment. Without being able to understand our human anatomy by looking inside our body, we wouldn't be where we are right now with being able to increase our life span with methods such as organ transplants.
DeleteRegarding instances similar to the demented professor:
ReplyDeleteWhile I fully support assisted suicide for presently consenting patients, I'm certainly less supporting of preemptive consent under certain circumstances. I'd argue the only person with the right to request cessation of life functions is the patient *at the moment of request.* Conditions of mental deterioration are often treated as an exception, but should they be? Temporarily removing the condition, or even the medical aspect helps show my point. I'll also admit, my reasoning may reek of phenomenology and dualism, to an extent.
At age 20 you tell someone "If I'm ever homeless, I'd want you to end my life." What if, at age 30, you fall on hard times and are left without a home. Your old friend shows up, ready to assist in a suicide you asked for a decade prior, regardless of the experience you're having at the moment. Are you sure you'd still want it, or would you opt out of the request? Well, I'd hope your current request would be the one respected.
I've purposely used an example far removed from the dementia example. We have a view of the professionalism surrounding euthanasia (and professional it should be). But it's still the end of a life, and the only person with the right to execute that is the present owner of said life.
A single exception exists to my knowledge, and that would be if consciousness has ceased, presumably permanently. Without a hope for consciousness, there is no present-self, thus allowing for a previous self to become the authority on the matter.
3. The idea that the doctor always knows best is called what?
ReplyDeleteThis idea is termed as "medical paternalism," where the doctor assumes a sort of parental role for a patient and makes decisions for them. However, it should be noted that the patient should be able to make their own decisions about their treatment, as it is their life.
5. What general principle allows breach of confidentiality?
ReplyDeleteThe text states that confidentiality should only be breached when there is a clear threat to a specific individual. In cases such as infectious disease or an STI such as AIDS, confidentiality can be breached because the health of others has been compromised.
6. What term expresses the central ethical concern about "designer babies"? What poet implicitly expressed it?
ReplyDeleteThe term that expresses the central concern about designer babies is "commodification," which refers to a designer baby being treated as a possession of the parents rather than being valued as a person. The child will be expected to live up to the standards of the parents.
The poet Kahlil Gibran talks about the development of a child's identity as something that is their own. The child is not owned by their parents.
Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
ReplyDeleteI've always though that your parents were those who contributed to raising and nurturing you. I definitely think a child could have 5 parents. In today's time families look so different. It's not just the traditional mom and dad anymore. Children have the opportunity to have multiple parental roles in their lives and I think it just adds character. I was technically raised by 4 people and I think it's the reason that I'm so comfortable with leaning and seeing perspectives within life.
Good point, parenting is more about care and nurture than about being a progenitor. "It takes a village..."
Delete5) Rajeev thought that Hatchett was a "philosopher type" because he was good at putting things into a bigger context.
ReplyDelete1. True, page 83,84
ReplyDelete2. Best interests of the patient
4. lack of capacity should never be assumed simply on the basis of a medical diagnosis (page 84)
7. Organ trafficking and transplant tourism violate the principles of equity, justice and respect for human dignity and should be prohibited. (page 98)
8. the fact that it destroys a 3-5 year old embryo, and turning hope into hype
9. Thus, palliative medicine helps people to recover what has been called the ‘art of dying’ (ars moriendi), and it has encouraged both patients and health professionals to see terminal illness not as a defeat but as an opportunity to bring a life to a satisfactory ending. (page 105)
10.decisions not to treat or to discontinue treatment are taken only because to treat would impose a burden on the patient and will bring no lasting benefit, then the action is morally permissible (page 107,108)