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 like 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?
What do you think of Thomson's violinist analogy (91-2)?
ReplyDeleteI think it perfectly establishes the point it set out to make: women who are involuntarily impregnated have the ethical right to and should face no stigma for deciding to terminate the pregnancy, regardless of the moral status of the fetus. We intuitively recognize that a person is not ethically required to stay hooked up to the violinist. It would be an act of kindness if a person were to stay hooked up to the violinist, but we do not recognize it as morally wrong to choose to unhook one's self from the violinist at the cost of his life. Likewise, a woman should have the right to abort an involuntary pregnancy, regardless whether the fetus is considered to be alive or not.
I agree, I think it gives a good perspective of what it is like to ask of a woman to sustain an fetus, especially an involuntary one. In the violinist analogy, the person isn’t forced to stay hooked up to the violinist and has the right to choose therefore why can’t women have to choice to? The person is already hooked to the violinist but they can unhook at any moment.
DeleteWhat concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
ReplyDeleteI believe the concept of individual autonomy is critical in the case of abortion. As David outlined in his comment above regarding the violinist analogy, "it would be an act of kindness to stay hooked up to the violinist." So too would it be an act of kindness to bring a fetus to term. Regarding legality it is challenging to decide a point at which a fetus has a "right to life." I think Aristotle's "quickening" at 40 days for men and 80 days for women is just a funny thing to note on this topic. However in all cases, especially involuntary pregnancies, the life of the mother and her individual autonomy holds precedence over the developing fetus in my mind.
Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
ReplyDeleteI think parenthood is defined by personal belief and is more of a social construct. If a person wants to have the five people involved in their conception as parents, that is valid. I think ultimately, the person should be the one to choose and define that and people should respect that. Legally, I’m not sure if all five can be legal guardians. But again, parenthood isn’t just who is your legal guardian or who is on the birth certificate.
What concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
ReplyDeleteI think personhood(?) and autonomy are both relevant concepts in evaluating abortion. I have been a believer of abortion should be allowed up to when the fetus is conscious. After that point, I think only pregnancies that put the life of the mother at risk or the fetus would not survive should be allowed an abortion. I do think at some point fetuses develop personhood before they are born but science shows that their consciousness develops at the third trimester of the pregnancy which is quite a late point. Most abortions due to social reasons happen before this point. However, I try to keep an open mind because there are many factors in this debate and science has trouble pinpointing an exact point of consciousness and just in general, what makes an organism “alive.”
Can you imagine ever facilitating a suicide, professionaly or personally?
ReplyDeleteLet me start by saying that I am 100% against suicide. I look at it as a giving up. One should fight to live no matter what. That being said, yes I can. After taking care of my grandfather as he died of dementia, I could see helping so one kill themselves to escape that hell.
Is there anything wrong with displaying cadavers in a museum exhibit (as in "Bodies: The Exhibition")? What guidelines should be followed?
ReplyDeleteIf consent was given beforehand, I wouldn't see any problems with this. The main thing that gives me pause in this is that I know cadavers aren't always treated as they asked to be. I remember an infamous example where a woman's son prohibited her body from being used in non-medical experiments, but she was used to test military explosives anyway (https://www.reuters.com/investigates/special-report/usa-bodybrokers-industry if anyone wants to check it out, very interesting read and also very infuriating). For something as public and exposing as museum display, I think the only cadavers that should be used are ones who volunteered specifically for this purpose. People who donate their bodies to science will probably assume that medical testing involves being dissected by a couple of med students, not being gawked at by thousands of people.
Another controversy I remember seeing about this is the use of pregnant women and the display of their fetuses. This is a tricky one to me. Logically, I suppose that this would be fine? I basically consider fetuses to be extensions of the parent rather than their own people until they're capable of surviving outside the womb. But something about it just rubs me the wrong way, and I can't put a finger on why. Would be very curious to hear some other thoughts on this issue, because I'm really having trouble deciding how to feel about it.
I agree with your take on allowing cadavers to be displayed as long as consent is given. In the case of fetuses being displayed, I think this is acceptable if the mother gives consent. The way I see it is that the mother has bodily autonomy and should be the one to make decisions about what happens to the fetus (which like you pointed out is at this point really just an extension of her) if she miscarries. Another thing to consider is that fetuses have no concept of any of this and likely would not have an opinion one way or the other. Obviously, they should be treated with dignity, but they lack the emotional depth of an adult human who wishes not to be displayed.
DeleteHow 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?
ReplyDeleteI personally go in with the mentality of I trust you until you give me a reason not to. I try to give people the benefit of the doubt when establishing new relationships. As a professionalist it's mandatory we trust each other and our patients. So I honestly think I would trust a clinical relationship more than a general relationship.
The idea of having 5 parents is very interesting to me, because in prehistoric times, human children were raised communally, and I wonder about what that kind of a society would look like. I wonder about the advantages and disadvantages of a society like that compared to one such as ours, with individual families of 4 to 5 exist in walled off houses, physically isolated from their neighbors and the broader community.
ReplyDeleteUnder what circumstances would you NOT violate confidentiality and inform a patient's partner that they were HIV positive?
ReplyDeleteInformation is confidential under HIPPA so under no circumstances would I violate confidentiality. I think I saw one time that the only time you would inform someone's partner is if you feel like they're actively being put at risk. But the only time confidential information would be shared is if permission is given.
I am not morally against suicide or assisted suicide as long as the assister is certain that the person suffering is of sound mind and that there is nothing that can be done to relieve this pain. I believe people who are seeking death should be talked to as people and need to be empathized with, so that the compulsion to kill oneself is understandable to us.
ReplyDeleteI think Dr. House (If he’s the one I’m thinking of from the show) would probably let patients figure out the hard way when it comes to not taking medical advice. He’s the type of person to let someone bend themselves to just before the breaking point and then offer help to make a point. I don’t think I would hire him due to his methods being considered outlandish.
ReplyDeleteI don’t think society has developed a healthy attitude towards mental illnesses and disorders. I feel like there are too many people who are afraid of their children having a diagnosis of a mental disorder as well as thinking they can use religion to fix it all. There are also too many people I feel that try to sensationalize disorders to the point of faking them, which is harmful to those who actually do suffer with them.
I could never imagine facilitating in an assisted suicide, considering I already know people that I’ve felt personally responsible for, whether they were just manipulating my good will or not.
3. The idea that the doctor always knows best is known as “medical paternalism”. The fact that the doctor/patient relationship can be compared to that of a paternal relationship is interesting. It is similar in many aspects, with the overwhelming amount of trust that patients put into their physicians, simply because “they would know the answer”
ReplyDelete5. Confidentiality is to be breached when there is a clear threat to a specific individual, such as when a direct connection is made between an individual with AIDS and their sexual partner. While it may be uncomfortable, the alternative in having an unknowing carrier of a disease is, in my opinion, a much worse option.
7. Organizations such as the WHO oppose organ trading as it harms the impoverished, as leaving the opportunity to live within the hands of the wealthy is a dangerous ethical dilemma.