Quiz Jan.29

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 the quiz: I enjoyed our impromptu discussion of House last time. Maybe some of us can find a few good YouTube moments, illustrative of what we were saying about 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?

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 (BB 48)

2. What's the leading global cause of death among women of reproductive age? (49)

3. (T/F) The "feminist critique" says bioethics has been dominated by culturally masculine thinking. (50)

4. What ethical perspective did Nel Noddings (supported by Carol Gilligan's research) describe as the "feminine approach"? (55)

5. What's a furor therapeuticus? (56)

6. Does Campbell consider the outlawing of female genital mutilation culturally insensitive? (58)

BONUS QUESTIONS:

What role do feminist bioethicists see themselves as performing, with respect to the victims of gender discrimination? What perspective do they wish to "re-assert"? and what classic (Cartesian) metaphysical/philosophical perspective do they oppose? (51-2)

What's allegedly distinctive about "Asian bioethics"? (59)


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)

BB chapter 3 quiz questions and discussion questions

Quiz questions
1. What is the "heart" of bioethics? (P.50)
2.What is one of the key concepts in the feminist bioethics literature?(p.51)
3. The WHO reported that women's natural advantages in health and longevity have been eroded by___________and_____________ polices. (P.51)
4.What does  ethnical relativism mean? (P. 57)
5.What are the five major religion discussed in the
Chapter? (63)
6. What religion is the most influential in the development of modern culture? (P. 73)

Discussion Questions?
1.How does religion and culture influence bioethics?  Is it a positive or negative influence?
2. How important is the feminist approach to bioethics?

Group 2 discussion 1/27

Similar to group 3, our group discussed what would we do in the mayor's situation. About half of the group talked about killing the two guerillas IF it was definite that the colonel would not kill the eighty people. We thought that Fox news would be the first to announce the murders that the mayor committed because he is a political figure. Also, killing the guerillas wouldn't really set the eighty people free. They would be enslaved for life. This is where the other half of the group came in. We thought that there isn't any certainty in whether or not the colonel would do what he said. A better thought to the other half was to take an act of defiance against the colonel. Dying trying to protect the people is better than letting them get enslaved. Basically, pull a super hero maneuver or in more humane terms, possibly pull what Denzel Washington did when he starred in the recent movie The Equalizer. If the mayor could pull killing the colonel and his army, he would be a hero to his people, and he will have shown that their lives mean a lot to them. Even if he were to die trying, he would still show the people in his town that he cared for them. The people would most likely be enslaved and if they are, after witnessing the mayor's example of defiance, they would have the courage to plan their own act of defiance against the colonel and their men. It would then be similar in context to the history of the American Revolution or the Haitian Revolution.

Group 3 Discussion 1/27

Our group focused on the mayor's dilemma, and what each group member would do when presented with the choice of death or murder.  Many said that they would attempt to kill the colonel with the weapon.  One person said that they would kill a citizen to try to confuse the soldiers.  The discussion then turned to why a gun was chosen and how the soldiers should have allowed the use of a sword, or pistol, or bat, or some other weapon.  Class ended amidst this very interesting discussion.

How would you react to this dilemma?
Is there a universally "right" course of action?

Today’s Quiz

1. (BB 20) Jeremy Bentham devised the:
A. George Town Mantra
B. Greatest Happiness Principle
C. Deontological Theory

2. (BB 26) What is the Golden Rule?
A: Do to others what you would want them to do to you.

3. (BB 32) What is Aristotle’s contribution to ethics called?
A. Virtue Ethics

4. (BB24) A reaction of distaste based solely on emotion and unexamined prejudice is the Yuk Factor

5. (BB 25) What are Immanuel Kant’s 2 imperatives?
A: Hypothetical and Categorical

6. (BB 43) True or false: the four Bioethics principles are Autonomy, Maleficence, Beneficence, and Justice.
A: False (Non-Maleficence)

Class quiz questions 01/27/2014

1. Jeremy Bentham devised the (BB 20):
a. Georgetown Mantra
b. Greatest Happiness Principle
c. Deontological Theory

2. What is the Golden Rule? (BB26)

3. What is Aristotle's contribution to virtue ethics? (BB 32)

4. A reaction of distaste or disapproval base solely on emotion and unexamined prejudice is? (BB 24)

5. Immanuel Kant had two imperatives. What are they? (BB 25-26)

6. True or False. The Four Bioethics principles are Autonomy, Maleficence, Beneficence, and Justice. (BB 43-46)

Quiz Jan.27

BB2-

1. (T/F) In the Mayor's Dilemma, one of the possible actions considered is to set an example of defiance.

2. Which theory has been dominant in bioethics and often used by many health professionals?

3. In deontological theory, what is the difference between hypothetical and categorical imperatives?

4. What ethical principle (and whose), in the name of rational consistency, absolute dutifulness, and mutual respect, "requires unconditional obedience and overrides our preferences and desires" with respect to things like lying, for example?

5.  What would Kant say about Tuskegee, or about the murderer "at our door"?

6. What more do we want from a moral theory than Kant gives us?

7. What is the distinctive question in virtue ethics?

8. What Greek philosopher was one of the earliest exponents of virtue ethics?

9. Paraphrase the Harm Principle. Who was its author?

10. Name one of the Four Principles in Beauchamp and Childress's theories on biomedical ethics?


DQs:

BB Chapter 2 Discussion and Fact Questions

Fact Questions

1. What is consequentialism?

2. What is the best form of consequentialism?

3. What does the Greatest Happiness Principle say? Who made it?

4. The _________ of _________ is also a feature of all medicine and health.

5. What are the problems with consequentialism?

6. What is the deontological theory?

7. Immanuel Kant had two imperatives. What are they?

8. What is virtue ethics?

9. What is communitarianism?

10. What is libertarianism?

11. What are the components of the Georgetown Mantra? Who made it?

Discussion Questions

1. What exactly is justice in medicine?

2. If moral rules such as the Golden Rule or "never tell a lie" only applies to some situations, is it really okay to tell younger generations about these rules?

4. Is it a necessity to have good reason and emotion to be quite virtuous? What if you're missing one or both?

5. Should paternalism be eliminated from healthcare?

Author posts

Group 1 - In regard to medical tourism, the group thinks that governments should not establish regulations. Also, patients should be able to access treatment as long as they are willing to take responsibility and risks.
When it comes to medical tourists, should government regulate medical tourism?

Group 2 -With regards to the relationship between doctors and patients, where does the primary responsibility lie in maintaining health? Who is more responsible for providing a solution to health problems (the doctor or patient)?

Who is primarily responsible for educating the general population on what constitutes a healthy lifestyle? Should the general population educate itself, or does such education require the input of healthcare professionals (such as medical doctors or potentially other mid-level practitioners)?
Author: James Hayes
Group 3 - What implications could plastic surgery supply to personal medicalization? Are we slowly forming a new form of biological evolution? Such as with cosmetic surgery, are people changing themselves for psychological reasons over medical ones?
Author Cassandra Taylor


When it comes to medical tourists, how far is too far? Is it acceptable to seek a doctor who will agree to a personal diagnosis over the diagnosis of a practitioner?

Fact Question and Discussion Question BB Chapter 1

Chapter 1

FQ: What are some historical atrocities that happened to peak the creation of Bioethics?

DQ 1: The first chapter introduced the revealing of the human genome project and privacy. Is predicting a person's genetic disease invading privacy? Even if the parents consented to genetic testing?

DQ 2: If doctors and patients are like salesmen and customers, is the customer always right?

Introductions

We begin, as in all my classes, with an invitation: tell us who you are, and why you're here. We'll introduce ourselves in class and here. I'll start.

I'm the prof for this course, PHIL 3345, Bioethics. I hold degrees from the University of Missouri and Vanderbilt, and I'm here because the ethics of life and death is at the very heart of what philosophy, defined as the love of (and quest for) wisdom, is supposed to be about. I'm still here in middle Tennessee, after relocating for Grad School, because it's the place where I met my wife and decided to call home. No regrets.

Enough about me (unless you're curious for just a bit more).

Who are you? Why are you here? (Bear in mind, as you reply, that this is an open site. There's nothing preventing the world from reading what we post here, except of course the world's own distraction.)

America's Bitter Pill

Steven Brill's new book may worth a look in Bioethics this semester, along with last night's 60 Minutes segment.

Bioethics needs philosophy

It is the JME's 40th anniversary and my 20th anniversary working in the field. I reflect on the nature of bioethics and medical ethics. I argue that both bioethics and medical ethics together have, in many ways, failed as fields. My diagnosis is that better philosophy is needed. I give some examples of the importance of philosophy to bioethics. I focus mostly on the failure of ethics in research and organ transplantation, although I also consider genetic selection, enhancement, cloning, futility, disability and other topics. I do not consider any topic comprehensively or systematically or address the many reasonable objections to my arguments. Rather, I seek to illustrate why philosophical analysis and argument remain as important as ever to progress in bioethics and medical ethics. Julian Savalescu

Coercion, discrimination and why medical ethics needs philosophy, better philosophy

Objecting to genetic selection and cloning, Leon Kass writes,A third objection, centered around issues of freedom and coercion… comes closer to the mark. … [T]here are always dangers of despotism within families, as parents already work their wills on their children with insufficient regard to a child's independence or real needs. Even partial control over genotype—say, to take a relatively innocent example, musician parents selecting a child with genes for perfect pitch—would add to existing social instruments of parental control and its risks of despotic rule. This is indeed one of the central arguments against human cloning: the charge of genetic despotism of one generation over the next.1

This objection from ‘coercion’ is the objection that Michael Sandel gives to genetic selection, which he calls ‘hyper-parenting’.2 In a similar vein, Jürgen Habermas argues that germline enhancements would represent a threat to the enhanced child's freedom because the parent's choice of enhancements would not only imply their endorsement of particular goods, but also communicate to their child that they expect her to pursue those goods.3 These expectations, Habermas suggests, may serve to hinder the child's freedom to do what she wants, when her desires do not align with her parent's expectations.4

The paradigm case of coercion could be said to be when a robber stops you and says, ‘Your money or your life’. Coercion involves the restriction of freedom (reduction of options), which causes that person to do what she does not want to do. Coercion is wrong when it harms a person or fails to respect that person's autonomy. That is a conceptual analysis of coercion.

Even professionals working in bioethics (which includes medical ethics), including Leon Kass, misuse this term. Embryos cannot be coerced since they are not persons and lack freedom of will. But more importantly, future people cannot be coerced by the act of genetic selection or cloning. Imagine that IVF produces two embryos, Anne and Bob. The parents choose Bob because that embryo has perfect pitch (or is a clone). Later in life, can Bob complain that his parents coerced or limited his freedom by selecting him on the basis of having perfect pitch (or being a clone)? No—he owes his very existence (all his options and freedom) to their act of selection. Without assisted reproduction and selection (or cloning), he would not have existed. It is metaphysical fact that those who owe their existence to a reproductive act cannot be coerced by that act. Even more broadly, they cannot be harmed by that act unless it makes their existence so bad that their lives are not worth living.

Failure to appreciate this metaphysical fact about identity-determining reproductive acts infects legislation and policy...

(continues)

==

1. Professor Julian Savulescu, Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, Suite 8, Littlegate House, Oxford OX1 1PT, UK; julian.savulescu@philosophy.ox.ac.uk

"Doctor, Shut Up and Listen"

...communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.

A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms. Evidently, we have a long way to go...

(continues)

Why Do Doctors Fail?

One of our upcoming authors in Bioethics next semester, Atul Gawande (Being Mortal), has joined distinguished company - Bertrand Russell, Arnold Toynbee, Robert Oppenheimer, and J.K. Galbreath et al - with his Reith Lectures, commencing with "Why Do Doctors Fail?"

Surgeon and writer Atul Gawande explores the nature of fallibility and suggests that preventing avoidable mistakes is a key challenge for the future of medicine.

Through the story of a life-threatening condition which affected his own baby son, Dr. Gawande suggests that the medical profession needs to understand how best to deploy the enormous arsenal of knowledge which it has acquired. And his challenge for global health is to address the inequalities in access to resources and expertise both within and between countries.

This first of four lectures was recorded before an audience at the John F Kennedy Presidential Library and Museum in Dr. Gawande's home town of Boston in Massachusetts. The other lectures are recorded in London, Edinburgh and Delhi.

Previous Reith Lectures

	NY Review of Books (@nybooks)
12/21/14, 1:41 PM Marcia Angell on getting old, and on choosing when to die j.mp/1wbDL6v

4 Ways to Embrace Aging

By WILL MEECHAM, MD, MA

Photo by Internet Archive Book Images

Our bodies age. As members of the kingdom of animals, we inherit a biology that grows less efficient with time. Glitches and injuries accumulate. Our youthful form is lost, and our aged one is gained.

By dint of fear of change, the innate sexual attractiveness of younger bodies, and massive exploitation of both by marketing forces, we feel embarrassed and deprived as our bodies slowly deteriorate.

Not all cultures view aging so negatively. So the bias could be overcome. But how?

1. Don’t take aging personally. After all, aging happens to everyone, from the beginning of life until its end. And like they say, Growing old beats the alternative! Every person who has ever lived beyond early adulthood has grappled with the changes the years impose. Granted, some people age more slowly than others, but every one of us looks and feels older as time passes. You are not alone.
2. See aging as Natural. We live in an era when ‘organic,’ ‘all-natural,’ ‘non-GMO,’ ‘cage-free,’ and other eco-marketing catchphrases are used to sell products. Moderns want the growth and harvesting of foodstuffs to proceed naturally. Well, aging is no less aligned with Nature than vegetables cultivated without pesticides; why not embrace growing older the way we embrace organic foods?
3. Appreciate the gifts of aging. As we grow older, we grow wiser. This isn’t folk mythology; it’s fact. We learn from experience. We find more acceptance in our hearts. We assess our strengths and weakness with more humility and self-compassion. We begin to view circumstances in shades of gray rather than black-and-white. Youthful hunger wanes until we find ourselves valuing what matters over the long run above what feels pleasant in the short run. We care less about personal goals and more about collective ones. To my mind, at least, the gain of gentleness, nuance, and altruism more than compensate for the lessening of passion and militance.
4. Embrace the big picture. If you listed the names of all 108 billion people who have ever lived, at the rate of one per second, it would take 3,400 years. And the entire human saga has unfolded over just the last 0.005% of the time since life began on this planet. Does it make sense to feel affronted by a body’s aging when so many people (and countless other lifeforms) have endured the same fate, and when the span of even the longest human life barely measures as a single tick on the cosmic clock? Each of us is a unique product of history, but we delude ourselves if we believe our own lives more important than those of all the others. If we identify with Life as it has grown on this planet for billions of years, rather than our personal speck of biology, we gain freedom from the constrictions of daily concerns. We feel opened to a larger world, a larger sense of Self, and the great, beautiful mystery that is Living.
5. Nurture a sense of humor. It helps to take aging less seriously. Early in 2014 I underwent major surgery. Postoperatively, I was horrified to see how the abdominal muscles I’d been strengthening for years ended up looking scarred and distorted. It helped lessen the sense of grief when I joked about losing my ‘last bastion of sexiness.’ The use of humor has a long history of helping the aged feel less burdened by wrinkles, sags, dribbles, creaks, and farts. Join the fun!

http://blogs.psychcentral.com/childhood-adversity/2014/12/4-ways-to-embrace-aging/
==

"The Fallacy of 'Giving Up'-Atlantic Monthly

Being Mortal, which was published in October, is ostensibly about the struggle to cope with the constraints imposed by flesh-and-bone biology—and the failure of medical science to acknowledge that any ability to push back is finite. Gawande's ultimate message, that death in America is not often enough discussed, and that patients suffer at the hands of well-meaning doctors because of it, has been generally celebrated, though not for breaking particularly new ground. His is the basic message for which the late surgeon Sherwin Nuland's How We Diewon a National Book Award 20 years ago; and it's the message of another book released last week, The Conversation, by another Harvard physician, Angelo Volandes. It's a message that has grown extremely loud inside of the health-professional echo chamber, but is somehow still only faintly reverberating into broader culture. 

"I think too many people don't know what's going on behind those closed doors in hospitals," Volandes told me. "But if they did, they'd be outraged. So many people are getting—not costly care—I'm talking about unwanted care..." (continues) 

"How Medical Care is Being Corrupted"

WHEN we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients.

 

But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions... nyt

 

(continues)

"Worried About MCAT 2015?"

Spotted this a.m. in the Science Building on our campus:

Thanks to Prof. Amy Jetton for creating the slide and putting it in rotation!

Bioethics

Returning to MTSU January 20, 2015-

PHIL 3345

Bioethics

Tuesdays & Thursdays 4:20-5:45 pm

BAS S113

(CRN #17011)

Exploring ethical issues arising from the practice of medical therapeutics (conventional and “alternative”), new biotechnologies, and reflection on life’s deepest meanings and prospects. This semester, mirroring the new MCAT, our readings will also “stress the psychological and social dimensions of medicine.”

TEXTS:

• Bioethics: The Basics - ”...the word ‘bioethics’ just means the ethics of life…”

• The Case Against Perfection - “When science moves faster than moral understanding, as it does today, men and women struggle to articulate their unease…”

• On Immunity - “If we imagine the action of a vaccine not just in terms of how it affects a single body, but also in terms of how it affects the collective body of a community, it is fair to think of vaccination as a kind of banking of immunity.”

• Being Mortal -  “We’ve been wrong about what our job is in medicine. We think it is to ensure health and survival. But really it is to enable well-being. And well-being is about the reasons one wishes to be alive.”

For more info, email Phil.Oliver@mtsu.edu

Bioethics and the MCAT

It's coming, and with it new emphasis on bioethical issues. We won't be teaching to the test, in our course; but the test will now reflect greater attention to critical thinking and the "heart and soul" issues that are our course's focus. 

MCAT 2015 FAQs... What's on the MCAT 2015?... Psychological, social, and biological foundations of behavior section

• The Official Guide to the MCAT® Exam (MCAT2015), Fourth Edition + Online Practice Questions: $35 (Recommended)
• The Official Guide to the MCAT® Exam (MCAT2015), Fourth Edition (Book only – no online access to practice questions): $30
• Online Practice Questions from The Official Guide to the MCAT® Exam: $10

Pre-Med's New Priorities: Heart and Soul...

"...what’s really exciting is not that taking this class will get these kids into medical school, but that it will help them become better physicians... The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.

The adoption of the new test, which will be first administered in 2015, is part of a decade-long effort by medical educators to restore a bit of good old-fashioned healing and bedside patient skills into a profession that has come to be dominated by technology and laboratory testing. More medical schools are requiring students to take classes on interviewing and communication techniques. To help create a more holistic admissions process, one that goes beyond scientific knowledge, admissions committees are presenting candidates with ethical dilemmas to see if their people skills match their A+ in organic chemistry.

...the Association of American Medical Colleges began three years ago to redesign the MCAT, surveying thousands of medical school faculty members and students to come up with a test tailored to the needs and desires of the 21st century. In addition to more emphasis on humanistic skills, the new test had to take into account important new values in medicine like diversity, with greater focus on health care for the underserved, Dr. McGaghie said.

As a result, there will be questions about gender and cultural influences on expression, poverty and social mobility, as well as how people process emotion and stress. Such subjects are “the building blocks medical students need in order to learn about the ways in which cognitive and perceptual processes influence their understanding of health and illness,” explains the preview guide to the new MCAT.

“I used to think of medicine as very methodical: you get the symptoms, find the diagnoses and treat,” she said. “Now it has made me think beyond pathology and biochemistry to the person. It’s made me think, ‘How will I communicate with them?’ ”

Professor Hale at Oklahoma said that, with a far larger component of pre-meds in his class, he had fielded new types of questions. “When pre-meds approach an ethics class, at first it’s: just tell me what to do to be ethical,” he said. “They’ll come saying they’ve been put in the class by an adviser, but then discover it’s relevant.”

...“I know what society needs and what patients want. They want a doctor who is technically competent but who also understands who they are. How to get there is more complicated.” 

POP QUIZ

The New MCAT

In February, the Association of American Medical Colleges approved an overhaul of the MCAT, due in 2015. New sections will stress the psychological and social dimensions of medicine (the samples below have been edited for length). 

QUESTIONS 1-4 Psychological, Social and Biological Foundations of Behavior

Psychologists have identified two forms of bias: explicit and implicit. Explicit bias is a conscious preference, whereas implicit bias is unconscious. Research on racial disparities in treatments for heart attacks has found that blacks are significantly less likely than whites to receive thrombolytic therapy (the administration of drugs to break up or dissolve blood clots). A study investigated the relationship between physicians’ implicit and explicit biases. Participants received a vignette describing a 50-year-old male with heart attack symptoms. Half the vignettes included a photo of a black patient; the other half a photo of a white patient. After participants indicated whether they would refer the patient for thrombolytic therapy, their preferences for blacks and whites were measured using a five-point Likert scale. Next, participants completed an Implicit Association Task (I.A.T.), which measured their response time to valenced words (words with good or bad connotations) that were presented with images of black and white individuals. No effect was found for levels of explicit bias and the likelihood of providing thrombolytic therapy. Figure 1 summarizes the findings related to implicit bias.

QUESTIONS

1Which concept is the focus of this study?

1. Fundamental attribution error
2. Elaboration likelihood model
3. Modern prejudice
4. Self-serving bias

Move your mouse over this block for the correct answer.C

2Which of the following explanations describes why the amygdala would most likely be activated by the use of the I.A.T. in this study? The amygdala is important for:

1. learning
2. fear
3. anxiety
4. value judgments

Move your mouse over this block for the correct answer.B

3How would a social identity theorist most likely explain the results summarized in Figure 1?

1. The physician is ethnocentric and places high value on belonging to his racial in-group.
2. The physician perceives blacks as competing with whites for scarce societal resources.
3. The physician is a product of prejudiced parents and peers.
4. The physician is surrounded by inaccurate stereotypes.

Move your mouse over this block for the correct answer.A

4Which conclusion is supported by the findings?

1. Participants high in implicit bias prescribed thrombolytic therapy for black patients more often than for white patients.
2. Participants prescribed thrombolytic therapy less than 50 percent of the time for all patients, regardless of their implicit bias levels.
3. Participants high in implicit bias prescribed thrombolytic therapy for black patients 77 percent of the time.
4. Participants high in implicit bias prescribed thrombolytic therapy for white patients more often than for black patients.

Move your mouse over this block for the correct answer.D

QUESTIONS 5-9 Critical Analysis and Reasoning Skills

A covenant of confidentiality characterizes physician-patient relationships. But suppose that during a routine medical examination, a prison physician notices that Prisoner A has drugs and paraphernalia. Should the physician report the crime or should confidentiality prevail?

Professional communications between physicians and patients are statutorily protected as confidential. Health professionals have an interest in maintaining confidentiality so patients feel comfortable revealing personal but necessary information. Prisoners do not possess full constitutional rights to privacy but generally retain them in the physician-patient relationship. In fact, respect for confidentiality is particularly important in a prison hospital setting, where patients feel distrust because physicians are often employed by the incarcerating institution. Even then, physicians’ first responsibility is to their patients. Circumstances in which to give privileged information to authorities remains the physician’s decision.

The right to privacy supersedes a duty to report the drugs and paraphernalia as there is no imminent threat to others. In contrast, a weapon harbored by a prisoner represents an imminent threat to others. Thus, upon discovering a sequestered weapon during a routine examination, the physician has a “duty to warn.”

The possibility of discovering contraband reinforces the need for informed consent at several stages. First, patients should be evaluated and treated only after they provide informed consent, unless they are incompetent. Before an X-ray is taken, they should be informed that it can demonstrate metal and other foreign bodies, and their agreement to the procedure obtained. Second, if a weapon is discovered, the patient should be given the opportunity to surrender it to authorities. And if Prisoner A is harboring drugs and a needle, it is the physician’s responsibility to educate about the potential harm of drug use.

— Adapted from “Cases in Bioethics: Selections From the Hastings Center Report,” 1989

QUESTIONS

5Assume that a prison did not have a policy of obtaining informed consent before a diagnostic procedure, and almost all of the inmates refused to be X-rayed. The author’s comments suggest this situation could be evidence that prisoners:

1. believe that they have a constitutional right to privacy.
2. are less concerned about their health than are nonprisoners.
3. distrust physicians employed by the prison.
4. feel a need to carry weapons for protection.

Move your mouse over this block for the correct answer.C

6Suppose that a prisoner under sedation for a medical procedure inadvertently reveals that a weapon is hidden in his cell. The author of the passage would be most likely to advise the physician to report the incident:

1. only if the prisoner threatened to use the weapon.
2. only if the prisoner consented to the report.
3. only if the prisoner subsequently denied that the weapon existed.
4. regardless of the patient’s assertions.

Move your mouse over this block for the correct answer.D

7With respect to prisoners, “necessary information” (paragraph 2) probably refers most specifically to a patient’s:

1. past criminal activities.
2. use of illegal drugs.
3. intent to harm others.
4. psychiatric history.

Move your mouse over this block for the correct answer.B

8Which of the following conclusions about physician confidentiality can be inferred from the passage?

1. It is more likely to be assumed in a private setting than in a prison.
2. It is especially important when patients are incompetent to give informed consent.
3. It is threatened by the use of invasive diagnostic tools such as X-rays.
4. It is an aspect of a constitutional right that is lost by prisoners.

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9Which of the following objections, if valid, most weakens the argument made for the special importance of the physician-patient covenant within prisons?

1. Prisoners understand that X-rays will detect hidden weapons.
2. Prisoners assume that physicians are independent of the institution.
3. Prison officials often question physicians about prisoners.
4. Prisoners often misunderstand their constitutional rights.

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