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Beneficence:
moral requirement to promote well-being of pts; helping action or "showing care"
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Benevolence:
geniunely caring about & having positive attitudes towards pts; caring motives & character
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Malady:
negative medical condition
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Illness:
how malady is experienced by the individual
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Medical good:
-what doesn't it include?
- pt's well-being measured in terms of health
- -doesn't inc. all aspects of financial well-being or happiness in relationships
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Total good:
overall, unified well-being
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3 crucial relationships of relationship-based care:
- 1. deep respect & concern for pt that expressed itself as partnership
- 2. self knowing & self caring that inc. knowing ones own beliefs & feelings
- 3. interdependency of healthcare team & shared responsibility for all apsects of pts well-being
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Professional distance:
not becoming inappropriately involved, emotionally or behaviorally, w/ clients & others involved in work
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Episodic conflict of interest:
- arises from choices made voluntarily
- ex: giving & accepting personal gifts on the job
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Systemic conflict of interest:
- arise from very structure of professions & other social practices
- ex: fee for service to provide unnecessary services to pts to inc profits
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Technical autonomy:
control over decisions & procedures related to one's work
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Socioeconomic autonomy:
control over economic resources necessary to complete one's work
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2 external countervailing forces of professional autonomy:
- -professional dominance
- -rationalization & de-professionalism
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1 internal countervailing force to professional autonomy:
insularity (profession becomes so focused on itself that it forgets it is there to serve public, & erosion of profession itself)
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5 principles of beneficence:
- 1. prevent evil
- 2. remove harm
- 3. rescue people who are in danger
- 4. protect & defend
- 5. help disabled
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Beneficence continuum:
strict obligation (truth telling, not committing murder) --> weak obligation (maintaining a civil level of disclosure during legitimate disagreement) --> ideals beyond the obligatory --> saintly & heroic ideals
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Role responsibility:
duties attached to formal assignmets within organization
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Interests:
all benefits to the professional as well as altruistic concerns of the person
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Conflicting interest ex:
parents wanting divorce but wanting to stay together for the kid
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Nonmaleficence:
do no harm
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5 rules of nonmaleficence:
- 1. do not kill
- 2. do not cause pain/suffering
- 3. do not incapacitate
- 4. do not cause offense
- 5. do not deprive others of the goods of life
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4 primary duties of professionals:
autonomy, beneficence, nonmalificence, & justice
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Quid pro quo (sexual harassment):
unwelcome sexual advances/requests that is made a condition of employment, promotion, pay rate, or other job benefit
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Hostile work environment (sexual harassment):
unwelcome sexual advances/requests that may unreasonably interfere w/ work performance or create intimidating or offenseive work environment
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Equality:
state of being equal in status, rights, & opportunities
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Equity & ex:
- the quality of being fair & equal
- -puts some constraints on autonomy so we can all live in just society
- ex: flat tax rate
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Principle of formal justice:
- no person should be treated unequally, despite all difference w/ other persons, until it has been shown that there is a difference between them relevant to the tx at stake
- -only use relevant variables to screen people in & out
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Distributive justice:
equally distribute, but takes something from us
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Comparative justice:
- looking at how our situation compares to someone else's
- ex: life expecancy, womens vs mens salaries
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6 material principles of justice:
- 1. equal share
- 2. need
- 3. effort
- 4. contribution
- 5. merit
- 6. free market
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Fundamental need:
something that a person will be harmed or detrimentally affected by in a fundamental way if that thing is not obtained
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Fundamental harm:
when we don't get fundamental needs, inc food, info, making own healthcare decisions, air, water, & safe working environment
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2 tiers in healthcare delivery:
- 1. covers fundamental needs, decent level of healthcare
- 2. anything else you want; you can buy health insurance to supplement tier 1
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Fair opportunity rule:
-narrow version of what principle?
- says that differences between people should be considered relevant only if those persons can be help responsible for those differences
- -principle of formal justice
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Fair opportunity rule divides things into 2 categories (define):
- -natural lottery: genetic things you inherently can't control
- -social lottery: things that are due solely to being born in particular area with particular things/ wealth
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Free market- advantage & disadvantage:
- -flexible
- -but easily manipulated and tends to exploit public opinion rather than public need
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4 ways to manage macroallocations:
- 1. free market
- 2. single payer
- 3. state managed competition
- 4. mandated insurance (universal healthcare)
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3 ways to manage microallocations:
- 1. lottery
- 2. queing
- 3. triage
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3 things necessary for giving consent:
- 1. must be voluntary
- 2. pt needs to be informed- know their rights & risks of participating
- 3. must be competent
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Nocebo:
harmful consequences caused by the belief in the threatened neg outcome
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Placebo:
positive results from an intervention that can't be attributed to a physical intervention or agent
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When is it ok to use a placebo?
Also, 2 specific factors that must be present:
- when no proven tx is exists & when use of placebo is necessary to prove a tx works
- 1. more harm than good
- 2. outcomes balanced
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2 placebo mechanisms (& examples):
- 1. results achieved through expectation: if you tell them it costs more, they will experience better outcomes; if you tell them it's morphine when it's really saline, they may still experience pain relief
- 2. classical conditioning: placebo treatment (saline) paired with a powerful drug tx, the placebo will elicit same physiological response for a while
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5 compromise positions for animal rights (define):
- 1. interdependency in nature: acknowledgement of the interdependency of all life
- 2. respect does not demand identical tx: all life is a continuum from single cell plants --> animals
- 3. principle of potentiality: future prospects & the potential for complex family & community relationships needs to be considered
- 4. minimal harm: when harm is done, it needs to be justified w/ good reasons (reasonable person standard)
- 5. principle of proportionality: must select species from lowest level of animal hierarchy to achieve desired outcome
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Pain (animals):
unpleasant sensory & emotional experience assoc w/ actual or potential tissue damage
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Distress (animals):
state in which animal is unable to adapt to an altered environment or to altered internal stimuli
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Discomfort (animals):
min. change in animal's adaptive or homeostasis as result of biological, physical, social, or psychological changes in environment
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Anxiety (animals):
emotional state of alertness prompted by unknown danger that may be present in environment
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Fear (animals):
experience or known danger in the immediate environment
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Replacement:
use computer to dec use of live animals
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Reduction:
gather greatest info from smallest number of animals
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Refinement:
minimize pain & discomfort of all animals in testing when there is no replacement for animals
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