health care ethics

  1. How might one distinguish between the ethics of a military doctor treating a wounded soldier and the ethics of a civilian doctor treating a wounded person? Is there a way of reconciling any differences?
  2. Is it necessarily a breach of research ethics to pay impoverished research subjects to participate in a study that imposes some risk?
  3. Because of your rich background in medical ethics, a prominent university asks you to sketch a policy for handling cases like the one inthe “Playing God” exercise. Consider three approaches and then set out and defend your favored policy.
    • 1. Randomization
    • the scarce resource is awarded to the highest bidder
    • 2. Auction (capitalism)-
    • auction is where the organ would go to the highest bidder
    • good: because it allows for money to go to the scarce resource...that way more can be afforded later
    • 3. Swedish
    • Swedish example is when the medical intervention cannot be provided for everyone then it won't be introduced until it is affordable for everyone
  4. Distinguish between a conflict of interest and a conflict of obligation. Give an example of each. Set out a clear policy intended to govern professional behavior as regards conflicts of interest. How should professionals manage potential conflicts of obligation?
    • conflict of interest occurs when, first, the practitioner’s role essentially involves some type of fidelity and, second, when some fact reasonably calls that fidelity into question.
    • conflict of obligation
    • when, for example, one owes it to A that one do R but
    • also owes it to B that one not do R. A surgeon, for example, who happens to be
    • a Jehovah’s Witness might be the only doctor on duty when an injured
    • non-Witness enters the emergency room in need of an immediate blood
    • transfusion. As a doctor, the surgeon has a clear duty to transfuse, but as a
    • Witness, the surgeon has an equally clear obligation not to.
  5. It is widely agreed that too many Americans die because of insufficient transplantable organs: too many usable organs arewasted. Set out THREE differentstrategies for “solving” this problem. Of the three, which one would you recommend and why?
    • 1. Mandated choice
    • Require competent adults to record choices on tax returns, drivers’ licenses or
    • state ID cards
    • 2.Compensating donors & families
    • Offering a decent burial.
    • A free market in organs, selling to the highest bidder
    • 3.Presumed consent
    • Citizens who do not wish to be organ donors must register with the government.
  6. Using examples, explain the notion of a “captive” professional. What types of ethical problems are generated by “captivity”?
    Is ethical “heroism” a good answer? What organizational strategies might address the problems?
    An example of a "captive" professional is that of an engineer who is under the authority of people who may not even be engineers. Prof. Kipnis covered this term briefly on Mar 31 relating to the incidents with McDonald Douglas DC-10, C-latch, one of the engineers saw deficiencies and composed a memo that was then 'filed' and put aside.
  7. A corporation pays doctors a bonus when they avoid referring their patients to specialists. Dr. Payne turns down a patient’s request for a cardiology referral when he should have granted it. The patient dies of heart attack a few weeks later. Set out and assess one argument for holding the corporation at least partially responsible for the death of the patient.
    • 1. Conflicted Fiduciary
    • The oath says that physicians will not "place their own financial interests above the welfare of their patients..."
    • 2.
  8. Describe the events of the Jewish Chronic Disease Hospital Case. What can researchers learn from it?
    • The distinction between the two relationships – doctor/patient and investigator/research subject
    • Researchers had already established that live cancer cells injected into healthy prison inmates did not develop into tumors; whether chronically ill and debilitated patients would exhibit the same response.
    • Firm nodules appeared at the injection site and disappeared in a few weeks. In July of 1963, 22 patients at the Jewish Chronic Disease Hospital were injected with live cancer cells without being informed about what was being done. Researchers would enter the patients’ rooms and describe the procedure as a “skin test” without suggesting that the patients were being used as research subjects.
  9. As regards their ethical dimensions, distinguish between the researcher-subject relationship and the doctor-patient relationship.
    • Doctor-patient relationship vs. researcher-research subject relationship: the direction of obligation is opposite. Physicians serve their patients, in clinical research, patient/research subject is serving the researcher.
    • The researcher is ethically obligated to make sure the subject is aware and safe
    • The doctor is ethically obligated to the patient, cause no harm
    • Though physicians are supposed to be serving their patients, in clinical research the patient/research subject is serving the investigator.
  10. What is the “therapeutic misconception” in medical research? How might it be managed?
    • Subjects characteristically enter trials on the chance they will benefit from access to a drug that works.
    • But Phase 1 clinical trials are not supposed to be about efficacy:
    • They are designed to assess pharmacokinetics and safety.
    • The research subject is vulnerable under these misconceptions

    • because he or she is driven by a false but persistent hope for a cure and, accordingly,

    • is likely to enter the study out of an unreasonable expectation of success.
  11. The warden asks a prison doctor to do a body cavity search on aninmate suspected of sequestering a firearm. Draft a reply explaining a refusal on professional grounds.
    Health-care professionals should scrupulously avoid enlisting in or being conscripted into activities that are not required as part of health care. They must especially avoid complicity in activities that would take advantage of their professional skills to promote prison security.

    The concern here is to keep the two spheres of responsibility -- security and health care -- separate. Only in this way can doctors and nurses continue to be seen as independent health care professionals rather than as agents of prison administration.
  12. The President of the United States calls you up and asks for your opinion on how health care should be organized nationally. He wants afew really good suggestions. What specific measures do you recommend and why?
  13. In Case 1, Swimmer is drowning near Bystander who is uniquely andeasily able to effect a rescue. Bystander offers to save Swimmer in exchange for $10,000. In Case 2, Patient is close to deathbecause of a medical condition that only Doctor can cure. Doctor offers to treat Patient for$10,000. Ethically, are the twocases different or similar? Havingagreed to the offers, do Swimmer and Patient each owe $10,000? Discuss.
    The bystander is not obligated to help
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health care ethics
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