Medical Ethics |
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There are a number of questions and topics for discussion provided here related to each chapter. They are intended to be suggestive of a range of questions that might be used in discussions in order to get at the central concepts and issues and principles presented in the chapter. They are also intended to develop in the learner not only an understanding of some of the concepts but also the ability to analyze and reason and apply principles to situations. Click on the chapter title to go directly to the topics for that chapter. |
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Chapter 1 Introduction | |
Chapter 2 Ethical Traditions | |
Chapter 3 The Moral Climate of Health Care | |
Chapter 4 Professionalism, Elitism and Health Care | |
Chapter 5 Ethics and Nursing | |
Chapter 6 Rights, Truth and Consent | |
Chapter 7 Human Experimentation | |
Chapter 8 Abortion | |
Chapter 9 Severely Impaired Newborns, Futility and Infanticide | |
Chapter 10 Care of the Dying | |
Chapter 11 Deliberate Termination of Life and Physician Assisted Suicide | |
Chapter 12 Genetics: Intervention, Control and Research | |
Chapter 13 Reproduction: Assistance and Control issues | |
Chapter 14 Ethnicity, Race and Gender issues | |
Chapter 15 HIV and AIDS: Related Issues | |
Chapter 16 The Allocation of Resources: Scarcity and Triage | |
Chapter 17 A Claim of a Right to Health Care | |
CONCLUSION | |
Chapter 1
Introduction
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Chapter 2
Ethical Traditions
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Chapter 3
The
Moral Climate of Health Care
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Chapter 4
Professionalism, Elitism and Health Care 1. Do you agree that whether or not a physician or a nurse is operating out of a code or covenant model it makes a difference? For example consider a physician or nurse observing a colleague make a mistake that leads to the injury of someone. ===================================== 2. A student preparing for a career as a nurse was working part time in the office of a proctologist. She told this tale to her class in Medical Ethics. She was instructed by the office manager to clean the instruments used between services being performed by the physician. She was told to place them in a device and to set it on "RINSE". When she asked why not set the device to "STERILIZE" she was told that it takes too long and the doctor has need of the instruments again. In the beginning whenever she place the instruments into he device she set it to "STERILIZE". Her supervisor observed her doing so and then instructed her once again to set it on "RINSE". She asked: "Won't that put patients at risk of infection?" The answer was : "Yes it will . But , by the time they learn of the infection several days would have gone by and they probably won't relate it to their visit to this office." The student went on working for that office and she attempted to set the device to "STERILIZE" whenever she could. She told the class this story and when asked by the instructor in front of the entire class for the name of the doctor so that the instructor could avoid that office if such services were ever needed by the instructor, the answer was : "Well I'll tell you after class but I do not want to day in front of everyone here." How would you feel if you were a member of that class? What is prompting her to continue to work at that office and accept the setting of the device on "RINSE" and subjecting people to possible harm of infection? What model of the relationship of physician to recipient of care do you think the doctor holds? What is the model of their relationship to those whom they serve being used by the office assistants in this situation ? ====================================== 3. How should a doctor, nurse, EMT, or medical technician behave when they are not working and they encounter an accident scene with people who are injured? Why? What model of their relation to the injured parties do you favor? ======================================== 4. What issues do you want to raise related to this chapter? |
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Chapter 5
Ethics and Nursing 1. What do you think of the conflicts that arise in the myriad of relationships that nurses have to doctors, fellow nurses, administrators, recipients of care and the families of the recipients of their care? How are nurses to handle the conflicts? 2. A simple case: A family wants to know the condition of a 55 year old women who has been undergoing a procedure in the hospital. They crowd into her room and in the doorway and as the nurse enters and leaves family members ask many questions. The nurse is aware that the doctor accurately reported the diagnosis and prognosis to the care recipient but has misinformed the family. What is the nurse to do and why? How would someone respond to this situation and questions using the ethical principles of:
======================================== 3. Consider: A newly hired nurse is assigned to the recovery room of a hospital that specializes in heart surgery. She is working there for a week when one evening a man in the recovery room is being closely monitored after surgery. The signs are not good. He recovers consciousness. The doctors inform him of the situation. They leave the recovery room. The man calls the nurse over and asks for a pen and some paper. Thinking that he might die and do so soon he informs her that he needs to write a brief letter to someone. She finds pen and paper and gives it to him. He writes his note and writes the address and asks the nurse to send it out for him. She agrees. As she is taking the pen and papers back from him the recovery room supervisor enters and observes her. The supervisor calls her over and inquires as to what she was doing. When the newly hired nurse reported that she had assisted the man in writing a letter and took it to mail it for him , the supervisor responded that : "It is not your responsibility to do such things." The new nurse responded that she was simply trying to help the man and had agreed to mail the letter. The supervisor replied with: "This is not a post office!" The new nurse repeated that she was only attempting to help the man. That he might die shortly. The supervisor wrote up the new nurse for subordination. The new nurse was dismissed form the hospital as she was in her probationary period. What was the new nurse to do and why? What ethical principles are you using in arriving at yur decision of what the morally correct action would be? How would someone respond to this situation and questions using the ethical principles of:
======================================== 4. A newly hired nurse is being given orientation and training in the hospital by a senior member of the nursing staff. Assigned to a medical -surgical unit the nurse receives instructions on procedures. The nurse is instructed to "push Heparin IV" through a tube in the person's arm. The nurse when being trained in nursing program was instructed not to do so such a thing as it could have serious consequences. When the newly hired questioned the procedure that nurse was told by the senior nurse: "Look that is how we do it here, missy. We are understaffed and do not have the time to do it intravenously. If you want to work here that is how you will do it too." What should the response of the new nurse be to this situation? Why? What ethical principles are you using in arriving at your decision of what the morally correct action would be? How would someone respond to this situation and questions using the ethical principles of:
========================================== 5. What issues do you want to raise related to this chapter? |
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Chapter 6
Rights, Truth and Consent 1. From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 451, Decision Scenario #1 “I don’t want to be treated,” Alice Nuvo said. “According to the statistics you gave me, even with the best treatment I’ve got no more than a five percent chance of surviving for another year.” “Pancreatic cancer is a bad customer,” Dr. Cervando Lupe said. “I wish the numbers were better.” “So why should I suffer the pain and nausea of chemotherapy and then radiation if I’m going to die anyway?” Alice snorted in contempt. “It’s absurd. I’d rather spend the remaining time with my husband and two daughters, then die in peace, instead of puking up my guts in some hospital.” “We can use drugs to control the nausea from the chemotherapy,” Dr. Lupe said. “Wand we don’t know that the statistics apply to you. They apply to a whole group of people, and I never tell a patient that she has a five percent chance.” “Just give me something to control the pain and let me go home,” Alice said. “I don’t want to talk about it anymore.” Should Dr. Lupe continue to urge Alice to have the treatments? Should Alice be forced to undergo the treatments? How would someone respond to this situation and questions using the ethical principles of:
===================================== 2. From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 454, Decision Scenario #6 “You realize that I talked to him for only fifteen or twenty minutes,” said Dr. Susan Beck. “Yeah, but you psychiatrists are supposed to be able to size up a guy just by listening to how she says hello,” Dr. Mark Brunetti said. “Tell me more about him,” Beck said. “His name is T.D. Chang. He’s fifty-two years old, a professor of Asian history at Southwestern University. He’s married, has two children in college, and has a solid scholarly reputation.” “What was his complaint?” asked Beck. “About a month ago he began to experience difficult and painful urination. His doc examined him, found he had an enlarged, knobby prostate and a wildly elevated PSA. His doc sent him here, and we’re doing a biopsy in the morning.” “And you want me to tell you how he’ll take it if you tell him you suspect cancer?” “Right,” said Brunetti. “I think he would take it all right. He shows no tendency toward hysteria, and his background reveals him to be a person who functions well under normal conditions of stress.” “Good, then if I have to tell him, I won’t worry about it.” “Mark, do you mean you’re not going tot ell him?” “Not until I know for sure. It’s a kindness to him. What he doesn’t know won’t hurt him, and there’s no reason to cause him unnecessary anxiety. ” “I don’t think I agree with that decision,” Beck said. “I think a man like Br. Chang has a right to know as much about his condition as you do.” “That’s silly,” Brunetti said. “He can’t possibly know as much as I do, and he wouldn’t know what to make of the information even if I gave it to him. He would probably figure he’s going to die in the next hour.” “So you aren’t going to tell him what you suspect or why you’re doing the biopsy?” “I’m not that cruel.” Should Mr. Chang be informed of his condition, the possibilities and the reason for further tests? How would someone respond to this situation and questions using the ethical principles of:
3. From: Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000 ., Page 457, Decision Scenario #12 “Sometimes I think that what I really want to do is to kill people and drink their blood.” Dr. Allen Wolfe looked at the young man in the chair across from him. The face was round and soft and innocent looking, like that of a large baby. But the body had the powerful shoulders of a college wrestler. There was no doubt that Hall Crane had the strength to carry out his fantasies. “Any people in particular?” Dr. Wolfe asked. “Women. Girls about my age. Maybe their early twenties.” “But no one you’re personally acquainted with.” “That’s right. Just girls I see walking down the street or getting off a bus. I have a tremendous urge to stick a knife into their stomachs and feel the blood come out on my hands.” “But you’ve never done anything like that?” Crane shook his head. “No, but I am afraid I might.” Dr. Wolfe considered Crane a paranoid schizophrenic with compulsive tendencies, someone who might possibly act out his fantasies. He was a potentially dangerous person. “Would you be willing to take my advice and put yourself in a hospital under my care for a while?” “I don’t want to do that,” Crane said. “I don’t want to be locked up like some animal.” “But you don’t really want to hurt other people, do you?” “I guess not,” Crane said. “I haven’t done anything yet.” “But you might,” Dr. Wolfe said. “I’m afraid you might let yourself go and kill someone.” Crane smiled. “That’s just the chance the world will have to take, isn’t it?”
Should Dr. Wolfe have him committed? Should Dr. Wolfe inform the authorities? How would someone respond to this situation and questions using the ethical principles of:
========================================= 4. What issues do you want to raise related to this chapter? |
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Chapter 7
Human Experimentation
What issues do you want to raise related to this chapter? |
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Chapter 8
Abortion
What issues do you want to raise related to this chapter? |
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Chapter 9
Severely Impaired Newborns, Futility and Infanticide
What issues do you want to raise related to this chapter? |
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Chapter 10
Care of the Dying
What issues do you want to raise related to this chapter? |
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Chapter 11
Deliberate Termination of Life and Physician Assisted Suicide
What issues do you want to raise related to this chapter? |
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Chapter 12
Genetics: Intervention, Control and Research
What issues do you want to raise related to this chapter? |
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Chapter 13
Reproduction: Assistance and Control issues
What issues do you want to raise related to this chapter? |
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Chapter 14
Ethnicity, Race and Gender issues
What issues do you want to raise related to this chapter? |
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Chapter 15
HIV
and AIDS: Related Issues
What issues do you want to raise related to this chapter? |
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Chapter 16
The
Allocation of Resources: Scarcity and Triage
What issues do you want to raise related to this chapter? |
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Chapter 17
A
Claim of a Right to Health Care
What issues do you want to raise related to this chapter? |
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1. OK, here we are at the
end of the semester. What
does Medical Ethics now mean to you and why?
Is it any good at all for anyone?
What has it meant to others through time?
2. What can we do to make
this course better and why do you think so?
What seems to work well, the
best, the least? Try not to
rate things by the amount of work involved.
Please attempt an evaluation based on its effectiveness in
assisting you to achieve the learning objectives or intended outcomes.
We know that the course required a great deal of time, effort and
labor on your part. Here is
where we can express whether the labor was worth it in terms of
contributing to the goals for the course. Those goals were set by both the
instructor and the students. For
those of you who wanted to take a course like this because you wanted to
learn about how others thought about things, etc...
Did you get to learn about such things? For those of you who were looking to find answers to
questions are you now in a better position to go about that task? |
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© Copyright Philip A. Pecorino 2002. All Rights reserved. Web Surfer's Caveat: These are class notes, intended to comment on readings and amplify class discussion. They should be read as such. They are not intended for publication or general distribution. |
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