Science

relate the course content to real-world applications from your work experience. I expect your message to reflect critical thought and an integration of the key themes and concepts from the readings.

1. Explain the statement, “Healthcare practitioners often find it more difficult to withdraw treatment after it has started than to withhold treatment.”
What attributes do you think a guardian ad litem should possess?
Describe a situation in which passive euthanasia might be acceptable.

2. Summanry: Careful distinctions must be made between the donation of renewable and nonrenewable parts, as well as between those that come in pairs and those that do not. The living donor may not donate a nonrenewable, nonpaired part because except in rare cases, this is equivalent to unjustified suicide. Other donations may be made for a proportionate reason. There is no obligation to donate organs inter vivos, but cadaver donation should be seen as an ideal to be encouraged. It is desirable that organs be donated rather than sold, but selling cannot be condemned out of hand.

Would-be recipients of organs should be on their guard against blackmailing or coercing donors. The recipient should look at all the factors when deciding whether to ask for or consent to a transplant.

Proper consent that respects the will of the donor and the feelings of families is essential even in cadaver organ donations. Legal schemes for increasing the supply of organs that disregard the feelings of families or are disguised forms of manipulation should be avoided.

Distribution by publicity may be tolerated, because it provides some overall educational benefits for society, as well as individuals. In the long run, a medical indications policy needs to be developed and enforced within the limits of the rights of citizens. Until society specifies that transplants are part of the minimum human and adequate medical treatment to which all have a right, economic factors must still be considered. Membership factors may also be valid factors in distribution.

Case Study: Robert Bean, age 25, has lost 80 percent of his kidney function due to diabetes, which has also left him blind and with severe neuropathy in his legs and feet. His general condition is deteriorating so rapidly that he probably has no more than a year to live. Robert’s father wants to donate his kidney, if he is compatible. Dialysis is not an option in the mind of the father, as he feels that Robert could not take it psychologically. The family has a history of both diabetes and liver problems. The transplant will help with the kidney problem, but will not reverse or stop the progression of the other effects of the diabetes.

Is either dialysis or a transplant medically indicated? Is the father’s belief about his son’s ability to endure dialysis relevant? Should Robert be consulted? Is the father ethical in donating his kidney in view of his family history? Do the ethics of allocation favor or militate against a transplant in this case?

References:

Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2009). Health care ethics: Principles and problems (5th ed.). Upper Saddle River, NJ: Prentice-Hall.

3. The readings for Chapter 11 provide an overview of the ethical issues associated with screening and testing, including cost and consent. Using the readings, describe how this issue creates ethical challenges for health care managers.

References:

Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2009). Health care ethics: Principles and problems (5th ed.). Upper Saddle River, NJ: Prentice-Hall.

4. Student discussion must be a minimum of 150 – 200 original words and supported by academic, peer-reviewed references (at least 1). Whenever possible, please try to relate the course content to real-world applications from your work experience. I expect your message to reflect critical thought and an integration of the key themes and concepts from the readings.  Discuss the ethical implications of the case study, using the questions below.

 

Historical Case Study

Mickey Mantle, Baseball Hall of Fame center fielder for the New York Yankees, received a liver transplant in 1995 after a six-hour operation. It took only two days for the Baylor Medical Center’s transplant team to find an organ donor for the 63-year-old former baseball hero when his own liver was failing due to cirrhosis and hepatitis. Mantle was a recovering alcoholic who also had a small cancerous growth that was not believed to be spreading or life-threatening.

 

There is usually a waiting period of about 130 days for a liver transplant in the United States. A spokesperson for the United Network for Organ Sharing located in Richmond, Virginia, stated that there had been no favoritism in this case. She based her statement on the results of an audit conducted after the transplant took place. However, veteran transplant professionals were surprised at how quickly the transplant liver became available.

 

Doctors estimated that due to Mantle’s medical problems, he had only a 60 percent chance for a three-year survival. Ordinarily, liver transplant patients have about a 78 percent three-year survival rate. There are only about 4,000 livers available each year, with 40,000 people waiting for a transplant of this organ. According to the director of the Southwest Organ Bank, Mantle was moved ahead of others on the list due to a deteriorating medical condition. The surgery was uneventful, and Mantle’s liver and kidneys began functioning almost immediately. His recovery from the surgery was fast.

 

There were mixed feelings about speeding up the process for an organ transplant for a famous person. However, Kenneth Mimetic, an ethicist at Loyola University in Chicago, stated, “People should not be punished just because they are celebrities.” The ethics of giving a scarce liver to a recovering alcoholic was debated in many circles. University of Chicago ethicist Mark Siegler said, “First, he had three potential causes for his liver failure. But he also represents one of the true American heroes. Many people remember how he overcame medical and physical obstacles to achieve what he did. The system should make allowances for real heroes.”

Mickey Mantle died a few years later from cancer.

1. As in the case of the liver transplant for Mickey Mantle, should the system make allowances for “real heroes”? Why or why not?

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2. Analyze the Mickey Mantle case using the seven-step model found in Chapter 1 for examining ethical dilemmas.

1. Determine the facts.

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2. Define the precise ethical issue.

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3. Identify the major principles, rules, and values.

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4. Specify the alternatives.

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5. Compare values and alternatives.

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6. Assess the consequences.

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7. Make a decision.

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Fremgen, B. F. (2009). Medical law and ethics (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

5. Student discussion must be a minimum of 150 – 200 original words and supported by academic, peer-reviewed references (at least 1). Whenever possible, please try to relate the course content to real-world applications from your work experience. I expect your message to reflect critical thought and an integration of the key themes and concepts from the readings.  Discuss the ethical  implications of the case study, using the questions below.

Historical Case Study: The Willowbrook State Hospital Case

Willowbrook State Hospital, an institution for mentally retarded children on Staten Island, experienced a large number of infectious diseases among its patients. Conditions at the hospital were not good, and most children suffered from hepatitis, measles, and parasitic and respiratory infections. Hepatitis, in particular, was a problem, since many of the children were not toilet-trained and the disease was spread through an oral-intestinal route. Researchers determined that nearly all susceptible children became infected with hepatitis during their first year at the hospital.

Between the years 1956 and 1970, 10,000 children were admitted to Willowbrook Hospital. Of those children, almost 800 were entered into a research project to gain information about the disease with the hopes of eventually developing an immunization against the disease. All the parents of the children in the research project granted written consent. The children were injected with the same strain of hepatitis that was already prevalent at the hospital.

The physician-researchers in charge of the project received intense criticism by subjecting the children to this research. The researchers defended their actions by stating that

1. The children that were used as subjects were unharmed or, at least, not made any more ill than they already were.

2. The children may have even benefited, since they were placed on an isolated unit and thus were not exposed to other infectious diseases.

3. The children in the study may have had a subclinical infection, which would render them immune to the hepatitis virus.

4. The children may have been better off as a result of the research, since the study added to the growth of information about the disease.

5. All the parents had given their informed consent.

The medical community was outraged about the experiment and raised the following objections:

1. Mentally retarded persons, especially children, should not be used for research experimentation.

2. The children are unable to defend or speak for themselves.

3. There is a greater possibility of abuse with children than with adults.

4. The parents may have been coerced to grant consent, since the hospital was full and there was only space to admit children into the hepatitis unit.

5. The experiment did not appear to be therapeutic.

6. The benefits to the hospital and the community at large were minimal.

7. The experiments were designed to confirm existing studies about the effects of gamma globulin immunization for hepatitis.

8. Researchers withheld from the nonresearch children (control group) an inoculation that may have been effective against hepatitis.

Since 800 children were isolated from other children, they did not acquire infectious diseases prevalent at the time. Ultimately, the claim that the children in the research study benefited from the project was upheld in court.

(Summarized from G. Pence. Classic Cases in Medical Ethics. New York: McGraw Hill Publishing Company, 1990.)

1. What are the pros (positives) of this study?

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2. What are the cons (negatives) of this study?

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3. Is society ever justified in permitting this type of research when the outcome benefits some members of society? Why or why not?

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4. Should public funds be used to pay for this type of research on children? Why or why not?

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5. Some say that the final outcome of the Willowbrook case falls into a “gray area” of ethics in which there is no one clear answer. If this is the case, then, in your opinion, where do we draw the line on testing children?

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Fremgen, B. F. (2009). Medical law and ethics (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

6. Explain the statement, “Healthcare practitioners often find it more difficult to withdraw treatment after it has started than to withhold treatment.”
Describe a situation in which passive euthanasia might be acceptable.

7. Discuss: Ethical aspects of future health care: globalisation of markets and differentiation of societies – ethical challenges. https://books.google.com/books?id=KtSZC8C-a0wC&pg=PA77&lpg=PA77&dq=Ethical+aspects+of+future+health+care:+globalisation+of+markets+and+differentiation+of+societies+-+ethical+challenges.&source=bl&ots=uNxUWVuach&sig=qG4VQuQhjHS8LlF14hG7sEr6SpE&hl=en&sa=X&ei=5mwcVe-fFIH3ggTpsIGACg&ved=0CCcQ6AEwAQ#v=onepage&q=Ethical%20aspects%20of%20future%20health%20care%3A%20globalisation%20of%20markets%20and%20differentiation%20of%20societies%20-%20ethical%20challenges.&f=false

8. Discuss the article: Charting the Future: Credentialing, Privileging, Quality, and Evaluation in Clinical Ethics Consultation https://www.questia.com/library/journal/1G1-220561080/charting-the-future-credentialing-privileging-quality

9. Discuss the article: Evaluation of Internet-Based Technology for Supporting Self-Care: Problems Encountered by Patients and Caregivers When Using Self-Care Applications

http://www.jmir.org/2008/2/e13/

10. Give a presentation to your organization’s board of ethics. You will discuss a current biomedical issue that faces your organization and its social responsibility toward the issue.

Prepare a 1- to 2-slides Microsoft® PowerPoint® presentation that discusses the biomedical issue. Include the following:

What is the historical and current impact of the biomedical issue?

Include at least one source in your presentation.

Include speaker notes

Format your presentation consistent with APA guidelines.

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