chapter 14: ethical issues in health and health care Flashcards
when was physician-assisted suicide made legal in Canada
in January 2015, the Supreme Court of Canada overturned the 1993 ruling that prevented Canadians with irremediable medical conditions from ending their life with the assistance of a physician
countries that legalized physician-assisted suicide
Netherlands, Belgium, Canada, and Oregon, Washington, and Vermont in the US
criticism of physician-assisted suicide
argued that honouring the “right to die” misrepresents the lives of people living with severe disabilities and could lead to a serious misuse of end of life directives
ethics
a dynamic decision-making framework that allows individuals to act in a way that aligns with their personal values, religious beliefs, or other important guiding principles
two components of ethics
- involves well-founded standards of right and wrong that prescribe what humans ought to do in terms of rights, obligations, benefits to society, fairness, or specific virtues
- standards of right and wrong situated in a societal context and enforced by the rule of law
bioethics
defined by Reich as the systematic study of human conduct in the area of the life sciences and health care, insofar as this conduct is examined in the light of moral values and principles
critical approach in bioethics means
investigate power differences and their impact on everyday ethics and bioethics scholarship, and emphasizes the use of empirical approaches to understand bioethical issues
what are the ten ethical challenges facing citizens in most Western industrial nations
- conflicts over treatment decisions
- determining essential services
- the lack of services for vulnerable populations
- a shortage of health care workers to provide care
- medical error
- decisions about end of life care
- the ability to give informed consent prior to receiving care
- the risks and benefits of participation in medical research
- determining who can make health care decisions on behalf of another
- the emergence of new medical technologies
bioethicist
their job is to explore, study, and support the resolution of ethical issues, they have the power to influence society’s understanding of, and response to, ethical issues
what is one common reason that causes disagreement over treatment decisions
- religious beliefs, making it a primary ethical challenge
- the rise of CAM can also create ethical challenges with patients seeking treatments that an allopathic physician seemed as harmful or unnecessary
lack of accessibility
especially among vulnerable populations, represents a major ethical challenge in situations where universal access is implied and expected
what are the two contexts where availability of care is compromised
- an individuals’ living circumstances can create barriers to health care (social stigma)
- cultural barriers can prevent or limit access to health care
primary care physicians
medical doctors who function as the first point of contact for a patient
what two effects does poor access to provider has
spatial - distribution of providers is lower across regions that are underserved
social - there are not necessarily providers available to assist those who are marginalized or required a greater degree of care
medical error / malpractice
physician error that breaches their legal contract with the patient, the physician is held culpable
adverse event
an unintended injury or other negative consequences that results from an issues within the medical system
Baker landmark study
reveals that 7.5% of hospital admissions in Canada were associated with adverse event, where about 38% of those events were preventable, advocating for the need to create a safer and more accountable health care system
the Canadian Patient Safety Institute (CPSI)
created to raise awareness and develop best practices to support patient safety
what does regulatory guidelines that require health care providers disclose errors do
- foster transparency, accountability, and trust
- promotes a more equal physician-patient relationship
- provides opportunities for carers to learn from their mistakes
Patients for Patient Safety Canada
developed by CPSI, encourages the public to become involved at the institutional and policy levels
end of life decisions
choices an individual must make regarding their medical treatment at the end of their life (an issues across the entire life course)
two aspects regarding the end of life care
- the notion of competency
- when the end of life should occur
improvements made to ease the end of life care process
- raising awareness of the importance of planning ahead for end of life care
- recognition by health care professionals that perspectives on end of life and the burden on families and loved ones is socially and cultural variable
- calling for a broader public discussion and debate about issues regarding end of life care, arguing that through public engagement, death and dying can be de-stigmatized
informed consent
providing all individuals who are being treated, or participating in research studies, with all information that could possibly affect their wellbeing, allowing individuals to actively participate in a decision that could greatly affect them
morals
ideas we believe about right and wrong (honesty, compassion, and understanding)
four elements to the access to health care
- coverage: facilitates entry into the health care system
- services: having a usual source of care is associated with individuals receiving recommended screening and prevention services
- timeliness: ability to provide health care when the need is recognized
- workforce: capable, qualified, culturally competent providers
triage systems
methods for systematic prioritizing of patients’ treatment according to how urgent they need care
palliative care
care that aims to improve the quality of life for those living with a life-threatening disease
medical assistance if dying (MAID)
occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a patient’s death, at that patient’s request (legalized in Canada in Jun 2016, Bill C-14)
substitute decision-maker
a person who is authorized to give or refuse consent to treatment, admission to a care facility, or personal assistant services, on behalf of an incapable individual
first nations nutrition experiments
a nurse takes a blood sample from a child at the Indian school in BC in 1948, during a period when nutritional experiments were being conducted on children in residential schools
Nazi human experimentation (WW2)
child victims of Nazi experimentation show incisions where body tissue had been surgically removed after they were deliberately infected with tuberculosis
the nuremberg code
included the principle of informed consent and required standards for research, created in the aftermath of the discovery of the camp experiments and subsequent trials to address abuses committed by medical professionals during the Holocaust
Henrietta Lacks
- 1920-1951, she was a Southern African-American tobacco farmer
- visited a hospital in 1951 and was diagnosed with cervical cancer, prior to treatment, cells from the tumour were removed for research purposes (done without her knowledge or permission)
- the sampled tumour cells would become the HeLa immortal cell line
HeLa Cells
- vital for developing the polio vaccine and uncovering secrets of cancer, viruses, radiation effects, and other scientific pursuits
- been used to test human sensitivity to many commercial products
- Henrietta’s family did not learn of her “immortality” until 1973
