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Final Flashcards

1
Q
  1. Schwartz, Ethics of Vaccination Programs,
A

a. One must consider all aspects of the argument including the ethical side

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2
Q
  1. Miller, Vaccine and Autism
A

a. There is no like between vaccines and autism

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3
Q

• What is herd immunity? How it protects the community?

A

Herd immunity theory proposes that, in contagious diseases that are transmitted from individual to individual, chains of infection are likely to be disrupted when large numbers of a population are immune or less susceptible to the disease. The greater the proportion of individuals who are resistant, the smaller the probability that a susceptible individual will come into contact with an infectious individual.[2]

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4
Q
  • How dose vaccine mediate protection?
A

• Depending on the type of vaccine, it could activate an antibody-mediated response or a cell mediated response. Know examples for each type of vaccine.
o Live Attenuated Vaccine
• Produced by growing the vaccine in less than optimal conditions and select for weaker strains. Expand and purify the virus
• -Activates a strong immune response often lifelong immunity with a few doses) Works for Measles mumps polio Rotavirus Rubella Tuberculosis Varicella, Yellow Fever
o Inactivated or Killed
• Produced by heat or chemical inactivation of the pathogen. This weakend pathogen produces an immune response safely because there is no replication in the host.

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5
Q

• Know the significance of the memory function of the adaptive immune system.

A

o Immune activation is faster and stronger the second time and antigen is introduced

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6
Q

4- Know the different types of vaccines

A

o Live Attenuated Vaccine
• Produced by growing the vaccine in less than optimal conditions and select for weaker strains. Expand and purify the virus
• -Activates a strong immune response often lifelong immunity with a few doses) Works for Measles mumps polio Rotavirus Rubella Tuberculosis Varicella, Yellow Fever
o Inactivated or Killed
• Produced by heat or chemical inactivation of the pathogen. This weakend pathogen produces an immune response safely because there is no replication in the host.

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7
Q

5- Vaccine production

A

• What is vaccine immunogenicity and why it is a significant aspect in vaccine production?
o Immunogenicity is the ability of the vaccine to elicit and immune response
• What are the different safety considerations in vaccine production?
o Manufacturing
o Transportation
o Administration
o Stability/storage
• Live vaccine= most tolerate freezing
• Inactivated vaccines
• Damaged by exposure to temperature fluxuation
o This damages potency

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8
Q

• What is vaccine immunogenicity and why it is a significant aspect in vaccine production?

A

o Immunogenicity is the ability of the vaccine to elicit and immune response

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9
Q

• What are the different safety considerations in vaccine production?

A

o Manufacturing
o Transportation
o Administration
o Stability/storage
• Live vaccine= most tolerate freezing
• Inactivated vaccines
• Damaged by exposure to temperature fluxuation
o This damages potency

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10
Q

6- Current vaccination schedule:

A

• CDC recommendation
o Reccomends vaccines for 16 preventable diseases
• Why so many vaccines at young age?
o Children may be to weak to fight these diseases
• Is this schedule safe? IOM report
o Yes it is safe thus there is no reason to test for alternatives
In addition it is unethical (no one has proposed and ethical way to test) to test for alternatives or to test for the effectiveness of this schedule

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11
Q

• Andermann, Genetic Screening, AND

A

o Primary care pro’s have important role in helping patients navigate genetic screening services by informing them about benefits and risks of genetic technologies→informed choices

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12
Q

• Haga, Ethical issues of genetic testing for diabetes

A

o Genetic screening needs to be pursued responsibly
o Involve all stakeholders in the discussion about genetic screening

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13
Q

1- Know the etiologic spectrum of diseases.

A
  • Genetic – Multifactorial/complex – Environmental
  • Ex: Single gene disease (Huntingtons) → Genetic
  • Ex: Caused by combo of genetic and environmental factors → Multi/complex
  • Ex: Due to environmental factors → Environmental
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14
Q

2- Genetic screening

A

o Population screening for a disease-causing gene in carrier individuals or in offspring of carriers
o Improve public health

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15
Q

• What are the major principles of genetic screening?

A

o Condition should be serious and relatively common
o Disease should be clearly understood
o There should be an acceptable way of intervention or treatment
o MUST have a strategy for communicating results efficiently and effectively

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16
Q

3- Genetic testing

A

o Used to identify people at risk w/in a clinical setting
o Ex: prenatal diagnosis, heterzygote carrier detection, presymptomatic diagnosis of disease
• Genetic tests can be classified based on the predictive value into predisposition testes, pre-symptomatic tests and susceptibility tests. Know what these tests are, and a disease example with each one.

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17
Q

o Predisposition tests

A

• Rare forms of common conditions: small subset of cases caused by mutation of single gene
• BRAC1/2
o Presymptomatic
• Test for conditions caused by mutations in single genes
• Huntingtons
o Susceptibility
• Tests for common conditions caused by complex gene-gene and gene-environment
• T2DM

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18
Q

o Analytical Validty

A

• With exception to human errors, the analytical validity of DNA-based tests is very high

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19
Q

o Clinical Validity

A

• Refers to how well a genetic result predicts risk of disease

20
Q

o Clinical Utility

A

• Refers to whether the genetic information is useful in guiding management and how the test results influences clinical decision making

21
Q

4-Ethical issues that come with the susceptibility genetic tests.

A
  • The issues that challenge the patient and his family, the impact of testing on family members,
  • Improved health outcomes/ Clinical utility
  • Familial implications/risk communication/ patient understanding/ discrimination/ GINA
22
Q

5- Genetic counseling

A

o Communication process between genetic consultant and individuals who are affected by a genetic disorder or who have an increased risk for a genetic disorder

23
Q

• What is the role of the genetic counselor?

A

o Medical aspects of disorders,
o social/psychological consequences,
o focus on patient and family,
o provide resources for understanding of the diagnosis and implications for the patients and their families
o Autonomy should never be questioned

24
Q

• What are the ethical principles that govern the actions of counselors?

A

o Confidentiality and privacy protection

25
Q
  1. Is there a link between thimerosal and autism?
A

no

26
Q

b. What did the CDC recommend regarding thimerosal and vaccines and why?

A

• Removal of thimerosal as precaution

27
Q

. What is the National Vaccine Injury Compensation Program?

A

a. What is its purpose and what does it do?
• Vaccine court that hears cases from patients harmed by vaccines and provides

28
Q

compensation if certain conditions met:

A

o Biological theory of harm
o Logical sequence of events that connect vaccine to harm
o Appropriate time frame in which injury occurred (30 days)
o No reasonable alternative medical explanation for injury was offered

29
Q

b. What were its findings on vaccines and autism?

A

• Standard proof is weaker and admissible eveidence is looser than scientific

30
Q
  1. What is the basic definition of autism, and what is the current prevalence rate?
A

• Neurological disorder w/ debilitating consequences
o Deficits in social interaction and communication
o Repetitive behaviors
• Prevalance: 1 in 88, increasing

31
Q
  1. Who is Andrew Wakefield and what were his main findings?
A

• Alleged that measles in MMR vaccine caused leaky gut that lead to autism
a. On what grounds have some challenged his study’s legitimacy?
• Immunization rates and autism prevalence rates are not related
• Falsified data

32
Q
  1. What are the major interest groups, their membership, and their positions on vaccine safety:
A

a. National Vaccine Information Center (NVIC)
• Organization formed by parent activists concerned about pertussis vaccine
• Promoted informed consent and vaccine safety
• Lost legitimacy when linked up w/ radical anti-vaccine groups
b. Coalition for Vaccine Safety
• Umbrella organization of radical autism groups that believe that vaccines cause autism

33
Q
  1. What are the Health Insurance Portability and Accountability Act (HIPAA) (1996) provisions on the privacy of medical information?
A
  • Protects individual medical records and health information in written, oral, and electronic form.
  • Privacy Rule gives individual rights over their health information and sets regulations and limits on who can look at such information.
  • Security Rule requires electronic health information be securely stored.
34
Q
  1. Who must follow HIPAA:
A

a. Health plans, health care providers, and health care clearinghouses (data collection entities that process nonstandard health info from another entity into standard format).
b. These companies often sell the medical data to third parties like employers, insurers.

35
Q
  1. What information can be viewed by these entities:
A

a. Info can be viewed for treatment and care coordination
b. , paying medical providers for care
c. by state and local governments and law enforcement agencies for ensuring public health and safety.

36
Q
  1. What limits does the Genetic Information Nondiscrimination Act (GINA) (2008) place on insurers and employers?
A

a. who has access to such information and under what conditions?
b. which types of insurance are exempt from GINA provisions, and what are the justifications for this?
c. what is group insurance and individual market insurance?

37
Q
  1. What is euthanasia and why is it controversial?
A
  • Ending a terminally ill patient’s life where an agent other than the patient is involved. *taking another person’s life.
  • . Absolutist view: Life is good, sacred, no exceptions.
    1. Prima facie value: Life is good but can be set aside for higher values (heroic self-sacrifice)

• 3. Relative value of life: life is good only if certain level of existence is possible.
(quality of life concerns)

38
Q

a. what are state and federal policies on euthanasia in the US?

A

. court recognized a patient had a fundamental right to refuse medical treatment, based on the constitutional right to privacy.

o c. highlighted importance of need for all to have in place legal safeguards: durable of power of attorney, advance directives

39
Q
  1. What is physician assisted suicide (or aid in dying)?
A
  • Physician assisted suicide: arranging death by mutual agreement between the patient and physician.
  • doctor supplies the means of death (e.g., drugs) but patients must take the dosage themselves.
  • proponents call this aid in dying, not physician assisted suicide
40
Q

. What constitutes withholding or withdrawing life-sustaining treatment? What is futile care?

A
  • allowing a patient to die, or nature to take its course. This is different from euthanasia or physician assisted suicide (positive actions on the body)
  • when the intervention for a dying patient will not sere their good.
41
Q
  1. What is palliative care? Palliative sedation?
A
  • Palliative/terminal sedation: high dose of narcotic (morphine) to help a patient in severe pain in final hours.
  • May hasten death but that is not the intent. Intent is alleviation of suffering.
  • cause of death is the disease taking its course, not the drug itself
42
Q

a. Quinlan case

A
  • a. court recognized a patient had a fundamental right to refuse medical treatment, based on the constitutional right to privacy.
  • b. even though Quinlan was not competent, she did not forfeit this right. Rather, a surrogate could exercise this right on her behalf (her father
  • c. highlighted importance of need for all to have in place legal safeguards: durable of power of attorney, advance directives
43
Q

b. Cruzan case

A

• US Supreme Court upheld continued use of feeding tube on grounds that protection of life of an incompetent person trumped rights of privacy and liberty/freedom to choose treatment.

44
Q

• Washington v Glucksberg and Vacco v Quill cases

A

• c. Has the Supreme Court ruled that there is a constitutional right to assisted suicide or a constitutional right to refuse medical treatment?

45
Q
  1. What is the Netherlands’ policy on euthanasia and physician assisted suicide?
A

• . It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care.[1] These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life.[1] To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.

morality (2 decks)

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