HBS 32,35,36 Flashcards
The four Principles
4 standards by which to adhere in all ethical situations that may occur in medicine, to overcome differences of religion, philosophy, opinion, etc.
Beneficence
Justice
Respect for Autonomy
Non maleficence
Autonomy
The right of a person to think, act and decide for themselves-to make their own decision regarding what they shall do, what shall be done to them, and what should happen to them.
Beneficence
The moral responsibility to act for the benefit of others. This is not merely avoiding harm, but promoting welfare of patients.
Justice
Justice refers to the obligation to provide fair, equitable, and appropriate treatment to patients. There are, however many theories of justice, including utilitarianism, libertarian, communitarian, egalitarian,
Non Maleficence
Taking sufficient care to avoid doing harm by either malpractice or negligence. Harm can be caused intentionally or non intentionally and includes offense, injury, pain, suffering, incapacitation, death.
Paternalism
The intentional overriding of a patient’s preferences by coercion, deceit or omission, as justified by the intention to preventing harm or representing the patient’s best interest.
Factors that contribute to health inequities in developing countries:
Wealth Sanitation Access to healthcare Education Political stability Access to healthy food and clean water
Factors that contribute to health inequities within countries
socioeconomic class
gender
occupation (manual vs professional)
education
Theory to explain inequities within developed countries: Artefact
Health and social class are artificial variables used in an attempt to measure a social phenomenon.
Theory to explain inequities within developed countries: Social darwinism
The healthy are naturally selected into higher classes. Poor health brings about poor economic conditions.
Theory to explain inequities within developed countries: Structuralist
Poverty and social class are determinants of health. Economic condition have a direct affect of health.
Theory to explain inequities within developed countries: Cultural/behavioral
Cultural beliefs/values within classes contribute to health.
Current theory on health inequities
Detrimental health affects of SES differences in childhood can be overcome by higher paying jobs in adulthood. Health disadvantages begin in adulthood when economic disadvantage is maintained.
Increasing disparity has significant effects health and health service.
Lower class contributions to health inequalities
Job insecurity = stress
Childhood deprivation = malnutrition
Housing = cold, mold, crowded
Education = poor health decisions (stds)
4 Levels of health determinants
- Economic/political/environmental
- Social/community context
- Health related behavior
- Individual (age, sex, genes)
Relative risk example
If you have high cholesterol and take provastatin, you reduce your risk of death by 22%.
This means that 32/1000 people died when taking pravastatin, compared to 41/1000 people who died not taking it.
Absolute risk example
Pravastatin reduced the number of people who die from high cholesterol from 41/1000 to 32/1000. The difference is 9/1000 = 0.9%.
Pravastatin reduces risk of dying from high cholesterol by .9%
Number Needed to Treat (NNT) example
NNT = 1 divided by absolute risk population.
1/.009 = 112.
this means that 112 people must be treated to save 1 life.
Relative risk perception of oral contraception and thrombosis
The pill increases chances of thrombosis by 100%. This relative risk sounds bad, but the absolute risk was only 1/7000 compared to 1/14000.
Clinical trial/study
Any investigation in human subjects intended to discover or verify the clinical, pharmacological or pharmacodynamic effects go an investigational product, and/or to identify any adverse reactions, or to study absorption, distribution, metabolism, and excretion with the aim of ascertaining its safety and efficacy.
Research steps in a clinical trial
Develop study concept Secure funding Prepare protocol Obtain ethical approval Setup study Conduct study Close study Analyse data Communicate the results
James Lind
Discovered Vitamin C scurvy cure by performing a research trial on sea.
The Tuskegee Syphilis study
Black men in Alabama with syphilis were not given penicillin treatment so that researchers could see what happened. Participants never gave their consent to participate in the experiment.
1932-1973
Thalidomide
Morning sickness drug sold across the world in late 1950s. 10,000 children born with birth defects.
Nuremberg Code
Research ethics code established ofter Nazi experimentation during WW2.
States that participants must be competent, provide consent, willing, understanding of the risks, and able withdraw at any time.
Declaration of Helsinki
- Established ethical principles for medical research involving human subjects. The new gold standard.
International council on harmonization
- Established international standards for research procedure and reliability. Prior, research was not trusted from country to country. Research had to be redone to confirm its validity. So harmonizing research standards internationally improves research efficiency.
