GIS 3207 Bioethics Blog

Pence Chapters 1 & 2 Questions

1. In the case of Elizabeth Bouvia, doctors were not asked to help the patient die, but rather not to interfere with her starvation attempts. The hospitals she tried did not honor these request, even though it is similar to a DNR (Do Not Resuscitate) or a DNH (Do Not Hospitalize) request. Do you see any fundamental difference between Ms. Bouvias request and a DNR/ DNH? Furthermore, do you agree with the books conclusion that this attempt was assisted suicide, and not regular suicide?

2. In cases of a patient wanting to die, should there be mandatory counseling and or treatment for depression to try to change the patients mind? If this treatment was implemented, do you think patients would see the true purpose, or do you think they would see it as the establishment labeling them as emotionally unstable?

3. At the end of chapter 1, the book talks about the limitations put on the lives of the disabled, citing loss of government aid as a result of any attempt at independence (getting a job, getting married). Do you see withdraw of government aid to the disabled as a money saving tactic by the government, or do you feel that the disabled should be subject to the same monetary constraints as other groups like others in need of aid?

4. In the Quinlans case, karens parents decided to have her respirator removed, allowing her to die. The hospital refused, however, for religious reasons. Do you think religion should play any role in medicine, and if so, do you think a doctors religious beliefs should be forced on the patient as in this case?

5. Chapter 2 mentions medical futility, and a doctors ability to discontinue treatment they see as being futile, regardless of family wishes. Do you see this as being hypocritical since doctors refuse to end care when asked by family who see treatment as being futile?

    

    

Devin Williams, September 15, 2009

Discussion questions  Obama’s Health Care Plan:

1)      Health Insurance cover’s medical costs from strep throat to triple bi- pass surgery. Why does health insurance cover every minimal health issue and not focus on major catastrophes? Would this be equivalent to an automobile insurance company not only paying for major accidents like collisions but also costs such as getting your oil changed? 2)      What drives up the cost to make it impossible to doctor? Is it the unnecessary treatments that doctors perform? If so do doctors do unnecessary treatments because of fears of malpractice of because of incentives that they receive?

3)      Obama’s idea of preventative medicine is expensive tests such as colonoscopies and mammograms. Is this really preventative medicine or detection? Would a better idea of preventative medicine be education on a healthy lifestyle to avoid diseases such as cancer, and heart disease in the first place?

4)      Why it is that pharmaceutical companies charge U.S. citizen’s up to 67 % more for medications than in other countries? Should such companies be allowed to advertise medications leading people to believe they will be better off taking them? Also Obama wants to allow U.S. citizens to purchase “safe” drugs from other countries at lower cost; however, who determines what is safe and what is not safe?

5)      Do you think we are going towards socialized medicine? How far are we from socialized medicine and what are the repercussions of it?  

Ethical Theories and Bioethics, Pence Ch. 8

1)      In chapter 8 of the book Medical Ethics many different ethical theories are listed. They are the Greeks theories and virtues, Christian ethics and virtues, Natural Law, Social Contract Theories, Kantian Ethics, Utilitarianism and Consequentialism, Contemporary Times: Four Principles, Feminist Ethics, and Care- Based Reasoning. Based on what was read on the theories above which is most applicable to issues in bioethics in today’s society? 2)      Is it possible to solve bioethics issues with one theory, or should ethical issues be looked at as individual cases depending on the circumstances of the situation?

3)      Naturalistic physicians emphasize technical competence, where religious physicians emphasize compassion. Which quality is more important for a physician to posses?

4)      With such advances in modern medicine, and new technologies emerging everyday how relevant are the theories talked about in this chapter to modern society?

Discussion Questions Pence Chapter 3 & Singer Article

1.      Pence translation of the Hippocratic Oath stated the Hippocratic School was attempting to protect its membership from others healing practitioners. In doing so though did these individuals actually become hypocrites for ignoring the patient’s right to die in a comfortable manner with dignity as many physicians of the times did, or were they justified in believing that the “God’s” should control the patient’s fate? 

2.      Physician-assisted dying has been controversial and one might make the argument it relieves an individual from pain and suffering. But where does one draw a line between what is truly suffering? For example what if Stephen Hawking had developed ALS as an infant and his parents decided that they did not want their child to suffer the effects of the disease and sought physician assisted suicide. Who would have actually benefited from his death?

3.      As Pence notes humans have a 100% mortality rate. Keeping this in mind how far does the physician’s role as a healer extend to maintaining a person’s body who has no chance of becoming self sufficient, meaning major organ failure would result from removal of machines and there is no brain activity?

4.      Singer discusses the economics of health care. He illustrated how an economist will calculate how much people are willing to pay to reduce the risk they will die. With this in mind, looking at HIV/AIDS in third world countries do the individuals infected with HIV have the ability to decide to get treatment that is known to extend their life for what is now an undetermined amount of years?   

5.      While economist have been using the quality-adjusted life-year to calculate the cost effectiveness of medical procedures is this method truly a valid measure or does this method actually ignore the individuals wishes on how he/she is cared for?

6.      Pence noted a Holland study conducted in 1995 that most of the 1000 incompetent patients killed had cancer or AIDS. Since this time treatment for HIV/AIDS has seen the disease go from a deadly one to a chronic manageable disease, and there have been considerable advances in the treatments for cancer. These advances though came with considerable cost. Do we continue to allow physician-assisted suicide for individuals who develop new diseases and health problems or do we continue to seek out more advance treatments?  

Here is a link to an opinion piece in today’s New York Times that relates to our discussion on Tuesday–http://www.nytimes.com/2009/09/10/opinion/10pollan.html?ref=opinion. Some of you may find information in this article that helps you make your argument for next week’s paper.

 BR

Here is a link to the text of the President’s health care speech, given to Congress on Wednesday, Sept. 9–http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html.

When you read it, please pay attention to how President Obama implicitly and explicitly frames the argument for his health care plan as an appeal to a common morality and shared ethical principles and standards.

Next week we will discuss in greater detail the principles of bioethics, and if you want to get a jump, you can find a concise statement of the four commonly accepted principles of biothics here–http://depts.washington.edu/bioethx/tools/princpl.html. The concept of justice clearly plays a key role in the President’s argument, but there are multiple types of justice that may have different policy implications if put into practice. (For example, many would consider it just to impose a tax or other penalty on those who place a greater burden on the healthcare system, smokers, for example. Is this the type of justice President Obama is discussing?)

If you have any thoughts prior to next week’s class, you are free to comment on this post or post your own thoughts.

 BR

Bioethics is a branch of applied ethics that involves the study of the moral and ethical challenges and choices faced in medical treatment and research, especially when the application of advanced technology is involved.  It is chiefly concerned with human life and well-being, though issues of the treatment of animals and the biological environment are sometimes examined.

You can find more detailed answers to this question here, here, and here.

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