Informed Consent Is A Central Part Of Medical Ethics

Without informed consent a person’s autonomy is taken away. Informed consent upholds the right that a person has to makes his/her own decisions concerning their health. We all can agree that doing something to someone without their consent is wrong no matter if it is health related or not. Informed consent gives a patient the ability to make a decision about his/her health give the benefits and the consequences with and without proper care. On the basis or having a patient who’s culture, ethnicity, or religion, does not permit them knowing about a particular action concerning their health, it is still the duty of the physician to uphold a patients American rights and the right to autonomy. If someone does not want to know about their condition then why seek care. In the end, something has to give. If that means informing a patient that does not want to be informed then so be it. There are many different cultures and nationalities in the United States, but that does not change rights and laws already in place in the United States. In the United States informed consent is a central part of medical ethics. Should we change our ethics according to the medical ethic in other countries and cultures? (Uhhh no!) That would be compromising our culture and ethics. Just because someone is from a different culture that does not change the rules of a Hospital or laws set in place. If I was getting an operation done in a foreign country, I would expect the procedure to be under the policy and rules of the governing country and not that of the country I am from. Informed consent is a vital part of medical ethics to protect the rights of the patient as well the physician. There are people out there who do indeed deny consent, but they are a small portion and are not a majority. So, we should take away everyone’s right of autonomy to please a few? I don’t think so. There is no law that is going to please everyone, but there are rights and laws that are for the better of everyone and operate in the best interest of the society as a whole. Sacrifice the ethics of a few to uphold the ethics of many….

Restraining Patients!

There was an article posted on AHRQ (Agency for Health Research and Quality) reporting on use of physical restraints in nursing homes creating substantial adverse consequences for resident. The use of restraints on nursing home residents has declined vastly between 1989 and now, but in those cases currently remaining, restraints have substantially impaired the resident’s health. A new study found that 3 months after being restrained the residents had lower cognitive performance, lower ability to perform activities of daily living (ADLs) like getting dressed and bathing, a more walking dependence. You could expect a 5% lower ADL performance, 10% more walking dependence, and 4% lower cognitive performance of those placed in restraints compared to those with no restraint use. In addition to the restraints creating adverse health consequences, the use of restraints may necessitate subsequent use of additional staff as a result of resident decline.
I think the use of restraints causes more harm than good. Even though those who are for it argue that restraints are used to increase the safety of the patient and the caregiver, there is no conclusive evidence that restraints actually do so. There is vast evidence of the serious problems they cause!!!! The use of restraints is the easy way out and it is hard for me to believe that they are mostly used with the ethical principle beneficence in mind. It creates more opportunity for moral hazard to “ease its evil eye” into wrongful use of restraints. Nonmaleficence is an ethical principle that requires caregivers to avoid causing patients harm, but lower ability to perform ADL’s, lower cognitive performance, and more walking dependence sounds like harm to ME. There are many alternative to decreased reliance and use of restraints, but all of them require a change in attitudes, beliefs, practices, and policies of a facility.

Nadya Suleman: Octuplet Mom!

In January 2009, Nadya Suleman, a single mother already of six children under the age of seven, gave birth to octuplets. All 14 of her children were conceived by in vitro fertilization. That is an issue all in its self. This extraordinary conception has been the focus of many ethical debates. Why would someone want 14 children all under the age of seven? I have a three year old and to me 14 is suicide, especially when your living conditions are not stable. She is reportedly $23,225 behind on their mortgage payments, which may lead to a public auction on May 5. How is she going to support all of these kids? I think she’s counting on endorsements and possible television show interest to profit from her situation. So that raises the question, did she conceive her children to gain personal and financial benefits? She apparently asked for 2 million dollars in endorsements shortly after the birth of the octuplets. It was also reported that Suleman is in the market to buy a $1.24 million home. But there is no financial benefit in that huh? She has made interviews on several shows, Dr. Phil, Today show, & Dateline just to name a few. To defend herself from selfish accusations, Suleman said that she dreamed of having a "huge family" because she lacked a "feeling of self and identity", but on January 10, 2009 it was revealed that Suleman, who suffers from a "depressive disorder," collected nearly $168,000 for a work-related back injury she sustained in 1999. Is just me or isn’t a vast amount of money being circulated by woman that does not have a JOB! So let make sure I got this right, she receives disability money from the state of California for a “severe” back injury that occurred in 1999, but she is able to give birth eight children. Not to mention she has had other children since 1999 before the octuplets. So how is she going to care for fourteen children? Newborns demand a lot of care and attention and she has eight of them not to mention six other children under seven. I could go all day on this because there are so many angles and that can be explored.

Conscientious Objection

Pertaining to the debate on conscientious objections, I do understand that different people have different values, beliefs, etc. and it is under their own discretion of what they will and will not do, but where do you draw the line. It is the duty of physicians to act in the best interest of the patient. If physicians are able to refuse care to patients because of personal beliefs, then that is diminishing the role of medicine and the duty to care in the best interest of the patient. It would then be in the personal interest of the doctor. Doctors do have a right to refuse care, but letting them refuse care because of personal beliefs broadens the spectrum of prejudice. What if a doctor refuses to treat black people or homosexuals because of his/her personal beliefs? Is that right? People enter the occupational field of Medicine because they want or have a passion for helping people and does that mean filtering the people who he/she helps and cares for. If there is no imminent danger to the physician or patient, I don’t think it is right to refuse care because of personal beliefs because it is a moral obligation for a physician to care for a patient in a patient’s best interest disregarding their own interest.

Spreading a man made epidemic!

“Smallpox vaccine triggered AIDS virus” read the front page of the London Times newspapers on May 11, 1987. The story suggested that the smallpox eradication vaccine program which was sponsored by the World Health Organization (WHO) was responsible for the emergence of HIV/AIDS in Africa. The smallpox vaccine connections to AIDS explains why Brazil, which was the only South American country covered in the WHO eradication campaign, has the highest incidence of AIDS in that region. Robert Gallo, a co-discoverer of HIV and director of the Institute of Human Virology, stated "The link between the WHO program and the epidemic is an interesting and important hypothesis. I cannot say it actually happened but I have been saying for some years that the use of live vaccines such as that used for smallpox can activate a dormant infection such as HIV." This raises a very controversial question. Was AIDS really introduced in Africa during the WHO vaccine program?

This is very controversial topic that has ignited the notion that HIV/AIDS is a man made disease and “us” humans were the test subjects. I find it very hard to believe that HIV/AIDS is not manmade and the fact that the WHO aided in its emergence around the world makes me believe that at any time we all can become “lab rats” without giving any consent. AIDS has the highest prevalence in Sub-Saharan “Black Africa” where the vast majority of the people are dark skinned. “I’m not gonna even jump into this big racial spill but facts are facts.” Or maybe the fact that in the US, the virus was thought to only be a homosexual disease, “but I’m not gonna get into a big spill about prejudices either”. The HIV/AIDS epidemic gives me the feeling I felt the first time I heard about The Tuskegee Syphilis Experiment. Except in this case it is on a much larger scales and more lives have been sacrificed, but for what? Science? Is it not wrong to target human beings and make them your “lab rats”? Experimenting on human being especially to the extent of giving people HIV/AIDS or letting them live with Syphilis to monitor the effect it has on humans if untreated is devaluing the life of a human being. We have come so far in society but yet we are still so far away from where we need to be.

PHYSICIAN AIDED SUICIDE

I’m a bit of indifferent on this topic, mainly because there are so many different circumstances that can alter your decision on whether it’s right or wrong. I agree that under certain parameters with specific guidelines and laws governing the process of physician aided suicide, it could be beneficial to our society, which is a society with rising health care cost, a growing aging baby boomer population, coupled with a looming recession. But it is still murder at the same time. If a patient wants to die because of a terminally ill disease or state, is it the doctor’s duty to “KILL” them? I don’t think it is! It undermines the profession of being a doctor. It may be more efficient economically, but if we start putting a cost on someone’s life, where do we draw the line? If you allow doctors to aid patients to death then you leave open the opportunity of moral hazard and both patients and doctors taking advantage of the system. There is always going to be that factor of abuse. It may be a good idea in some circumstances, but a part of me fears that if you allow it, it will be abused. I feel terrible about and do not agree with letting patients suffer, but to the extent of the doctor KILLING them, what kind of a psychological effect would that leave on a doctor? What if you were a doctor and you were asked to kill someone? Would you do it? If so, does this make you a murderer? That is the dilemma.

RESTRICTION AND LAWS ON ABORTION: WAITING PERIODS

I think there should be a waiting period on abortion so the mother can have the chance to make a well-though out informed decision. There should be a grace period for the mother to think about her possible choice and what that choice is going to mean in the future. What impact is the choice going to have on the mother? A pretty big one no matter whether she aborts the fetus or not. The choice is going to impact the mother’s life. With no waiting period there are reckless abortion being performed and I have encountered several women that have experience sever emotional damage due to an abortion because they believe that they made an impulsive decision too soon. Once the fetus is aborted, it’s gone! Forever! You can’t get that child back. We are talking about life or death for a human fetus, so there should be at least a grace period for additional thought, information, counseling, or other resources to make a rational decision about the child. I think the waiting periods should be more than 24 hours. I think it should be at least 5 days to ensure that there are no external pressures or influences forcing a mother to make such a pivotal decision. In most states a person has to wait 5 days to purchase a hand gun to purchase a grace period that eliminates the retaliation factor. The way a mother may feel after conception or finding out she is pregnant may exhibit an immense amount of stress, anxiety, and even fear on her at that time and for her to be able to make an impulsive decision on something that is going to affect more than just her life is not, in my mind, right. If the mother is made to wait five days then you will see that her thought process on day 5 is very different than her thought process on day 1. If she really wants to abort the fetus then there shouldn’t be a problem with waiting because whether or not she can get it on day 1 or wait till day 5 she is still going to get it regardless. The only way I could see a person able to get an abortion as soon as possible is in an emergency situation.

Dilemma: Attacked by Indians

In class the dilemma was presented that a woman and her children are hiding in a cabin that is being attacked by Indians. If one of the babies starts crying, should she suffocate it to save the rest of the children and herself?

I believe that she has the make the choice the serves to the greater good of her and her children. We are clearly not talking about something happening in a civil American society, so I don’t think we can analyze the situation the same as we would in our society because our life and situation is much different. Just look at the Darfur situation where 35 African Fur tribe villagers were killed in 2002 when bandits raided their village looting and killing everyone they found. If the woman from the dilemma had a safe haven or secure hiding spot of protection, in order to save the rest of her kids and herself, I think, she should suffocate the crying baby. Its either one die or they all die. That is the choice she is presented with. In stressful dilemmas where life or death situations are presented the world is no longer governed on a moral or ethical code. It’s now a survival code! Take away civilization and you take away moral code and ethics because it is all created by man living in a civil society. We live in a civil society so we hold things like morality, virtue, and ethics high, but someone living in tribe or out in nature holds survival high. In the dilemma with the woman and her kids she has to sacrifice one to save many. To let her child cry is to say that one of her child’s life is more important that the livelihood of all of her children and her. It’s not about right or wrong because no matter the situation it is always wrong to take a life, but she had to ensure the survival of her and her children. “Live to see another day!” American society and any society in general are built on making sacrifices for the greater good of the society. It’s different than the thousands of troops dying in war for the greater good of the millions living in the United States.