Full Year Notes for PHL283

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Jonathan Peterson

PHL283 th January 6 Bioethics - deals with moral problems that arise in particular in the practise of medicine, healthcare, research involving the two, in policy setting that has to do with healthcare - moral issue that arises fair distribution of healthcare resources o consider what the province will pay for is it fair to refuse something like in vitro-fertilization o expensive/more experimental cancer treatments o do people have a right to have healthcare provided by the state? - the problem of abortion is it permissible under what circumstances o are there moral grounds to say its wrong? - research in medicine the relationships with the researchers are the subjects the issues of clinical trials o test drugs, procedures, etc. o most clinical trials are conducted in the developing world dont have access to healthcare, wont be getting good care after the trial o is it acceptable to test drugs on people, without knowing the future effects o is this exploitation? - physician/patient relationships healthcare workers and the patients o confidentiality o refusal of treatment religious beliefs constrain should you respect the patients beliefs? - how do morality and law relate to one another? o morality has to shape the law in various issues o ex. how do we define informed consent ex. signing forms - how do we define the difference between morality and ethics? o morality actual rules whereas ethics is more philosophical thinking o but regardless, its philosophical thought of right and wrong interchangeably in this course - thinking carefully and critically and using moral reasoning to answer how we should approach the cases below - 4 principles: o 1. Respect for Autonomy autonomous persons should be allowed to exercise their capacity for self-determinism o 2. Beneficence: we should do good to others and avoid doing them harm o 3. Utility: we should produce the most favourable balance of benefit over harm for all concerned cost benefit analysis o 4. Justice: equals should be treated equals like cases should be treated alike what are the obligations of people? what do we owe to the people who have been bad to their bodies are people entitled to certain things The Case of Isabelle Dinoire - in 2005, received the worlds first partial face transplant - was suffering from depression unemployed, divorced, mother - took sleeping pills and passed out accidentally overdosed version 1 o intentionally overdosed on sleeping pills version 2 - had a pet black lab who bit her very severely and chewed off the lower half of her face o lips/chin/most of nose was gone - was taken to the hospital and was treated muscles contracted and she couldnt open her mouth that much couldnt eat solid foods - became seriously disfigured such that the bone of her jaw was visible she wore a surgical mask to cover her face - doctors though she would be a good candidate for a face transplant experimental but was this the right thing to do in the situation? - who gets the make the decision about what is to be done? the doctor, Isabelle, team? - what kinds of things do we take into account what kind of factors are relevant in this situation to decide if she gets the transplant? - 1. concern about risk and benefit what about other options reconstructive surgery o are the benefits outweighed by the risks? perhaps the something else with a lower benefit, but much lower risk o always the risk that the body will reject the transplant o costs to the patient? o benefits are not so easy to assess how successful will it be in terms of physical scarring, movement regained in her face, feeling regained in her face - 2. issue of consent is someone in her position to truly consent to this procedure o not simply yes or no people have to understand what will be done, their risks and benefits, their options must be in the position to assess that information - 3. the doctors motivations o why were the doctors pushing this option as opposed to the others available o what does this mean for the doctor? prestige and recognition glory and publicity would it be wrong for the doctor to include that in his/her reasoning? o social benefit not just the benefit to the patient this is a learning opportunity and a stepping stone for future surgeries it may be risky for her, but the payoff to society is terms of new knowledge could be significant weigh the social benefit to the benefit of the patient is it even appropriate to bring social benefit into consideration? - 4. is she a good candidate for this type of operation? o is she emotionally stable to keep up the drugs, and rehab o will she be able to deal with the publicity that comes with this given her previous lifestyle The Case of Robyn Twitchell - in 1986 (2 years old at the time), was at home with her parents and after eating dinner she started vomiting and screaming parents were Christian scientists and defined being sick as the absence of being God is absent - what would the appropriate treatment be? mental and spiritual healing illness is not physical, but spiritual - brought in a Christian scientist nurse who sang hymns and such Robyns condition worsened and at some point she died - the problem was a bowel obstruction could have been treated and she would have survived - Robyns parents were arrested and charged with involuntary manslaughter failure to provide the care that she needed o should parents be able to control or prevent children access to medical care based on religious beliefs o how do we decide on cases like these? what sorts of things do you appeal to? PHL283 th Jan 13 - what is the principle of autonomy? o governance right to make your own decision respect for their right - physician-patient relationship - paternalism Starson - in and out of mental institutions suffers from bipolar disorder o mood shifts/wildly varying energy levels - suffers from serious delusions believes he is a scientist etc. - trained in physics cares about it - he has a history of making death threats against people o gets in trouble with the law o not criminally responsible for the threats on the basis of his condition committed to an institution for 12 months - involuntarily - you believe over time, his condition has been getting worse o without treatment, he will not get better and not be able to live a life outside an institution and function in a society - there is a new medication, and you have good reason to believe that it will help him lead a normal life o Starsons response? doesnt want to take the medication dulls his mind - cannot think clearly stifles his creativity no interest in taking the medication sees no benefit - given the fact this person is mentally ill, why should his decision matter? - what should be done? - raises questions about the patients role in medical decision making o conflict between autonomy and other values promoting the well being of the patient obligation of heath care workers? - what happened? o the courts decided that since he understood that he was ill, and he understood what the results of refusing the medication will be, he was competent enough to make his own decision to refuse it 4 Models Emanuel & Emanuel - 4 variables in which the models differ from each other o A. the goals/purposes of the physician-patient relationship o B. the duties/obligations of the physician o C. the role of the patients values o D. whats the conception of autonomy that the 4 models offer and how do they differ 1. Paternalistic Model - fatherly or parental model where the doctor knows best - no longer the dominant model o A. promoting the patients well being and health o B. patients interests are paramount objective values health what should you do for the patient/what does the patient want patient might be confused, but they should want those things physicians do their best to promote those values and do whats best for them even if they dont want to accept it o C. what does the patient want? what SHOULD the patient want? o D. - what
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