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HLTH241-14W Ethical Issues in Health Care
List of potential discussion topics
“I had my DNA picture taken.” NY Times 2013-12-30. Author had DNA profile done by 3 labs.
Results & explanation varied significantly between labs. Ethicist Arthur Caplan is quoted in the
article. Ethical issue raised: privacy; potential for abuse if results acquired by employer, insurer,
litigant, etc.; government regulation of medical advice; paternalism; how much should patients
be told and by whom.
Palliative care helps patients and their families have the tough conversations. Johns Hopkins
Magazine, Winter 2013. Describes good and bad ends of lives, with examples of both.
Describes how palliative care has evolved at Johns Hopkins Hospital. Includes examples of
misconceptions about end-stage chemotherapy and CPR: many patients and family members
overestimate the probability that such measures could cure or save them (NEJM 2012 article is
referenced). Ethical issues: end of life care, dying with dignity,
“Breast Cancer Screenings: What We Still Don’t Know.” NY Times 2013-12-29. The ratio of
lives saved to false alarms and overdiagnosis and overtreatment due to breast and prostate cancer
is not well understood. To find out what the ratio is would require extensive, lengthy, and
expensive studies (but the cost would be small compared to the amount spent annually on
overtreatment). The author is a physician scientist who focusses on breast cancer screening and
has a forthcoming article on this topic in JAMA. This article does not address ethical issues in a
direct way. Relevant ethical issues include allocation of health care resources, balancing of costs
and benefits, informed consent.
Patients deserve the truth: health screening can do more harm than good. Guardian (London)
2014-01-03. Similar to 2013-12-29 article in NY Times.
A Brain Is Dead, a Heart Beats On. NY Times 2014-01-05. Doctors say 13 year old girl is brain
dead, but her heart is beating. Hospital wants to discontinue mechanicial ventilation, but parents
say she is still alive and have gone to court. Ethical issues: defining end of life, parental rights
versus hospital rights.
Butler, K. (2010). What broke my father’s heart. The New York Times Magazine. Retrieved from
www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html. End of life care, nonmalifecence.
Ethics: Deactivating a Cardiac Pacemaker: Is it Ethical? Hosmer-Cernava, H. OJIN: The Online
Journal of Issues in Nursing Vol. 18.
Physicians and the (Woman's) Body Politic. Charo, RA. NEJM 2014. DOI:
10.1056/NEJMp1313499. Author reviews legislation related to abortion and pregnancy and
legislative intrusion in the doctor-patient relationship, as well as what the author says is incorrect
claims of fact that are part of some such legislation.
Pregnant, and Forced to Stay on Life Support. NY Times 2014-01-08. A pregnant brain dead
woman is kept alive despite her wishes, as expressed by her husband and parents. At 14 weeks
gestation, the fetus is not viable outside the womb and abortion would be legal. The hospital
says pulling the plug would violate Texas law. Some bioethicists dispute the law and the
hospital’s interpretation of the law.
Medicaid Policy on Sterilization. NEJM 2014. In 1960s and 70s, there was evidence that female
sterilization was done disproportionately to poor and minority women, so Medicaid (government
health insurance program for the poor) implemented strict new regulations and a consent form.
The authors argue that this now prevents some poor and minority women from getting tubal
ligation when they want it. The authors argue for a revised informed consent form and reducing
or eliminating the 30 day waiting period.
When a patient declines curative care. Lamba S et al. (2013) Western J Emerg Med 14: 555-558.
Retrieved from Medscape.com 20140107. Case study. 71 y.o. patient in ED has abdominal
aortic aneurysm. Likely to die in hours to days without surgery. Mentally competent. She also
has lung cancer, previously diagnosed. She declines the surgery. Authors identify and address
the following issues, among others:
Issue#1 Refusal for Curative Care (Surgery) and Assessing Decision-making Capacity
Issue#2 Shared Informed Decision-making (Goals-of-Care ED Discussion)
Most Talked About Ethical Issues, Medscape Business of Medicine (MBM)
Deciding on Death While Traumatized and Under Pressure? A man suffered a tragic, sudden
accident and woke up paralyzed and with a breathing tube. Doctors asked him whether he
wanted to continue living. Should they have waited? MBM, Dec. 2013.
What's the Right Way to Apologize if You've Made an Error? Some doctors wonder whether
it's wise to apologize if they've made an error. MBM, Dec. 2013.
Should You Report a Colleague Who Makes a Medical Error? Some doctors who have
informed administrators about another physician who made a medical error were called
'snitches' or 'rats.' MBM, Dec. 2013
The Law: Get a Flu Shot or Wear a Mask, Healthcare Workers! New York State has made
it a law that healthcare workers either get a flu shot or wear a mask. MBM, Nov. 2013.
Vocal Cord Operation on Constantly Screaming Autistic Teen? A Wisconsin family was at
their wits' end when their 16-year-old autistic son screamed as loudly as he could about 1000
times a day. They okayed an operation that lessened the sound. Was this wrong? MBM,
Nov. 2013.
Will New Genetic Tests Lead to More and Earlier Abortions? New blood tests that screen
fetal cells for genetic conditions/predispositions may replace amniocentesis someday, but
will women decide to abort fetuses who, as adults, might get a disease? MBM, Oct. 2013.
Kick Out Fat People to Lower Healthcare Costs? Obesity creates health problems, and the
New Zealand government dealt with one overweight couple by deporting them. MBM, Oct.
2013.
YOUR Fault if Your Unvaccinated Child Makes Someone Sick. Some parents choose not
to have their child vaccinated, but then it is also their responsibility to keep an ill child from
infecting others. MBM, October 2013.
Why Can't You Be Friends With Your Patients? Being friends with your patient could
distort your medical judgment. MBM, Oct. 2013.
Is It Ethical to Tweet From Someone's Deathbed? People share the most private moments
on social media, even when someone is at death's door. Is this an invasion of privacy?
MBM, Oct. 2013.
What if a Patient Gives You an Outrageously Expensive Gift? Accepting a small gift from
a patient seems perfectly fine, but what if you receive a very costly gift that has the potential
to influence the care you give? MBM, Sept. 2013.
Deny Organ Transplants to Marijuana Users? It has been said that people who use
marijuana shouldn't receive transplants because they may have liver damage or they may not
comply with medical regimens. Is it time to revisit that guideline? MBM, Sept. 2013.
Why Brain Death Should Be a Legal Fiction. Brain death is clearly not 'clinical' death, but
using a legal fiction to make it 'as good as dead' would allow organ harvesting and other
situations. MBM, Sept. 2013.
Death of the Brain Is Not the Death of the Human Being. Are physicians inventing
definitions of death merely to make it convenient for them to use organs for another patient?
MBM, Sept. 2013.
Brain Death: You're Legally Dead Despite Your Beating Heart. When the brain no longer
functions, the patient should be considered dead, says this neurologist. Official definitions
back him up. MBM, Sept. 2013.
Children Shouldn't Automatically Receive Organ Transplants Should a child receive lungs
even if she is not the best transplant candidate? MBM, Aug. 2013.
Science Gone Crazy? Cord Blood to Trap Sex Offenders. Mississippi passed a law enabling
the use of cord blood to identify older men who had sex with underage girls. Is it ethical for
doctors to comply with this? MBM, Aug. 2013.
Doctors and Nurses Should Be Drug-Tested -- Get Used to It. Many doctors consider
mandatory drug testing for health professionals an insult, but if we're going to improve
quality of patient care, it makes sense. MBM, Aug. 2013
Medical Marijuana: OK for Kids, but Not as First Treatment. If adults can have medical
marijuana, why can't kids? There may be dangers to take heed of, but if the active ingredient
is helpful for young patients, they should be able to have it. MBM, July 2013.
Organs Donated by Prisoners? No, No, No! It has been suggested that using organs
voluntarily donated by prisoners could help ease the shortage. MBM, June 2013.
Is Patenting Genes Fair to Society? A company identified the relationship between a
certain gene and increased breast cancer risk. They patented that association. MBM, June
2013.
Get Real: No Need to Overdo Risk Disclosure. In a recent study testing optimal oxygen
levels in premature babies, researchers were called 'unethical' because some felt their risk
disclosures were not strong enough. MBM, June 2013.