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Week 1: Culture and Spirituality
Learning Objectives for Cross-Cultural Care and Communication
article:
1. Define culture.
a. A system of beliefs, values, rules, and customs that is
shared by a group and is used to interpret experiences and
direct patterns of behavior
b. Plays a large role in shaping individual health-related values,
beliefs, behaviors, and impacts clinical care
2. List core values needed to provide effective cross-cultural care.
a. Empathy, curiosity, and respect
3. List the four components of the patient based approach.
a. Assessing core cross-cultural issues; exploring the meaning
of the illness; determining the social context; and engaging
in negotiation
4. List the five core cross-cultural issues that should be taken into
account.
a. Styles of communication; mistrust and prejudice; decisionmaking and family dynamics; traditions, customs, and
spirituality; and sexual and gender issues
5. Discuss how to determine the social context.
a. Manifestations of illness linked to individual’s social
environment
b. Not limited to socioeconomic status; encompasses
migration history, social networks, literacy, etc.
c. Three aspects have particular relevance to clinical
encounter: change in environment (such as migration);
literacy and language; and life control, social stressors, and
supports
6. Define “health literacy”.
a. Understanding about the causes, consequences, and
appropriate treatment of illness based on medical
information
Learning Objectives for Religion, Spirituality, and End of Life Care
article:
1.
Define religion and spirituality.
a. Religion: refers to an organized faith system of beliefs,
practices, rituals, and language that characterize a
2.
3.
4.
community searching for transcendent meaning in a
particular way, generally based on belief in a divine being
b. Spirituality: that which gives ultimate meaning and purpose
in an individual’s life; can be expressed in religious beliefs
and practices; can include a relationship with God/Divine or
a higher power, or with family, or with cultural communities
i. Involvement may be through formal religious rituals
or sacraments, or through interactions with nature,
humanity, or the arts
ii. Continuous process that changes over a person’s
lifetime, affected by illness and dying
Discuss the spiritual history tool FICA.
a. Stands for Faith/beliefs, Importance/Influence, Community,
Address in care
b. Can be a helpful starting point to open conversation about
importance of beliefs, faith community, and intersection
with health care
Differentiate the different types of spiritual care providers.
a. Chaplains: graduate level theological degree, certified by
one of five organizations after completion of 2-year training
program (Clinical Pastoral Education, CPE)
i. Qualified to work with patients of any religious
denomination, those who aren’t religious or don’t
identify as spiritual
b. Non-chaplain clergy: provide more religiously-oriented care,
usually with patient of same religious denomination
c. Pastoral counselors: mental health counselors with
advanced degree (masters, PhD) who have additional
training in spiritual, existential and religious issues
d. Spiritual directors: work with patients to deepen
relationship with divine power/higher being/transcendent
Discuss the practices of the major world religions as they relate
to health care.
a. Buddhism
i. Life is filled w/pain and suffering that can be
overcome
ii. Spiritual practices: meditation, contemplation, precept
practice, yoga, and chanting
iii. Dietary restrictions: differ amongst different branches
iv. Death: belief in rebirth, heaven, hell, and pari-nirvana
v. Dying person’s state of mind is important; to achieve
peace of mind, family, friends and monks read
religious texts and repeat mantras to dying person;
assist passing into next life
vi. When the mind is no longer alert or person is in
excessive pain, natural death is preferable
b. Christianity
i. Acceptance of suffering to deepen union with God;
may be seen as punishment for sin
ii. Spiritual practices: prayer, sacraments, rituals,
meditation, and formal religious services
iii. Dietary restrictions: varies with tradition, fasting on
particular religious holy days, some abstain from
eating meat on certain days, hospitalized or ill
patients are excused
iv. Death: seen as a natural part of life; family, friends,
priests, or ministers pray or sing at the bedside of a
dying person
v. Ethical issues: influence on end of life care and organ
donation decisions vary; emphasis on respect for and
value of life, as well as quality of life and dignity
c. Islam
i. Suffering is caused by alienation from the will of Allah
and relieved by total surrender to His will
ii. Spiritual practices: Five Pillars of Islam, daily required
periods of prayer
1. Ill patients still required to perform 5 daily
prayers by prostration and bowing as long as
condition allows; afterwards prayer is to be
performed in best position allowed by condition
iii. Dietary restrictions: rigid, no pork or alcohol, must
wash specific body parts before prayer
iv. Death: creation, death, and resurrection linked; dying
Muslims want to lie facing Mecca; family members
repeat prayers, reciting key verses of Islamic scripture,
encouraging patient to repeat statement of faith
1. Body isn’t considered dead until cold and rigor
mortis sets in; eyelids are closed and jaw is
closed/bound; within 24 hours, body must be
washed, anointed, shrouded, prayed over, and
buried
v. Ethical issues: human life is highest value, physician-
assisted suicide is prohibited
1. Permissible to use life support to save and
extend life, aggressive medical intervention
cannot clearly interfere with will of God and
natural course of life and death
2. Not permissible to cause harm to the patient
with equipment or drugs when futility of
treatment is established
3. Withdrawing care permissible in 2
circumstances: when dx of brain death is made,
and when current tx, curative or palliative, is no
longer curing or palliating
4. Organ donation is permissible, must not delay
burial
d. Hinduism
i. Suffering is caused by karma from bad deeds carried
out in this or a past life, physical or mental
ii. Spiritual practices: devotion to God/gods; performing
selfless good deeds; studying holy texts; meditating
on God/gods
iii. Dietary restrictions: mostly vegetarian, may avoid
onions or garlic
iv. Death: viewed as death of the body and separation of
the eternal soul from the body; soul will reenter
another body or attain salvation
1. At death: remove from bed and place on ground;
pour holy water into mouth; recite mantra of
favorite god; light lamp at head of corpse when
person dies
v. Ethical issues: mercy killing, assisted suicide, and
suicide are disapproved of; allowing “nature to take its
course” is acceptable
1. Living will and organ donation are individual
choices
e. Judaism
i. No particular spiritual connotation, avoid as much as
possible, attempt to relieve world of pain and suffering
ii. Spiritual practices: prayer is a staple; study of sacred
texts
1. People visiting the ill may help them create
Jewish ethical will, in which person tells family
story, describes what is important to him/her,
articulates hopes for future of family and world,
and expresses love
2. Fasting practiced during Yom Kippur, excused for
severely ill patients
iii. Dietary restrictions: Kashrut – fish with scales and fins
(no shellfish); domestic fowl (no birds of prey);
animals whose hooves are parted and who chew their
cud; specific slaughter of fowl and animals (blood
drained from meat); no dairy products with meat meal
1. Some are vegetarians
iv. Death: everything must be done medically to save life
and health, but death is a natural part of life
1. Someone stays with body from moment of death
until burial, reciting Psalms; ideally buried same
day before sundown
2. Not acceptable to perform an autopsy to “benefit
future patients” or medical science
v. Ethical issues: most prohibit assisted suicide but allow
withholding or withdrawal of life support systems
(including artificial nutrition and hydration); donation
of organs for transplant is encouraged
Week 2: Introduction to Medical Law,
Ethics, and Bioethics
Assigned Readings and Corresponding Learning Objectives:
Medical Law and Ethics text, Chapter 1 (Introduction to Medical Law,
Ethics, and Bioethics), pages 1-28
Learning Objectives:
1.
Define the glossary (key) terms – page 1.
a. Amoral – lacking or indifferent to moral standards
b. Applied ethics – practical application of moral standards to
conduct of individuals involved in organizations
c. Bioethicists – persons who specialize in the field of bioethics
d. Bioethics – moral dilemmas and issues of advanced
medicine and medical research
e. Comparable worth – theory that extends equal pay
requirements to all persons doing equal work
f. Compassion – ability to have a gentle, caring attitude
towards patients and fellow employees
g. Cost/benefit analysis – ethical approach in which benefits of
the decision should outweigh the costs
h. Due process – entitlement of all employees to have certain
procedures followed when they believe their rights are in
jeopardy
i. Duty-based ethics – focuses on performing one’s duty to
various people and institutions
j. Empathy – ability to understand feelings of another person
without actually experiencing pain or distress that person is
going through
k. Ethics – branch of philosophy relating to morals and moral
principles
l. Fidelity – loyalty and faithfulness to others
m. Indigent – a person who is impoverished and without funds
n. Integrity – unwavering adherence to one’s principles;
dedication to maintaining high standards
o. Justice-based ethics – based on moral restraint of “veil of
ignorance”
p. Laws – rules or actions prescribed by a governmental
authority that have a binding legal force
q. Litigious – excessively inclined to sue
r. Medical ethics – moral conduct based on principles
regulating behavior of healthcare professionals
s. Medical etiquette – standards of professional behavior that
physicians use for conduct with other physicians
t. Medical practice acts – laws established in all fifty states
that define the practice of medicine as well as requirements
and methods for licensure in a particular state
u. Morality – quality of being virtuous or practicing right
conduct
v. Precedent – ruling of an earlier case that is then applied to
subsequent cases
w. Principle of autonomy – right to make decisions about one’s
own life
x. Principle of beneficence – action of helping others and
performing actions that result in benefit to another person
y. Principle of justice – warns us that equals must be treated
equally
2.
3.
4.
z. Principle of nonmalfeasance – means “First, do no harm.”
aa.
Quality assurance – gathering and evaluating
information about services provided as well as results
achieved and comparing this information with accepted
standard
bb.
Rights-based ethics – natural rights ethical theory that
places primary emphasis on person’s individual rights
cc.
Sanctity of life – sacredness of human life; all human
beings must be protected
dd.
Sexual harassment – unwelcome sexual advances or
requests for sexual favors
ee.
Sympathy – pity for someone else
ff. Tolerance – respect for those whose opinions, practices,
race, religion, and nationality differ from our own
gg.
Utilitarianism – ethical theory based on principle of
greatest good for the greatest number
hh.
Virtue-based ethics – character trait based on concern
for the person
Describe the similarities and differences between laws and
ethics.
a. Laws – rules or actions prescribed by an authority that have
binding legal force
i. Address legal rights and obligations that affect
patients and protect individual rights
ii. Some illegal action are ethical
iii. Many unethical actions are not illegal
iv. In general, an illegal act is always unethical, but an
unethical act may not be illegal
b. Ethics – branch of philosophy relating to morals, moral
principles, and moral judgments
i. Always involves people
ii. Always involves formal consideration of the interests
of others in deciding how to act or behave
Discuss the reasons for studying law, ethics, and bioethics.
a. Understand litigious society
b. Protection from being sued
c. Develop strong ethical values
d. Knowledge of protection during states of emergency
e. Assist in making sound decision based on reason and logic
Describe how to apply the three decision-making models
discussed in this chapter.
5.
a. Is it legal? Is it balanced? How does it make me feel?
i. Illegal = unethical
ii. Determine if another person or group of people is
negatively affected by the action
iii. How will the action affect you emotionally?
Explain why ethics is not just about the sincerity of one’s beliefs,
emotions, or religious viewpoints.
a. Ethics must be grounded in reason and fact
b. Ethics may overlap with religious teachings of right and
wrong, but very strong ethical and moral beliefs can exist
without formal religion
AOA Code of Ethics and AOA Interprets Sections of Code of Ethics
http://www.osteopathic.org/inside-aoa/about/leadership/Pages/aoa-code-ofethics.aspx
http://www.osteopathic.org/inside-aoa/about/leadership/Pages/aoa-code-of-ethicinterpretation.aspx
Learning Objectives:
Review the sections of the AOA Code of Ethics with particular attention
to section 17.
Section 17. From time to time, industry may provide some AOA
members with gifts as an inducement to use their products or services.
Members who use these products and services as a result of these gifts,
rather than simply for the betterment of their patients and the
improvement of the care rendered in their practices, shall be considered
to have acted in an unethical manner.
2.
List what the physician-patient relationship must be founded on.
- Mutual trust, cooperation, and respect
3.
Discuss what is meant by abandoning a patient.
- Abandoning a patient means that a physician withdraws from the
case without giving due notice to the patient or to those responsible
for the patient’s care.
4. Define sexual harassment.
- Physical or verbal intimation of a sexual nature involving a colleague
or subordinate in the workplace or academic setting, when such
conduct creates an unreasonable, intimidating, hostile or offensive
workplace or academic setting.
Week 3: Ethical and Bioethical Issues in
Medicine
Medical Law and Ethics text, Chapter 11 (Ethical and Bioethical Issues
in Medicine), pages 263-289
Learning objectives:
1.
Define the glossary (key) terms – page 263.
a. Alleges: to assert or declare without proof
b. Censure: to find fault with, criticize, or condemn
c. Chromosomes: threadlike structures within the nucleus
(center) of a cell that transmit genetic information
d. Clone: group of identical matching cells that come from a
single common cell
e. Control group: research subjects who receive no treatment
f. Double-blind test: a research design in which neither the
experimenter nor the patient knows who is getting the
research treatment
g. Euthanasia: the administration of a lethal agent by another
person to a patient for the purpose of relieving intolerable
and incurable suffering
h. Expulsion: the act of forcing out
i. Gene markers: list of genes that are responsible for disease
j. Gene therapy: the replacement of a defective or
malfunctioning gene by splicing or connecting onto the DNA
of body cells to control production of a particular substance
k. Harvested: removed organs or embryos
l. Human genome: the complete set of genes within the 23
pairs of human chromosomes
2.
3.
m. Human Genome Project: a research program funded by the
federal government to “map” and sequence the total
number of genes within the 23 pairs, or 46 chromosomes
n. Institutional Review Board (IRB): a hospital or university
board of members who oversee any human research in that
facility
o. National Organ Transplant Law of 1984: federal law that
forbids the sale of organs in interstate commerce
p. Nontherapeutic research: research conducted that will not
directly benefit the research subject
q. Placebo group: research in which an inactive or alternative
type of treatment is given
r. Posthumous: after death
s. Revocation: the act of taking away or recalling, such as
taking away a license to practice medicine
t. Social utility method of allocation: a method of determining
the allocation of organs by giving them to people who will
benefit the most
u. Stem cells: master cells in the body that can generate
specialized cells
v. Therapeutic research: a form of medical research that
might directly benefit the research subject
w. United Network for Organ Sharing (UNOS): the legal entity
in the United States responsible for allocating organs for
transplantation
List and discuss at least ten bioethical issues the modern
physician and health care professional face.
a. Abortion, allocation of scarce resources, cloning,
determination of death, euthanasia (active and passive),
fetal tissue research, genetic counseling, harvesting of
embryos, HIV/AIDS/ARC, in-vitro fertilization, organ
donation and transplantation, quality-of-life issues, random
clinical trials, stem cell research, sterilization, surrogate
parenthood, withdrawing treatment, withholding lifesaving
treatment
Describe how an ethical decision-making model, such as the
Seven-Step Decision Model, can be used when confronted with
difficult ethical dilemmas.
a. This model allows for careful analysis of the facts in order to
make an ethical decision. It avoids rash decision-making.
b. Determine facts by asking following questions: What do we
4.
5.
6.
need to know? Who is involved in the situation? Where does
the ethical situation take place? When does it occur?
c. Define the precise ethical issue.
d. Identify the major principles, rules, and values.
e. Specify the alternatives.
f. Compare values and alternatives
g. Assess the consequences
h. Make a decision
Discuss ethical issues relating to genetic testing.
a. Effect on human dignity  control creation of “defective”
human beings
b. Health risks from mutation of genes
c. Emotional risks
d. Abuse of the technology
Describe the advances in human stem cell research.
a. Removal of a single cell to preserve the embryo
b. Blood stem cells can regenerate specialized cells to treat
blood disorders
Summarize the ethical issues of organ transplantation.
“Medical suitability”  medical need and medical benefit to individual
patient
Allocation of local resources  funding for Medicaid vs. Organ
transplantation in Oregon
Live donation  health concerns of both the donor and recipient
5.
Discuss the importance of codes of ethics such as the
Nuremberg Code. (Appendix A).
a. Voluntary consent of human subject is essential, person
needs legal capacity to give consent, exercise free power of
choice (no coercion or force), should have sufficient
knowledge and comprehension to make an informed
decision
b. Ascertaining consent is responsibility of person who
initiates, directs, or engages in the experiment
c. Experiment should yield fruitful results for good of society,
unprocurable by other means or methods of study, not
random or unnecessary
d. Designed and based on results of animal experimentation
and knowledge of natural history of disease or other
problem under study
e. Conducted to avoid all unnecessary physical and mental
suffering and injury
f. No experiment conducted when there’s a priori reason to
believe death or disabling injury will occur
g. Degree of risk taken cannot exceed that determined by
humanitarian importance of the problem to be solved by the
experiment
h. Proper preparations must be made to protect subject
against remote possibilities of injury, disabilities, or death
i. Experiment should be conducted only by scientifically
qualified persons
j. Human subject should be at liberty to end experiment if he
has reached physical or mental state where continuation of
experiment seems impossible
k. Experimenter must be prepared to terminate the
experiment at any stage if he has probable cause to believe
that continuation of the experiment is likely to result in
injury, disability, or death to the subject
Week 4: Ethical Issues Relating to Life
Learning objectives:
1.
Define the glossary (key) terms – page 291.
a. Amniocentesis: test for the presence of genetic defects
in which a needle is used to withdraw small amount of
amniotic fluid that surrounds fetus in uterus
b. Anencephalic: missing a brain and spinal cord
c. Artificial insemination: injection of seminal fluid that
contains male sperm into female’s vagina from her
husband, partner, or donor by some means other than
sexual intercourse
d. Artificial insemination donor (AID): procedure in which
donor’s sperm is used
e. Artificial insemination husband (AIH): procedure in
which sperm from woman’s husband or partner is used
f. Child Abuse Prevention and Treatment Act: prohibited
withholding of medical treatment solely because the
2.
infant is disabled
g. Contraception: birth control
h. Embryo: unborn child between the second and twelfth
week after conception
i. Eugenic (involuntary) sterilization: sterilization of
certain categories of persons, such as the insane, in
order to prevent them from passing on defective genes
to their children
j. Eugenics: science that studies methods for controlling
certain characteristics in offspring
k. Fetus: unborn child from the third month after
conception until birth
l. Gestational period: time before birth during which the
fetus is developing, usually nine months
m. Harvested: removed organs or embryo
n. Induced abortion: abortion caused by artificial means
such as medications or surgical procedures
o. In-vitro fertilization (IVF): process of combining ovum
and sperm outside of a woman’s body
p. Preimplantation genetic diagnosis (PGD): genetic
testing on embryos for genes that cause untreatable or
severe diseases
q. Safe Haven Laws: safe alternatives to leaving babies in
unsafe places when a parent voluntarily gives up
custody
r. Spontaneous abortion: termination of pregnancy that
occurs naturally before the fetus is viable
s. Sterilization: process of medically altering reproductive
organs so as to terminate ability to produce offspring
t. Surrogate mother: woman who agrees to bear a child
for another couple. Husband’s sperm is implanted into
the woman’s uterus
u. Therapeutic sterilization: sterilization undertaken to
save the mother’s life or protect her health
v. Unborn Victims of Violence Act: law that provides legal
penalties for any harm done to an unborn child at
federal facilities such as military bases or in crimes that
cross state lines
w. Viable: in the case of a fetus, ability to survive outside
the uterus
Discuss the ethical considerations relating to artificial
3.
4.
5.
insemination.
a. Consent for Artificial Insemination Donor (AID) 
problems arise if donor is not related to woman
i. Husband and wife must both provide written
consent for procedure
b. Legal status of offspring  who is responsible for the
child’s support
i. Written consent makes the husband responsible
for the child’s support
c. Ethical considerations in artificial conception
i. AID records are confidential, same handling as
adoption papers, not part of public record
ii. Resentment may arise from the husband, child
may question their parentage
Describe the Baby M case.
a. Surrogate parenting contract between Mary Beth
Whitehead and Mrs. And Mr. Stern
b. Mrs. Whitehead served as surrogate mother, received
$10,000, inseminated w/Mr. Stern’s sperm
c. Mr. Whitehead kidnapped the child for three months
d. Parental rights were granted to Mrs. Whitehead, but
continuing custody was given to the Sterns in the best
interest of the child, overnight stays and vacations
were allowed with the natural mother
Discuss the ethical considerations relating to surrogate
motherhood and contraception.
a. Potential court battles over custody of child conceived
outside of marriage
b. Potential embarrassment for gestational (surrogate)
mother, actions have been likened to prostitution
c. Potential harm to surrogate mother’s own children
when they learn she has given away one child for
money
d. Future emotional distress when child learns he/she was
deliberately taken away from natural mother
e. Reducing birth to legal arrangement in exchange for
money
List several ethical issues surrounding sterilization and
contraception.
a. Eugenic sterilization is abhorrent to most people,
carries stigma of attempting to determine who shall
6.
live and who shall die
b. Distribution of contraceptive devices by public schools
(receiving federal and state funding)
c. Sterilization for habitual and violent sex offenders
d. Sterilization for women receiving welfare money
e. Hospital refusal to allow sterilization procedures
f. Sterilization of mentally incompetent women
g. Treatment of children as property
h. Destruction of human life for live birth of healthy
children
i. Issues of contraception can interfere with relationship
between husband and wife
Explain the importance of the Roe v. Wade case.
a. Women should be allowed the right to privacy over
matters that relate to her own body, including
pregnancy
Week 5: Death and Dying
Assigned Readings and Corresponding Learning Objectives:
Medical Law and Ethics text, Chapter 13 (Death and Dying), pages
321-344
Learning Objectives:
1.
Define the glossary (key) terms – page 321.
a. Active euthanasia: actively ending the life of or killing a
patient who is terminally ill
b. Brain death: an irreversible coma from which a patient does
not recover; results in cessation of brain activity
c. Cardiac death: death in which the heart has stopped
functioning
d. Cardiopulmonary: pertaining to heart and lung function
e. Comatose: vegetative condition
f. Curative care: attempt is made to cure the patient; the
opposite of palliative care
g. Electroencephalogram (EEG): test to measure brain activity
h. Expired: died
i. Hospice: a multi-disciplinary, family-centered care designed
to provide care and supportive services to terminally ill
patients and their families
2.
j. Hypothermia: state in which body temperature is below
normal range
k. Life support systems: systems such as
ventilators/respirators and feeding tubes, that allow medical
practitioners to sustain a patient’s life
l. Mercy killing: another term for voluntary euthanasia
m. Palliative care: care for terminally ill patients consisting of
comfort measures and symptom control
n. Passive euthanasia: allowing a patient to die by forgoing
treatment
o. Persistent vegetative state (PVS): an irreversible brain
condition in which the patient is in a state of deep
unconsciousness
p. Principle of double-effect: when an action can have two
effects: one that is morally good and desirable and one that
is not
q. Quality of life: the physiological status, emotional wellbeing, functional status, and life in general of an individual
r. Respite care: providing the family with relief from the
responsibilities of patient care
s. Rigor mortis: stiffness that occurs in a dead body
t. Substitute judgment rule: used when decisions must be
made for a person who cannot made his or her own wishes
known
u. Terminally ill: one whose death is determined to be
inevitable
v. Viatical settlements: allows people with terminal illnesses,
such as AIDS, to obtain money from their life insurance
policies by selling them
w. Withdrawing life-sustaining treatment: discontinuing a
treatment or procedure, such as artificial ventilation, after it
has started
x. Withholding life-sustaining treatment: failing to start a
treatment or procedure such as artificial ventilation
Discuss the difference between cardiac and brain-oriented death.
a. In cardiac death, the heart, respiratory and circulatory
function has ceased. Medically trained personnel can make
this determination based on lack of pulse or breathing. It is
considered a legal death.
b. In brain-oriented death, death occurs when there is
irreversible cessation of all brain function. This is based on
3.
4.
the premise that the brain is responsible for all bodily
functions, and once the brain stops functioning, all other
bodily functions will stop. Most states accept this definition
of death.
Describe the Harvard Criteria for a definition of irreversible
coma.
a. Includes consideration of whether the patient:
i. Is unreceptive and unresponsive, with a total
unawareness of externally applied, and even painful,
stimuli
ii. Has no spontaneous movements or breathing, as well
as an absence of response to stimuli such as pain,
touch, sound, or light
iii. Has no reflexes, has fixed dilated pupils, lack of eye
movement, and lack of deep tendon reflexes
Discuss the pros and cons of euthanasia.
a. Pros:
i. Respect for patient self-determination, right to
determine outcome of their lives
ii. Provides a means for harvesting viable organs
iii. Provides relief for the family of a patient with an
irreversible condition or terminal disease
iv. Provides a means to end a terminally ill person’s
suffering
b. Cons:
i. There is no certainty regarding death, many terminally
ill patients have been known to recover
ii. Modern technology may find a cure for a terminal
disease
iii. Families undergoing stress due to financial burden of a
dying relative may be examining euthanasia just to
relieve the burden
iv. If euthanasia is allowed, then it might be used
indiscriminately
v. It is not good for society to have physicians kill
patients or for patients to kill themselves
vi. There is value and dignity in every human life
vii. When physicians and other healthcare professionals
become involved in any form of euthanasia, it erodes
the very ethical basis of the professions
viii. The sick and dying may have a fear of involuntary
5.
6.
euthanasia if euthanasia is legalized
ix. Judeo-Christian beliefs declare that only God has
dominion over life
Provide examples of ordinary versus extraordinary means used
in the treatment of the terminally ill.
a. Ordinary refers to treatments that are morally required,
such as fluids and comfort measures
b. Extraordinary measures refers to those procedures and
treatments that are morally expendable or inappropriate,
such as chemotherapy in the final days of a cancer patient’s
life
List and discuss the five stages of dying as described by Dr.
Kübler-Ross.
a. Denial – refusal to believe that dying is taking place;
patient or family member needs time to adjust to reality of
approaching death; this stage cannot be hurried
b. Anger – patient may be angry with everyone and express
intense anger toward God, family, healthcare professional;
usually taken out on closest person
c. Bargaining – attempting to gain time by making promises in
return; may be done between patient and God; patient may
indicate a need to talk at this stage
d. Depression – deep sadness over the loss of health,
independence, and eventually life; additional sadness of
leaving love ones behind; grieving patient may become
withdrawn
e. Acceptance – reached when there is a sense of peace and
calm; patient makes comments such as, “I have no regrets,
I’m ready to die”; better to let the patient talk and not
make denial comments such as, “Don’t talk like that, you’re
not going to die”
The Osteopathic Oath (included immediately below)
I hereby affirm my loyalty to the profession I am about to enter.
I will be mindful always of my great responsibility to preserve the
health and the life of my parents, to retain their confidence and
respect both as a physician and a friend who will guard their secrets
with scrupulous honor and fidelity, to perform faithfully my
professional duties, to employ only those recognized methods of
treatment consistent with good judgment and with my skill and ability,
keeping in mind always nature’s laws and the body’s inherent capacity
for recovery.
I will be ever vigilant in aiding in the general welfare of the community,
sustaining its laws and institutions, not engaging in those practices
which will in any way bring shame or discredit upon myself or my
profession. I will give no drugs for deadly purposes to any person,
though it be asked of me.
I will endeavor to work in accord with my colleagues in a spirit of
progressive cooperation, and never by word or act cast imputations
upon them or their rightful practices.
I will look with respect and esteem upon all those who have taught me
my art. To my college, I will be loyal and strive always for its best
interests and for the interests of the students who will come after me.
I will be ever alert to further the application of basic biologic truths to
the healing arts and to develop the principles of Osteopathy which
were first enunciated by Andrew Taylor Still.
In the presence of this gathering, I bind myself to my oath.
Learning objective:
Discuss the Osteopathic Oath, particularly as it applies to physicianassisted suicide.
It is against the Osteopathic Oath. It states: “I will give no drugs for
deadly purposes to any person, though it be asked of me.”