Special Topics Assignment
Justice as Fairness and Palliative Care
Sameed is an 80 year old man who has lived in Canada for most of his adult life. He is married to Rima who, though five years younger, can no longer care for her husband in their home on her own. Sameed and Rima have eight grandchildren ranging in age from 11 to 20, and their children have busy lives with demanding jobs and family responsibilities. Often on weekends, one or more family members will help out at home, but during the week when the children are at school or the parents are working, Rima has little caregiving help. Within the last six months, Sameed’s health has taken a turn for the worse, and he has congestive heart failure and failing kidneys. Recently, Rima spoke with a home care service provider who informed her that Sameed is probably eligible for palliative care at home, but setting up the service will be very difficult because of a lack of health care resources, both financial and human. Rima finds it stressful to even think about moving Sameed into residential care, but two days ago, Sameed had to be transported to the emergency department for arrhythmia where he spent several hours on a gurney waiting to be seen by a doctor.
Define palliative care. How does hospice care differ from palliative care?
Click on the link and read the article by Andre Picard on the state of palliative care in Canada. Summarize the main facts about palliative care that Picard mentions. https://www.theglobeandmail.com/canada/article-almost-all-canadians-would-benefit-from-palliative-care-only-one-in/
Read the article on justice and health care by Norman Daniels. What material from this article can be used to develop a better understanding of “justice as fairness” as it affects palliative care in Canada? https://pdfs.semanticscholar.org/8696/149ffdc0457f2dcaeaa60a3def0a0442521d.pdf
Browse the PDF of the full report from CIHI. Write a critical response to the ethical issues that are raised by this report. https://www.cihi.ca/sites/default/files/document/access-palliative-care-2018-en-web.pdf
Public Health Ethics: School Food Policies
Read and think about policies that are meant to prevent harm, respond to the following questions:
In his article, Michael S. Merry argues that although “interference with another’s liberty is not morally objectionable per se,” what three things does he stress is of critical importance?
Summarize Merry’s thoughts on paternalism. Do you agree or disagree that paternalistic interventions can be used to curb obesity in children and adolescents?
With respect to the Ontario School Food and Beverage Policy (OSFBP), explain how autonomy and beneficence play a role in the interaction between students and public health officials.
Using the Ethics for Public Health Framework developed by Nancy E. Kass, evaluate the OSFBP by providing answers to each of the six questions proposed in her article.
Capacity and Consent
Sixteen year-old Elliot died of a drug overdose in Vancouver. Toxicology tests showed that Elliot’s blood contained fentanyl, heroin, cocaine, and crystal methamphetamine. Elliot’s substance abuse began shortly after he was treated with opioids for pain related to sports injuries and surgeries. When he was hospitalized with a blood infection, he left the hospital on a day pass only to return later after acquiring drugs. Hospital staff found Elliot unresponsive and a doctor treated him with naloxone. Elliot’s parents overheard the conversation between the doctor and Elliot, and for the first time, were aware that Elliot has a serious problem with opioids. Within a short period of time after leaving the hospital, Elliot was found unresponsive at home and died. About a month later, his parents wrote a letter to provincial officials claiming that provincial law and hospital policy prevented them from helping their child make decisions about his health care.
Read the Relational Autonomy and Individualism article before responding to the following questions. http://pediatrics.aappublications.org/content/133/Supplement_1/S16
Describe the standards of competence
Explain the concept of capacity and consent as it relates specifically to adolescents.
How can changing the autonomy model from that of an “in-control agent” to one of relational autonomy benefit those exhibiting “at risk” behaviours?
As one who delivers health care, what recommendations would you make to resolve the confusion that surrounds chronological age and maturity?
Moral Value, Personhood, and Moral Agency
Margaret, 85 years old, has been living at home with occasional help from a home care service. She has diabetes with complications and her mental faculties have been declining for several years. A diagnosis of mild to moderate dementia was made two years ago. Recently, Margaret was hospitalized for a severe burn on her hand. In questioning Margaret, the triage nurse became concerned because Margaret’s ability to explain what happened was unclear. It appears that Margaret had forgotten to eat and her blood glucose level was very low. She was trying to prepare a meal but did not remember turning on the stove. She burned her hand on the hot stove. Not long after, her daughter found Margaret unresponsive in her armchair and called an ambulance; this was not the first time Margaret’s daughter had to accompany her mother to the emergency department. Since being admitted to the hospital to the complex continuing care floor for a diabetes re-assessment, her burn has begun healing and her overall physical condition has improved. Margaret no longer needs a high level of care; yet, it would not be wise to discharge her. Margaret would happily return home alone, but her ability to make decisions has raised red flags for Margaret’s daughter, the home care workers, and the hospital nursing staff. Margaret’s daughter has four children between the ages of 18 months and 7 years of age, and is actively trying to find residential care for her mother.
Define the terms moral value, personhood, and moral agency.
Explain the cognitive criteria for determining personhood. What other criteria should be taken into consideration when determining personhood? See the article posted on Personhood and Dementia to help you answer this question. https://www.alzheimer-europe.org/Ethics/Definitions-and-approaches/Other-ethical-principles/Personhood
Summarize the research conducted to determine the perspectives of both health care workers and patients on personhood. How does one’s understanding of personhood affect clinical practice?
Read and react to the following two quotes from Peter Singer, the controversial Australian philosopher.
“The notion that human life is sacred just because it is human life is medieval.”
“Almost everybody accepts that some people can be killed. ‘The concept of ‘brain death’ – the belief that people on respirators can legitimately be killed – shows that.”
Predictive Genetic Testing
Gail, a 30-year-old marketing executive, received the gift of a direct-to-consumer genetic testing kit from a client. She is toying with the idea of providing a DNA sample and mailing the package; however, she has some concerns about what she might find out about her future health risks. She was adopted and knows very little about her biological parents, so the information would be novel and interesting. At the same time though, Gail has struggled with meeting her weight and physical activity goals and wonders how she might react to the information.
Describe briefly the type of results that Gail might receive. Explore the 23andMe web site to help you answer this question. https://www.23andme.com/en-ca/
Define the term genetic exceptionalism. In a defense of genetic privacy laws, three reasons are given for why genetic information must be protected. What are they
A case can be made that direct-to-consumer genetic testing may cause individuals to change behaviours based on test results. What evidence exists that this might occur? Answer this question by examining the literature and by reflecting upon the knowledge you have about behaviour change among your peers. How would a false sense of security or a fatalistic approach affect one’s ability to practice healthy lifestyle behaviours?
Imagine that you are Gail and that you have mailed the DNA sample. When you open the results, you find that you have genetic variants that promote weight gain. What is your reaction?
Eugenics and Technology
Dystopian novels are a popular genre, and the first dystopian novel, The Time Machine, was written by H. G. Wells. One of Wells’ main influencers was Thomas Huxley, an advocate of Darwinism and the grandfather of Aldous Huxley. Aldous Huxley wrote the novel Brave New World in 1932. Begin your exploration of the topic of eugenics and technology by reading chapter 1 of Brave New World. https://www.huxley.net/bnw/one.html
Explore the history of eugenics by reviewing the materials in the web sites on eugenics. https://historynewsnetwork.org/article/1796 http://eugenicsarchive.ca/discover/world
Watch the video on CRISPR and read the article regarding the ethics of CRISPR. After giving some thought to the concept of eugenics and technology, respond to the following questions.
In Brave New World, what were the goals of the Central London Hatchery and Conditioning Centre. Why were these goals important?
Explain eugenics and briefly discuss the history of the eugenics movement. What defines eugenics as ethically problematic?
Explain the process known as CRISPR/Cas 9. What are the major ethical issues associated with this process?
How could the use of this technology encourage a new eugenics movement? What can be done to ensure that this movement never gains any traction?
Regenerative Medicine and Artificial Intelligence: Influence on Health Care
In the Week 11 folder, read the two articles AI vs. MD and Quest to Live Forever. Then, read the ethics articles regarding regenerative medicine and biotechnology. Think about what you have read before responding to the following questions. https://www.newyorker.com/magazine/2017/04/03/ai-versus-md
Explain the terms regenerative medicine and artificial intelligence.
Discuss the ethical implications of biotechnology and regenerative medicine. Describe how artificial intelligence can contribute to the quest to live forever.
Imagine what the future of health care might look like when humans have fully harnessed the powers of biotechnology, regenerative medicine, and artificial intelligence. Describe a scenario. Talk to your peers and be creative!
How can one prepare for such scenarios if they become real? How might such scenarios make us rethink ethics?
Assisted Death: Rights, Obligations, and Conscientious Objection
In Chapter 4, Professional Ethics, read the following two articles:
The Nature and Limits of Professional Autonomy and Professional Responsibility
– Patient and Physician Autonomy: Conflicting Rights and Obligations in the Physician-Patient Relationship, Edmund D. Pellegrino https://pdfs.semanticscholar.org/ed88/9b8a32892bdd27a49ce28afc4ff42d284f82.pdf
Why Medical Professionals Have No Moral Claim to Conscientious Objection Accommodation in Liberal Democracies, Udo Schuklenk and Ricardo Smalling
Define the following terms: liberal democracy, professional autonomy, professional responsibility, conscientious objection.
Summarize what the Canadian Charter of Rights and Freedoms states about freedom of conscience and religion. In the Supreme Court of Canada decision about assisted death, which part of the Charter was used to justify assisted death as a right?
What approach does Pellegrino take in his exploration of the moral conflicts that exist between patients and physicians regarding autonomy? What approach do Schuklenk and Smalling take in their exploration of the moral conflicts that exist between patients and physicians regarding autonomy?
As one who delivers health care, what recommendations would you make to find the middle ground where rights and obligations are in conflict?