Medical Ethics Final Study Guide: Key Terms & Definitions

Briefly describe the Tuskegee Syphilis study.

The tuskegee syphilis study was a highly unethical clinical study conducted in tuskeegee alamabama over the course of 50 years. In this study poor african american men believed they were going to recieve free medical care for "bad blood" which was actually syphillis. It is a main example of human research with out ethical codes.

what went wrong with tuskegee and why

there was a lack of informed consent and the well being of participants was not prioritized

-participants were misled about th enature of the study and thought they were getting free medical care when in reality they were being studied for syphillis. them not knowing they had syphillis lead to a lack of informed consent to join the study

- beneficence: maximizing benefits and reducing harms but the researchers denied them penicillin and also subjected them to painful testing.

-justice: used a vulnerable population of poor african american men with limited access to helath care

What is the Belmont Report, and what role does this report play today?

belmont report was a foundational document in the field of research ethics that was issued by the national commision for the protection of human subjects in biomedical and behavioral research. it layed the foundation for todays ethical codes

Why does research require special oversight?

it involves human subjects

dual obligation: want the subject to be well but also the purpose of the research is to advance the generalizable knowledge of medicine. it requires special oversignt to ensure that the human subjects are not being treated unethically

practice vs research

practice is an intervention that is solely for the wellbeing of one individual while research is focused on gaining generalizable knowledge in the field of medicine.

have different ethical considerations

Does Belmont's category of research cover all of the double agency problems that might be raised in medicine?

double agency is a situation where the healthcare professionals have a clinical care role and a role in research which can create a conflict of interest between the well being of the patient and the goal of the research. it outlines specifically what is considered research vs practice as well as ethical considerations for research and also ensures that review committees are used for research

What principles does Belmont advance to regulate human subjects research, and what are the applications of each of these principles for the way research should be conducted?

respect for persons is about recoginizing the importance of individual autonomy and the application is informed consent

beneficence is the obligation to maximize potential benefits and minimize potential harms to research participants. requires harms to be minimized as much as possible

justice: the principle of justice requires the fair distribution of the benefits and burdens of research. emphasizes the need to avoid exploitation and ensure that the selection of research participants is fair and equitable

Briefly describe the Chinese program for harvesting organs from prisoners of conscience.

In china there was a extremely high rate of organ transplants. for example there were 10,000 transplants per year. But the source of the organs was said to be organ donors and prisoners on death row. they were actually using prisoners of conscience of the falun gong religious movement. they promoted truthfulness and morality and went against the chinese goverment in these beliefs. It was estimated that between 40,000 and 60,000 prisoners had their organs harvested and transplanted.

How might the Chinese government use the values expressed in Document 9 to prevent any domestic discussion or ethical criticism of this practice within China?

Document 9 was a leaked government document that stated that the chinese goverment did not support western constitutional values and views. They did not support transparacy, freedom of press, or freedome of speech as well as individual rights. The people of china were not allowed to speak out through the media about these issues without fear for their lives.

what ethical principals were violated by the organ harvesting practices?

respect for persons: lack of informed consent. people recieving organs didn;t know where they were coming from

justice: selection of participants. they harvested organs from falun gong practitioners which is a religious minority in china

What, according to H. Tristram Engelhardt, is the post-modern predicament?

the post modern predicament is teh recognition that a content full secular morality will never be reached because there is diverse view and no way to lessen the diversity of the world

What challenge does this predicament pose for any ethic?

since everyone is so diverse moral strangers will never come to a content full morality. it is impossible to create a ethical code that is not secular.

How, for him, should an ethic be advanced for "moral strangers" and how is this different from the kind of ethic that might be advanced among "moral friends"?

moral strangers are people who dont share moral premises or evidence to resolve moral controversies by sound rational argument. moral friends share enough of a content full morality to resolve moral controversies. This is because they share the same views. Moral strangers need to recognize and respect each others moral obligations.

What implications does this have for toleration and law?

because there is so much diversity there needs to be a secular ethic. this secular ethic can be enforced by laws. as for toleration it needs to be understood that within what is legal each person can make their own decisions. it does not mean you have to like what someone else is doing only accept htat they are within their right to do as they please as long as it is legal

How does Abraham Flexner distinguish modern medicine from earlier dogmatic and empiric stages? What was deficient about the earlier stages, and what is distinctive about the way modern medicine understands illness and the activity of a physician in diagnosing and treating illness?

dogmatic and empiric stages relied on observaton and experience and passive teaching rather than active teaching. it was also not built upon science. modern medicine is more critial and skeptical. we now have knowledge of pathogens and parasites because of deleveopments in biology.

How is a physician supposed to work up a case?

using the scientific method. first the physician gathers all of the data using history conditions an dsymptoms. these facts allow the physician to make a diagnosis or a hypothesis. actions taken to treat the hypothesized diagnosis will comfirm or deny the hypothesis.

Reductionsim

the scientific strategy of breaking a system down into increasingly smaller parts in order to understand it

is Flexner's approach reductionistic? Explain.

yes flexners approach is reductionistic because it only focuses on the body and its part. he focuses on the science behind medicine and avoids the person being being treated

How does Eric Cassell define suffering, and how is this suffering different from pain?

Suffering is not purely physical. suffering requires a sense of the future and a fear for that future. it requires a person not being able to complete their purposes roles and goals in life. pain is purely physical.

how can a physician know when someone is suffering

to know someone is suffering you have to understand the identity of a person and their a past and future. they have to know the individuals goals and purposes. narratives provide the life story of the person and their medical history. aesthetic conditions are about the physical state and well being of the individual. finding disruptions in these can help doctors

How, according to Kay Toombs, does illness bring about a "distinct way of being in the world"? Explain. Would these transformations count as suffering according to Cassell? Give examples of how her illness alters the ways she relates to herself and others, and why these are associated with suffering.

kay toombs writes about her experience with multiple sclerosis. her illness does not just impact her physical body but took away her purposes and goals in life. she feels like her body is in opposition with her mind and that they are separate entities. she also wrtes about her sensory disorders and how she doesn;t know where her limbs are in space. bladder and bowel control as well.

these are suffering because this illness has robbed her of what she had planned for her life. it has given her a fear for the future and disrupts their purposes and goals. the disease is progressive and there is a continual threat.

ex. stairs, standing, bladder control

In Richard Selzer's Imelda, does Dr. Franciscus practice medicine in the ways Flexner suggests? Explain, giving examples. Does he treat his patients in an impersonal way? Explain.

in imelda dr. franciscus practice medicine in the ways flexner suggests. he focuses on the body and the science. he treats imedlas condition solely as one of the flesh. his treatments were exact and thourough. he doesnt have emotional conversations. he delivers news good and bad in the same way. he walked away from a grateful man becuase he wasn;t comfortable with the emotion expressed. he separates himself form his patient. the only time he shows any sort of emotional resonce is when he fixed imeldas lip agter she had died

On pp. 70-76 in the Soul of Medicine, Dr Raymond describes an encounter between a resident, Doctor X, and a medical student, June T. Why does Dr X criticize June T? Does Dr X practice medicine in the ways Flexner suggests? Does he treat patients in an impersonal way? Explain. How might a perspective like that of June T or Dr Raymond enable a creative, broader response to patients (and students) as people?

dr x was veyr impersonal. june was examining a patient with abdominal pain and dr x thought that her findings weren't up to his standard because there was little about th epain and more about the patients life details. he wanted to look at location, quality, severity and if naything worsened and improved the pain. he practices the flexner way of medicine because he focuses on the science of a body not on the person.