PHI Flashcards 2/2

Triage

General allocation strategies when demand is greater than supply

Traditional Triage

Prioritize who will survive without medical support, but not without

Savulescu’s Allocation Principles 1st Level

1. Support Autonomy

2. Assess urgency (delay non-urgent)

3. Consider resource availability

4. Save the most lives

Resource Adjusted Probability Ratio

Probability of Survival / Expected resource demand

Factors of RAPR

Age, frailty (health status), co-morbidity

Savulescu’s Allocation Principles 2nd Level

1. Lottery or FCFS (egalitarianism)

2. 2nd triage (utilitarian)

3. Priority (utilitarian/desert-based)

4. Trial of treatment

Emanuel Fundamental Views

1. Maximize benefits (max life years)

2. Treating equally (lottery)

3. Promoting instrumental value (can/have saved others)

4. Priority to worst off

Disability Paradox

Gap between disabled persons self-assessment & how others view quality of life

Activist Alice Wong argument

Ethical framework for triage discriminates people with disabilities

Joe Stramondo critique

Priority based on quality of life (ableist)

Disability components

Physical/mental impairment and personal/social limitation

Statistical impairment

Regard to an average

Biological impairment

Theory of functioning

Normative impairment

View of flourishing

Impairment definition

Loss or abnormality

Disability definition

Restriction/lack of ability

Handicap definition

Disadvantage given

Goal of Human Research

Producing scientifically valid, generalizable knowledge

Therapeutic Misconception

Confuses aims of research and practice

Coercive Vaccine Enforcement

Conditional mandates, public or private businesses, medical/religious exemptions

Libertarianism

Primary role of state is protection of individual rights, maximize liberty

Millian Harm Principle

Only state-justified interference: coercively enforcing prohibitions on harming each other

Largent & Miller Argument

1. Vaccine must be recommended for & readily available

2. Public health threat must persist

3. Adequate evidence of safety & efficacy of vaccine

4. Effort for voluntary vaccine first

Nuremberg Code (1947)

Not legally binding, informed consent, international

Declaration of Helsinki (1964)

International ethical code, nuanced view of informed consent

Helsinki Points

Rights/interests over knowledge, importance/benefit must outweigh risks

Belmont Report (1979)

U.S. ethical code

Belmont Main Ideas

Distinction between research & practice, any research needs review

Belmont Applications

1. Respect for persons'

2. Beneficence

3. Justice

Health & Human Services Regulations

U.S. regulations, CFR

The Common Rule

Requires IRBs (additional protection for fetuses/neonates, prisoners, & children)

Preclinical Phase

In animals, cells, etc.

Phase 1

New drug tested on small group (find safe dosage)

Phase 2

Larger group, test effectiveness

Phase 3

Confirm effectiveness, compare, monitor, collect info

Phase 4

Gone to market, monitor, effects in population

Double-Blind Trials

Investigator & subjects don’t know who got what

Randomized Trials

Assigned to arms randomly

Control Arm

Placebo or Standard of care

Clinical Equipoise

Don’t know which arm is better

Makes randomization ethical

if Clinical Equipoise

If during trial one arm is superior

Move participants slowly to that arm

Emanuel, Wendler, Grady

Focus on informed consent is misguided (not necessary or sufficient)

Emanuel, Wendler, + Grady Proposal

Value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, respect for potential & enrolled subjects

Respect for Potential & Enrolled Subjects

Privacy, permit mind changes, provide new info as it arises, monitor welfare, recognize contribution (inform of results)

Kriegar Lead Paint Study Goal

Find cheap ways to reduce contamination

Krieger Lead Paint Study Problems

Not fully informed consent, long time till notified of lead ingestion

Kriegar Lead Paint Study Result

Parents can’t consent to children’s participation that poses more than minimal risk

Placebo

Inert substance/treatment with no pharmalogical effect