Clinical Ethics
TWO scenarios for which you will write a thorough response to not exceed ONE complete paragraph for each. Responses will vary based on an individual’s cultural upbringing, ideology, and educational knowledge; however you must support your position with appropriate theory and principle.
Please use two to three references. One reference should be from the book and another reference from the internet
Book reference: Health Care Ethics Critical Issues for the 21st century Third Edition by Eileen Morrison and Beth Furlong
In Clinical Ethics, three clinical ethicists (a philosopher – Jonsen, a physician – Siegler, and a lawyer – Winslade) developed a method to work through difficult cases. The process can be thought of as the “ethics workup,” similar to the “History and Physical” skills that all medical students use when learning how to “workup” a patient’s primary complaints. While this method has deep philosophical roots, clinicians who use this method like the way it parallels the way they think through tough medical cases.
Medical Indications – All clinical encounters include a diagnosis, prognosis, and treatment options, and include an assessment of goals of care
Patient Preferences – The patient’s preferences and values are central in determining the best and most respectful course of treatment.
Quality of Life – The objective of all clinical encounters is to improve, or at least address, quality of life for the patient, as experienced by the patient.
Contextual Features – All clinical encounters occur in a wider social context beyond physician and patient, to include family, the law, culture, hospital policy, insurance companies and other financial issues, and so forth.
Scenario 4
You have been treating a 24-year-old man for many years in your family practice. He has an anxiety disorder and had some trouble with substance abuse in his teens but has been doing well and attending university.
After his last visit for a minor injury you noted that a prescription pad was missing. A few weeks later you received a call from a pharmacy asking you to verify a prescription for Lorazepam 1mg bid, 300 tablets and acetaminophen with codeine 300 tabs written for this patient.
You report that this is a forgery and ask the pharmacy not to fill it. Your colleague urges you to report this to the police and states this is allowed under the Health Information Act. You are very angry with the betrayal of trust with your patient but you have never reported a patient to the police and wonder what you should do.
The CMA code of ethics advises you to keep patients’ personal health information private and only consent to release to a third party with consent or as provided for by the law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm.
You are wondering if your patient has a substance abuse problem and whether he could be selling this medication. You have called the patient to come in for an appointment but he has refused. Should you notify the police?
Scenario 7
John, a 32 year-old lawyer, had worried for several years about developing Huntington’s chorea, a neurological disorder that appears in a person’s 30s or 40s, resulting in uncontrollable twitching and contractions and progressive, irreversible dementia. It typically leads to death in about 10 years.
John’s mother died from this disease. Huntington’s is autosomal dominant and children of an affected person have a 50% chance of inheriting the condition. John had indicated to many people that he would prefer to die rather than endure the progression of the illness. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist. Nevertheless, he was a productive lawyer.
John first noticed facial twitching 3 months ago, and 2 neurologists independently confirmed a diagnosis of Huntington’s. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. But when he went home, he ingested all his antidepressant medicine after pinning a note to his shirt to explain his actions and to refuse any medical assistance that might be offered. His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note.
How much weight should John’s preferences (especially his attempt to end his life) carry in managing his emergency and subsequent clinical care?
