Bioethics
select three questions from the following nine
Please answer three of the following nine question sets. There is a
six-page limit for the entire examination (single-spaced).
1. Is embryonic stem cell research moral? Is it necessary for
advances in medical treatment? Present both sides of the discussion using
the discussion in the Australian Parliament, the speeches by Bush and
DeGette, and the essay by Harris. Then defend your own position. Should
we be concerned if other countries conduct this research and we don't? Is
there any common ground for potential agreement on lines of research? What
do you think will happen to open or close embryonic stem cell research in
the next decade?
2. Do we own our body parts and bodily fluids? Do we own our own
genes? In your view, should we have a property right that is alienable?
How does this discussion affect issues of autonomy and public interest in
the abortion debate? A complete answer would integrate the Moore v.
Regents case and discuss property rights issues in gene patenting and organ
donation, both before and after death.
3. Would the survival lottery eliminate the organ shortage in the
United States? What are the arguments for the survival lottery? What are
the arguments against it? Should our country adopt a survival lottery? If
not, what alternatives do you suggest that would be as effective?
4. Why are the following important issues in clinical trials: full
disclosure, consent, and prohibitions against conflict of interest? Give
examples to illustrate the ethical dilemmas that arise for each issue?
Briefly summarize the NIH and Helsinki Declaration protections for human
subjects in clinical trials. Should the NIH restrictions of human subject
research be extended to all clinical trials in the United States? Should
they be extended to all U.S. funded trials abroad? Why or why not? In
your view, what can we do to make human subject research more ethical?
5. Should the pharmaceutical industry be run as a business or a
service? Should it be concerned with issues of equity in access to
pharmaceutical products, cost-cutting for patients in developing countries,
development of orphan drugs for small numbers of beneficiaries, or removal
of patent exclusivity for products desperately needed? In your view, what
can be done to make the pharmaceutical industry more profitable? More
socially and medically responsible?
6. Should the distribution of health resources be equitable?
Summarize Menzel and Harris. Explore the guidelines presented in the
handouts (Hippocratic Oath, Helsinki Declaration, etc.) to see if there is
any guidance about distribution of resource. Then justify equitable
distribution of resources or offer up an alternative way of determining who
should get what. Set out your view in a rule (such as “justice equals
fairness”). Justify your position.
7. Is there a difference between active and passive assisted suicide?
Summarize Rachels and Nesbit. Make sure to have a thorough presentation
of their examples. Can you draw a bright blue line between active and
passive actions? Using Kuhse, Hill, and Admiral, please explain your
position on assisted suicide. Justify your views.
8. What is the importance of patient confidentiality? Summarize the
relevant portion of the Hippocratic Oath and the ruling in the Tarasoff
case. Under what circumstances, if any, should it be broken? Please give
examples to support your views? Veatch thinks we should abandon the notion
of informed consent. What is his view? Is he correct?
9. What are the expectations of truth-telling in medicine? Should
health care personnel always tell the truth? What is Collins' position?
How is truth telling related to outcomes? In your view, under what
conditions, if any, should they lie?
For Question 9
In medicine, truth telling is a broad subject with big repercussions. There are so many ethical issues involved in this area and it is upon the physician to find a healthy balance between what to reveal and what to leave. Perpetually, there are always issues about the rights of the patient and family to know about illness and diagnosis (Sullivan, Menapace & White, 2001). Nevertheless, several questions always arise when looking at such issues. Is the medical personnel ever justified in concealing information? How and why does the doctor decide that some of the information would be harmful if revealed? A conflict exists between the patient’s side and that of the doctor when dealing with sensitive information about an illness or diagnosis.
Truth-telling in medicine helps the patient understand his medical condition, and make informed choices about his health. In line with the need to create a true impression in the patient’s mind, the physician must always be honest and accurate, these being the mainstays of truth-telling. (Hébert, 1997)
In the analysis of importance of truth-telling, ethics is the main focus. Telling the patient the truth about their conditions helps in two major ways. First, it fosters a high level of trust between the doctor and patient. Secondly, such ethics help the patient to cope with the prevailing condition more easily. The reverse is also true when information is withheld from the patient. As a person, the patient has the right to information. Some patients who rely on such information to make critical decisions in their life or get comfort, failing to provide the information will do more harm than good. (Hébert, 1997)
Truth-telling in medicine as a critical ethical issue stretches beyond mere disclosure for decision making. The legal aspect of this issue emphasizes on the need for honesty and accuracy in communication with the patient. For example according to the supreme court of Canada, giving information to patients is very vital for their recovery. (Hébert, 1997)
With all these campaigns for truth-telling, there are some in the medical world who feel that telling the truth to patients is not beneficial. While giving the patient information, the end-result or the effect must be reflected upon. According to Dr. Joseph Collins, doctors ought to withhold information from patients. He also argues that it is important for doctors to develop the art of lying. ("Joseph Collins: should doctors,")
In support of his argument, Dr. Collins cites a number of cases which prove that lying to the patient works. One of such is a scenario which involved a spinal injury patient. Collins argues that telling the patient about his serious form of rheumatism would have thwarted his efforts to face the condition. In yet another scenario, a man who had worked so hard in his life and was finally making it in business was taken ill and was to undergo surgery. The doctors did the surgery but were unable to treat the condition. Considering his prospects in business, the doctors opted not to disclose the results of the surgery. Consequently, the man was able to improve his business which later on supported his family on his demise. This would not have been the case had the doctors revealed to him about the failed surgery. Though there are instances where lying in medicine has achieved negative results, Collins still maintains that it is right to lie to the patient in some instances. ("Joseph Collins: should doctors,”)
Given the varied instances that require a decision on truth telling encounter doctors all the time, getting a common ground on this issue is not very easy. Medical uncertainty is undesirable on the side of the patient, yet sometimes patient’s family does not want disclosure of illness or diagnosis. Considering all the ethical and legal issues surrounding truth telling, I think it is necessary for the healthcare personnel to desist from withholding information from the patient. Telling the whole truth to the patient is the best way of putting the interests of the patient before those of anybody else.
References
Hébert, P. C. (1997). Bioethics for clinicians: 7. truth telling. Canadian Medical Association Journal, 156, 225-228. Retrieved from /eppp-archive/100/201/300/cdn_medical_association/cmaj/vol-156/issue-2/0225.htm
Joseph collins: should doctors tell the truth? (n.d.). Retrieved from http://faculty.arts.ubc.ca/pfindler/collins.htm
Sullivan, R. J., Menapace, L. W., & White, R. M. (2001). Truth-telling and patient diagnoses. Journal of Medical Ethics, 27(3), 192-197. Retrieved from http://jme.bmj.com/content/27/3/192.full
For Question 4
Clinical trials are part of the clinical research process which is a common with pharmaceutical companies, doctors and other medical practitioners. The trials sole purpose is to test the effectiveness and safety of a drug or device. (Sullivan, 2010) It is not a secret that clinical trials form a very fundamental aspect of advancement of medicine. There are also several benefits that participants in such a trial can get, including medical cover. ("Clinical trials," 2013) However, are the processes safe enough? Furthermore, are there ethical issues and if any, do the doctors adhere to them?
Due to their nature, clinical trials are very sensitive matters especially in the legal perspective. The administration of the trial medical attention is guided by several regulations. In the USA for example, a number of protocols are involved in all phases of clinical trials. Some of the bodies which are related to clinical trials are the Food and Drug Administration (FDA) and Independent Review Boards (IRB’s). (Sullivan, 2010)
Over the years, full disclosure on clinical trials has been a subject of controversy. This was compounded by the results of a study done by PLoS Medicine in 2008 which unraveled serious discrepancies between trial data and information in published data. (Bruderlin-Nelson, 2008)
Problems with full disclosure of clinical trials are not new. According to PLoS Medicine researchers, it is even a common trend for some data from the trials to go unpublished. Usually, trials that have unfavorable outcomes are more likely to be omitted in the reporting stage. (Bruderlin-Nelson, 2008) Apart from full disclosure, other issues prominent in clinical trials are consent of the subject and prohibitions against conflict of interest.
In the administration of clinical trials, medical practitioners strive to adhere to international standards of the most sound ethics and science. Apart from that, the trials need to be relevant to the population needs, especially if they are done in the developing nations. Informed consent has remained a major consideration in clinical trials for more than a century. Some of the problems that clinical research encounters in developing countries are differences in social practices and languages. (Emanuel, 2004)
Because of sensitivity surrounding clinical trials involving human subjects, a form of regulation is worthwhile. The World Medical Association declaration of Helsinki was first adopted in June 1964, in Helsinki Finland. There have been several amendments since then including 1975 in Japan, 1989 in Hong Kong and the latest 2000 in Edinburg Scotland. The main purpose of the ...