Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs

Background:

Dr. Asadour is a physician working for a non-governmental organization (NGO) whose mandate is to “participate in a global vertical aid anti-cholera program”. (Thomas 267). He travels to a town in South Sudan containing thousands of refugees from the internecine war. These refugees have a variety of health issues and Cholera has also broken out. The purpose of the NGO was to treat patients with Cholera only and other patients must be sent to the local hospital, which presents a problem as the local hospital is already beyond capacity. The dilemma is whether or not Dr. Asadour will admit patients who are in need that don’t have Cholera.

Analysis/Argument:

“Cholera is an often fatal bacteria disease of the small intestine, typically contracted from infected water supplies and causing severe vomiting and diarrhea” (CDC). The illness is not as clear cut to tell compared to other illnesses. Especially given the conditions of the patients in South Sudan, many of them exhibit symptoms that are similar to cholera. Therefore, admittance into the NGO is something that is already of a hassle and Dr. Asadour faces the moral dilemma of rationing resources. Should he stick by the litigation and only admit those with Cholera?

I would want Dr. Asadour to treat the illnesses within the community based on urgency and the severity of the symptoms rather than rationing to those with Cholera. One of the main reasons would be due to a time frame. With numerous patients who needs admittance, taking the time out to reject those that don’t display the symptoms of cholera could result in wasted time in saving lives. However, Dr. Asadour and his staff should not completely reject the idea of only admitting patient with Cholera. They should keep it in the back of the heads that Cholera is highly contagious and facilitative matters should be handled in order to prevent any type of contamination. Admitting patients with severe symptoms would also result in less patients being sent to the local hospital, which is already beyond capacity. If a patient is in a very severe state of health, then they should be admitted immediately to Dr. Asadour’s care. This has a higher potential to save the patient’s life.

The idea of vertical aid programs is also something that should be considered when taking this case into account. Dr. Asadour’s mission was funded primarily from wealthy philanthropists who are in hope of eradicating the disease Cholera. However, having that one disease aim seems to bring upon some issues. These western donors and NGOs often “overlook the voices and priorities of local communities” (Thomas 268). As we see with this case, there are many different illnesses in South Sudan with many levels of severity and urgency. Therefore, if the moral obligation was to just save as many lives as possible, then rationing to those individuals only with Cholera negates the moral purpose. According to an article published by Dr. Levine in the Center for Global Development, vertical aid programs “risk diverting attention from, or even undermining, broader “horizontal” health systems established to prevent and treat all forms of ill-health”. In global health, targeting a specific illness or area of health is very difficult and ineffective because health is in a sense, on a spectrum. Especially in an area like Southern Sudan, with ongoing wars, corruption, and rivalries of power, a broader approach to health seems to be a much more favorable one than a one track vertical aid program.

What do you guys think about what Dr. Asadour should have done in this specific instance? Furthermore, do you guys think that vertical aid programs should continue? I’d love to hear from you all!

 
Works Cited

“Cholera – Vibrio Cholerae Infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 09 Nov. 2016. Web. 11 Apr. 2017.

Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center For Global Development. CGD, 05 Oct. 2007. Web. 11 Apr. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and Good: a Case Study Approach to Health Care Ethics. 4th ed. Canada: Broadview, 2014. 131-138. Print.

O’Byrne’s Lecture on Kinship

O’Byrne brings up her lecture by talking about the idea of “where you come from is who you are”. Henceforth, to know who you are is to know where you come from. There is a sense of belonging or solidarity that comes from kin. O’Byrne brings up many questions in her talk.

What really is kin? How much do we really know about where we come from? Why are we so committed to having a connection with those who share the same blood? How is kinship related to injustice?

O’Byrne first starts off her lecture talking about the origins of belonging in a historical, scientific, and linguistic sense. What I found interesting was when she mentioned that our own DNA tests show that who we are as individuals is actually very blurred. A question that she made me ponder about was what a white supremacist would do if the white supremacist finds out that there is a small percentage of African ancestry in the kin. She then delves into an even deeper meaning of human lineage. She brought up the fact that we cannot appropriate our own lineages. One cannot “not have been born”. What was interesting was that she brought up the other point of on the other hand, the parent could not have known that the child would be “you”.  However, I found her talk on the types of belonging very difficult to understand. She mentions an oceanic, or earthly, type of belonging as well as a transcendence type of belonging.

In the second part of the lecture, she talked more about the idea of kinship and the injustices that are behind it. We as humans are all committed to our own “blood” and who we are is supposedly determined from where we came from. As a result, genocidal violence, and injustice spurns form this ideology. She also brings up the question of becoming kin other than in blood? This question made me think about the connection between a really good friend and how a bond with a really good friend could be comparable to a bond between blood. O’Byrne also talks about how the alienation of a child from his/her parents a form of injustice. Her Fredrick Douglas example in which Douglas’ mother walked 12miles just to see her alienated child was very interesting.
Overall her lecture was very interesting and it got me to think a lot about kinship and it’s role it plays with us as individuals as well as with us as a society. O’Byrne ends off her lecture by talking about what we could do. She asserts that we should acknowledge both types of belonging. Belonging to belong as well as belonging to a pure belonging.

Both non-maleficence and beneficence are concepts that are universal across our world, whether it is in everyday actions or in a healthcare setting. However, to what extent is non-maleficence and beneficence universally recognized? We can analyze this question by delving into the motives and virtues of multiple cultures across the world and we can compare and thus contrast the aspects of non-maleficence and beneficence.

As we can see across the United States and in most western countries, non-maleficence and beneficence across a health care setting derives from the relationship between the doctor and his/her patient. Across history, our doctor-patient relationship in the United States has changed towards greater respect for patient’s autonomy rather than a historically paternalistic ideology. There needs to be much more consent from the patient before any type of medical procedure is placed upon the patient. Even in bioethics class, we place the importance on the consent of the patient and the patient’s autonomous decision.

In the sense the word “beneficence” is a type of paternalism in which the doctor assumes what is beneficial towards the patient. In many other cultures beneficence is actually emphasized more than autonomy. There has shown to be correlations between the type of government and the power of beneficence over autonomy. Pellegrino and Thomasma’s article asserts that this could be as a result of many different factors, of which includes technology, religion, economy, and politics.

Accordingly, in Islamic medical ethics, there has been studies done on the works of Mawlana, a prominent Sufi theologian and philosopher, that showed that beneficence is prioritized over autonomy. We also see that religion is a major factor when considering the emphasis of beneficence with Confucianism in China. Beneficence is emphasized greatly as “A humane art, and a physician must be loving in order to treat the sick and heal the injured” (Kao, 2002). Politics also play in a major role when considering beneficence. The world’s “democratization” carries with it distrust for authority, and thus there seems to be a correlation between the United States of America’s democratic politics and the lowered respect for paternalistic beneficence of the physician in most healthcare settings. Technological advancements in our society is also something that can be greatly considered when thinking about autonomy versus beneficence. Technology in a sense brings about freedom within people. Having different cars, phones, and other forms of technology allows us to assume that we are autonomous beings who have great power in our own decisions. This in turn seems to be correlated with our western culture being more focused on autonomy.

Does looking into a cross cultural prospective of the principles and aspects of autonomy and beneficence in a bioethical lens helps us in a way? I would say that it helps us to generalize less about “an individual” and to realize that there are many complicated factors when considering balancing autonomy of the patient and beneficence of the physician. I would love to hear comments and thoughts about this topic.

Works Cited:

Pellegrino, Edmund. “The Conflict between Autonomy and Beneficence in Medical Ethics: Proposal for a Resolution.” Journal of Contemporary Health Law & Policy. N.p., n.d. Web. 12 Mar. 2017.

“Non-Maleficence and Beneficence.” The EIESL Project RSS. EIESL Project, n.d. Web. 12 Mar. 2017.

“Ethics – Definitions and Approaches – The Four Common Bioethical Principles – Beneficence and Non-maleficence.” Alzheimer Europe. Visual Online, n.d. Web. 13 Mar. 2017.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.

Case 6.1: Two Different Requests to Be Left to Die: John versus John

In Case 6.1a and 6.1b the two cases are compared and contrasted on multiple levels. What stands out to me the most is John’s case of “sanctity”. John is a man of 26 years of age who suffers from the elephant man’s disease, also known as Proteus Syndrome. John is captive on the respirator and urges his conscious decision to end his life and disconnect from the respirator. Many questions arise from paying respect to John’s decision. Should the doctors and his family respect his “sanctity” and allow him to die by his own choice or should others take over and exert control over his life?

John is fully alert, conscious, and in control of his mental faculties and clearly he wants to die. What stood out to me was what the elephant man’s disease was and how it could cause someone to consciously want to die. John has been suffering from this syndrome for 20 years and has gone over 100 operations as a result of uncontrollable tumor growth.

Proteus syndrome is results in abnormal growth of bones and blood vessels, as well as benign tumors on the body’s nerves. This syndrome results in a whole facial disfiguration, as well as physical disfigurement (DermNet). The case is mirrored by the “Real Elephant Man”, an Englishman named John Merrick, who the disease is named after. Merrick was supposedly a “circus performer” due to his physical appearance. However, Merrick had an indomitable spirit in which he utilized his freakish physical appearance and became a popular icon. He was in fact one of Queen Victoria’s favorite performers at that time. In a sense John Merrick’s attitude towards his syndrome is very dissimilar to the John in this case study. In a bigger sense, are two scenarios comparable in bioethics due to similar diseases and symptoms?

According to the physicians, John would most likely live for many years if John continued on life support. However, the question of whether or not John’s autonomy should be respected arises. Is allowing for a patient to live for a few more years morally correct even though the patient wants to die right now? John’s family members were initially very opposed to John’s autonomous decision to end his life. However, after extensive counselling, they accepted his decision. Therefore, the role of the counselor is also very impactful on the family’s perception of the scenario. Could John also be counseled and therefore have a change in his autonomous decision to die?

Now a question arises of how much of an impact can external factors have on one’s decision making, especially in the case of choosing to end one’s own life. For John Merrick, there was popular support in his actions and he was notoriously a figure/icon to many people around him.

Merrick obtained many supporting visits from many different people when he was hospitalized.

In this scenario I would choose to encourage as much positive support for John (from case study) as possible and encourage counseling and social support.

Works Cited

Ngan, Vanessa. “DermNet New Zealand.” Proteus Syndrome | DermNet New Zealand. N.p., n.d. Web. 9 Feb. 2017.

Sheward, David. “The ‘Real’ Elephant Man: A Look at the Life of Joseph Merrick.” Biography.com. A&E Networks Television, 15 Dec. 2014. Web. 10 Feb. 2017.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. Print.

Research Involving Alzheimer Patients and Moral Status

The Question:

There is a new drug called Tetrahydroaminoacridine (THA) to be tested on Alzheimer’s patients which could possibly reduce Alzheimer’s disease. Dr. Selleck, who was running the trials, contacted Ann Wilson, the director of St. Mary’s, in order to recruit elderly patients. The guidelines for testing the patients would be that both the patient and their closest relative provided written consent. If the patient was unable to make a decision, then their only consent would be provided by their closest relative. Ann was strongly opposed to this study as she said “I will simply not permit elderly patients under my care to be used as guinea pigs” (Thomas, Waluchow, and Gedge 116).  Now the question presents itself of what an individual would do if he/she was in the position to make that decision.

Discussion:

Though there are many arguments and discussions about the case, one of the primary arguments made by Ann was that elderly Alzheimer’s patients are an especially vulnerable group who should not be used in medical experiments. Now with this in mind, a question of moral status arises. What constitutes the elderly deserving of special consideration and protection? And would Ann’s decision making be different if this wasn’t Alzheimer’s affecting the elderly but rather another disease affecting another age of patients?

Five main theories of moral status are discussed by Beauchamp and Childress and what stands out to me the most is the theory based on cognition. This theory implies that the more cognitively vulnerable individual tends to have a lower moral status. This could be seen in the case of experimenting on rats versus experimenting on humans, as rats have a lower cognitive ability and thus a lower moral status. In the case of Alzheimer’s, the brain shrinks as a result of nerve cell death and tissue loss. According to the NCBI, areas of the brain shrink dramatically and lesions occur that could impair cognitive ability to that lower than some monkeys.

So where do Alzheimer’s patients stand relative to other patients in terms of moral status? Are some patients valued below that of nonhuman primates? Therefore, an argument for the testing of Alzheimer’s patients could be made by devaluing their moral status. On the contrary, Ann’s argument to have the Alzheimer’s patients relieved of testing shows that she morally values elderly Alzheimer’s patients and thus ranks them high in terms of their relative moral status.

Though cognitive ability is an interesting thought, this dilemma cannot be sole attributed to that theory of moral status alone. There are other theories involved, as well as many other factors aside from moral status. In addition, I analyzed just a very small part of such a large case presented. The arguments both for and against are infinite and very complex.

Works Cited:

Colbert, Treacy. “What Does Alzheimer’s Do to the Brain?” Healthline. Healthline, 20 Sept. 2016. Web. 19 Jan. 2017.

Gold, Carl A, and Andrew E Budson. “Memory Loss in Alzheimer’s Disease: Implications for Development of Therapeutics.” Expert review of neurotherapeutics 8.12 (2008): 1879–1891. PMC. Web. 18 Jan. 2017.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. Print.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.