Dr. Asadour is a physician in a vertical aid program to treat cholera in South Sudan where many refugees have come to escape war. A vertical aid program only targets one disease instead multiple and because of this, it is mandated to send away anyone who does not have that particular disease of interest. The refugees are poor, tired, and many are very sick with various diseases, not just cholera. Dr. Asadour is conflicted because the program only allows him to treat cholera patients but people with other diseases and illnesses come to his work station because the hospitals are beyond capacity or do not have enough or the right resources. He knows that most of the illnesses that the people have can be easily treated in his work station under the program, however he also realizes that this could cause further problems as cholera is communicable and could be passed to the people who do not have cholera in the first place or the people who do not have cholera but are treated at his workstation could tell other people in the community resulting in over capacity at the workstation. (Thomas, et. al., 267-268).

How Should Dr. Asadour Decide Which Patients to Treat?

On the same terms as his employer, I would say that Dr. Asadour should turn away the non-cholera patients as his only job for that program is to treat those with cholera. Furthermore, it would cause more problems than needed, especially if he mixes cholera patients with non-cholera patients or if his work station gets filled because then that would not be beneficial for anyone. On the other hand, in the ethical sense, Dr. Asadour should treat the patients that have easily treatable illnesses if he has the right resources to do so. As a physician his duty is to treat and turning away patients goes against this duty.

“Diagonal” Aid Program

Vertical aid programs are beneficial because they have the potential to eradicate a specific disease, they receive sufficient funding, and it is easy to measure the results (Thomas, et. al., 267). The case mentions that, “Dr, Asadour wonders whether vertical aid programs simply undermine efforts by local authorities to develop sustainable health responses for their own communities and for health broadly” (Thomas, et. al., 267). After some research I found an article that talks about the advantages and also the disadvantages of not only vertical aid programs but also horizontal aid programs. Horizontal aid programs have the goal of treating all of the “underlying issues of a population that cause various diseases and health problems” (Jimenez). Although this seems like the perfect fix to Dr. Asadour’s worries, there are still drawbacks to how cost-effective this type of program is and the long length of time it takes to see successful, measurable results (Jimenez). Because of these two independent programs that both have their ups and downs, the article proposes that they be combined to be “diagonal” where the new program “aims for disease-specific results but through improved health systems” (Jimenez). If this new type of program was implemented, Dr. Asadour would not have to be so conflicted about the right thing to do because he would be helping the community as whole instead of focusing on just one part of the community.

Works Cited:

Jimenez, Yilena B. “Vertical Vs. Horizontal Approach: The Drawbacks of Each and a Need For a Merging or “Diagonal” Approach.” ANTH 1310 S01 International Health Anthropological Perspectives. Brown University, 22 Oct. 2015. Web. Apr. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. Print.

During the rise of HIV/AIDS about thirty years ago, clinicians were put to the important task of finding effective treatments through clinical trials. As the number of diseased rose, people became desperate to find drugs that offered even a little bit of hope. Placebos were seen as useless as it almost guaranteed death. In saying this, people would cheat the system and dilute their drugs and give it out to people who were not in the clinical trial. Furthermore, some bribed research assistants for the drugs and others lied about how sick they were knowing that the clinical trials were not taking people who were sick after a certain stage of their HIV/AIDs (Thomas et. al, 256). In Harald and Jim’s case, Harald developed AIDS and was denied to be in clinical trial because he had surpassed the stage to be tested and for that reason he was only treated for his basic symptoms. Upset that so little was being done for the gravely ill, Harald and Jim made a group of advocates to discuss an “open arm alternative” rather than the normal double-blind experiment where patients who are in Harald’s position of being very sickly can participate in a clinical trial by consenting to receiving the drug and the risks that come with it and then participating in the trial while being “monitored for outcomes” (Thomas et. al, 257).

Important Questions (from page 258 in W&G):

Does the principle of autonomy mean that very ill people should be able to access any drug they wish if they accept the risk?

In essence, the principle of autonomy in this case, does mean that “very ill people should be able to access any drug they wish if they accept the risk.” But in reality, it is not a black and white kind of deal. Sickly people should not be able to casually get any drug they want just by giving consent for the risks. That can be very dangerous in many aspects such as if the drug is more harmful than expected or if that patient cheats the system and gives/sells their drug to other people. Therefore, there should be criteria and at least a hoop, if not a hoop AND hurdle, to be able to access the drug. However, on that point, I do not think the criteria should be super stringent and thorough as the patients are usually very sick and have little time.

Is cheating the system in order to gain access to a drug ethically acceptable if the alternative is certain death?

It should not be ethically acceptable for the system to be cheated to obtain the drug if the alternative is certain death, but saying that, in my opinion, it should be easier for people who are near death to access the drug without having to cheat the system. This would reduce cheating in the first place and also will at least give hope to those are near death and taking the new drug.

Is the use of a placebo wing in a clinical trial acceptable if there is only one prospective drug to test (as was the case in the early days of HIV drug testing)?

In my opinion I feel like there would not be a need to have a placebo if only one drug was being tested because the result of the drug would be did the drug work or did it not work. Dr. Richard Simon explains that, “Placebo-controlled clinical trials proposed in situations in which effective treatments exist should receive careful scrutiny with regard to 1) whether the effectiveness of the active control is sufficient that interpretable active-control trials could be conducted and 2) whether the trial can be conducted in a manner consistent with principles of patient autonomy and physician beneficence” (Simon).The use of a placebo wing in a clinical trial would only be acceptable if they needed significant statistical data that that prospective drug was better than another drug. Otherwise, placebos would be unnecessary.

Works Cited:

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. Peterborough, Ontario: Broadview, 2014. Print.

Simon, Richard. “Are Placebo-Controlled Clinical Trials Ethical or Needed When Alternative Treatment Exists?” Annals of Internal Medicine. American College of Physicians, 19 Sept. 2000. Web. 20 Mar. 2017.

Sue Rodriguez had ALS, a progressive degeneration of the motor neurons of the central nervous system, leading to wasting of the muscles and paralysis. Rodriguez knew that she would “soon lose the ability to swallow, speak, walk, and move about with assistance (and then later), lose the capacity to breathe on her own without the help of a respirator” (Thomas et al., 214) previously deciding that she would not like to continue her life if she was not enjoying life in the capacity she wanted to, she petitioned the courts to allow he to obtain physician-assisted suicide. They denied her plead and she ended up taking her own life later on. A second case arose from Gloria Taylor with the same disease as Rodriguez who also wanted to petition the courts to allow physician-assisted suicide. Although Taylor further in court than Rodriguez did, there were still many opposing arguments. The important question of this case is: Should the courts should allow physician-assisted suicide and at what cost.

Arguments Against Legalizing Physician Assisted Suicide:

One of the main concerns of legalizing physician-assisted suicide is that there are going to be increased cases of involuntary acts of this type of suicide. Pressure from different kinds of sources will play a role in making this a problem. Family who is not able to fully financially support the patient or feel as if they are doing everything just to watch the patient die, may have more reason to pressure him/her to hasten their death. Physicians who feel as if the patient is very likely to die and is using up many resources to keep him/her alive in the meantime could also feel inclined to pressure the patient to make that decision sooner than wanted. This is comparable to Case 5.1 with the decision to treat Baby Q who had a small chance to live and if she did live there was a large chance of severe mental disabilities. The Resident of the hospital argued to not do the treatment and let Baby Q die as she claimed, “We are always being told how expensive this unit is, and look at how much it will cost if this baby is kept alive and requires long-term institutional care!” (Thomas et. al., 187). A further pressure would be the actual patient due to the fear that they are a burden on their family and friends and that it would be easier for the family if they ended their life. In this sense, legalization can become dangerous if handled incorrectly.

Arguments for Legalizing Physician Assisted Suicide:

Although there is room for misconduct in legalizing medical suicide, the arguments for the legalization outweighs the arguments against. In Rodriguez’s case, and in many other related cases, the quality of life that she had envisioned for herself had been taken away by the detriments of her illness. Rodriguez saw no value in continuing a life that is inevitably going to become harder and is going to cause her to suffer longer due to the degeneration effects of ALS. Not legalizing physician-assisted suicide goes against the autonomy of the patient by denying “individuals the right to control areas of their lives fundamental to their dignity” (Thomas et.al., 216). Furthermore, it is said that, “to impose unwanted treatment on a competent patient is to commit a battery against him, which would be condemned in both law and morals” (Thomas et.al., 219). People against physician-assisted suicide argue that there are other ways to commit suicide including “refusing to eat or drink,” which would cause even more pain and suffering. And also the problem is not that there are other ways to commit suicide, the problem is that patients who are dying do not have the capacity to commit suicide on their own. That is why there is a need for this legalization.

In my opinion, the government should legalize physician-assisted suicide because if not, it goes against a person’s autonomy. People have the right to refuse medical treatment and it is wrong for the government to make them endure a longer period of suffering against the patient’s wishes. Also, if the patient is competent, they should be able to make that decision and have it respected without major backlash.

Works Cited:

Thomas, John E, et al. “Case 6.2: Sue Rodriguez: ‘Please Help Me to Die.’” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 214-22. Print.

Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 186-92. Print.

Background:

Amira gets in a car accident with her partner, Casey and her three-year-old daughter, Samantha. Amira and Casey are both in critical condition upon arrival to the hospital. Samantha comes out of the accident with only minor injuries. When in the emergency room, Casey’s health declines rapidly and the trauma team tries to resuscitate her with no success. The nurses have to figure out if, when, and how they should update Amira on her partner’s death in a timely manner. Keep in mind that Amira is due for an urgent surgery and then will be induced into a coma for a week while her body recovers.

Dilemma:

Because Amira is declining in health, any distress can affect if she will pull through the urgent surgery she needs. The doctors are not even letting the police question Amira to make sure there is no unnecessary stress.

Reasons for telling Amira about Casey’s death immediately:

Amira is entitled to know of her partner’s death as soon as possible. Moreover, the nurses, especially, have a job to develop a healthy relationship with the patient, which includes trust and assurance that the patient is not being deceived.

Reasons for telling Amira about Casey’s death after surgery:

Even though the nurses should tell Amira as soon as possible, there are factors that should allow for the nurses to stall on giving out that information. For one, if the nurses do decide to tell Amira of her partner’s death, Amira will inevitably experience increased stress. Any person who is already in critical condition and is put into a mental state of even more anxiety could worsen his or her condition. In this article it is said that, “if she is told the tragic news about her partner’s fate in the emergency room, her response may have a serious effect on her chances of survival. Her condition may deteriorate, and her condition could become even more unstable.” If Amira is told, there is a large chance that she could lose hope in surviving or become so mentally unstable that she cannot pull through the surgery.

My thoughts:

Given the circumstances of Amira’s case, I would argue that the nurses should wait until after the surgery to tell Amira about Casey’s death. Although, it would seem more appropriate to tell Amira as soon as possible, there much more other factors to consider than just saying that the patient deserves to know. There are too many risks involved in informing Amira while she is in such a critical condition as it might lead to death. If Amira does not survive this condition, then Samantha, her three-year-old daughter will be affected tremendously. Hypothetically, if Amira dies Samantha is left with no parents. Samantha will have gone through a traumatic event at an age where she is still developing and very vulnerable.

Excerpt from “The Benevolent Deception: When Should a Doctor Lie to Patients?”:

“Every clinician has encountered situations in which being too bluntly honest about a diagnosis can actually be harmful to the patient, and so we employ what is euphemistically referred to as “benevolent deception.” Consider mentally fragile patients with whom full disclosure of a devastating diagnosis may cause excessive anxiety, abandonment of ongoing therapies, or total loss of hope. In these circumstances, strict adherence to the clinical virtues of truthfulness and candor risks violation of the core ethical principle to do no harm”

This excerpt relates to this case because Amira is a mentally fragile patient

where there is “devastating” information that she needs to receive at some point

but the negative risks of knowing in her state are too high. So in some aspect,

according to this article, it is ethical for the nurses to not tell her, because it

would be causing Amira mental and, in turn, physical harm if told about

Casey’s death.

Works Cited:

Agronin, Marc E. “The Benevolent Deception: When Should a Doctor Lie to Patients?” The Atlantic. Atlantic Media Company, 24 Oct. 2011. Web. 30 Jan. 2017.

RD Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.