Case 8.2 discusses the issue of vertical aid programs, programs that are intend to target a specific disease. Dr. Arman Asadour has been sent to a town in South Sudan to set up temporary work stations for the treatment of cholera. Dr. Asadour is under the strict jurisdiction of the non-governmental organization (NGO) to treat ONLY those patients who present symptoms of cholera and to direct all other cases to the local hospital. While the NGO possesses the medical supplies necessary to treat other cases, they fear that an integrated program will reduce the number of cholera patients who are able to benefit from the work station. How should Dr. Asadour decide which patients to treat (Thomas et al., 267-268)?

This case study reminded me of Friday’s class debate. In class, we were asked if individuals who have suffered from extreme alcohol abuse should have the same right to a liver transplant as non-alcoholics (note the phrasing is slightly different)? While I don’t think that a consensus was ever reached, I want to highlight several of the arguments made by each side. The pro side stated that liver transplants should be based on the potential success of the treatment and that alcoholics are likely to abuse the new liver as well. By contrast, the con side argued that alcoholism is highly affected by social and biological determinants such as genetics, location, peer pressure etc. with genetics accounting for 50% of the risk for alcohol use disorder (“Genetics of Alcohol Use Disorder”). Though the debate was not ultimately decided, Beachamp and Childress argue that although individuals with alcoholic use disorders who receive a liver transplant and continue to abstain from alcohol tend to do as well as other patients there is reason to exclude high risk patients altogether (Beauchamp et al.,275). For example, they argue that the alcoholic who fails to seek effective treatment for alcoholism prior to receiving a liver transplant should receive a lower priority for treatment (Beauchamp et al.,276).  Like the case debated in class, case 8.2 is also based on the allocation of limited resources.

Unlike the case presented above, case 8.2 discusses the decision to provide basic healthcare to patients unaffected by cholera. That being said, I believe that cases such as case 8.2 and the case debated in class should be decided on a case by case basis. While I understand that such a platform does not yield to both national and global health policy, I believe that all people have a right to a decent minimum of health care. According to one theory presented by Beauchamp and Childress, healthcare should be thought of as a two-tiered system with the first tier meeting needs by “providing universal access to basic services” while the secondary tier covers “better services” that can be acquired with voluntary private coverage (Beauchamp et al., 273). Under this mandate, patients seeking basic needs would be able to seek treatment at work stations.

Beauchamp, Tom L., and James F. Childress. Principals of Biomedical Ethics. New York: Oxford U.P., 1983. Print.

“Genetics of Alcohol Use Disorder.” National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 15 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.

Case 7.4 describes Jim and Harald, a couple who had been together for an extended period of time before Harald was diagnosed with an HIV infection that had developed into AIDS with indications of encephalopathy (Thomas 256). Unfortunately, due to Harald’s severe diagnosis he was rejected as a participant in a clinical trial for AZT and was simply treated for symptoms. Harald and Jim, together with their friends who were also not qualified to participate in the ongoing trial and who didn’t want to be subject to the bribery and lies that other HIV patients had resorted to decided to enroll in an open arm in which they would consent to receiving the drug and be monitored for outcomes (Thomas 257). While Harald did eventually receive the drug, it didn’t save his life.

In his case discussion, Thomas et al. presented two questions: “does the principle of autonomy mean that very ill people should be able to access any drug they wish if they accept the risk and is cheating the system in order to gain access to a drug ethically acceptable if the alternative is death?” (Thomas 258).

According to Beauchamp et. Al. moral status does not equate to respect for autonomy. “Obligations to respect autonomy do not extend to persons who do not act in a sufficiently autonomous manner–and who cannot be rendered autonomous­–because they are immature, incapacitated, ignorant, coerced, or exploited” (Beauchamp 108). They then argue that infants, irrationally suicidal individuals, and drug dependent individuals fall into this category. I would argue that Jim and Harald’s complete disregard for authority, and decision to take a harmful drug proves their ignorance and therefore disregards their right to autonomy. That being said, people do unconscionable things for people they love.

This brings me to the second question. The sheer force of love has given mothers the necessary strength to protect their babies, has made people make utter fools of themselves as they coordinate mass flash mobs and parades in order to express their love for someone, and has caused individuals to abandon all moral reasoning to fight for those they love. While Jim and  Harold’s decision to organize and open arm, in which they would administer unapproved drugs, it undeniably unethical, in a case where death is the only alternative, it is justifiable.

What do you think? Would your decision be different if it didn’t involve obtaining a drug, rather a loaf of bread? For those of you who are unfamiliar with the reference, in the play Les Miserables, the protagonist, Jean Val jean, is initially imprisoned for stealing a loaf of bread to save his starving nephew.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2016. Print.

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.

In 1981, researcher Dr. Richard Ward consulted the Nuu chah nulth nation, a group of Aboriginal people living on the west coast of North America, about conducting a study on the increased rate of rheumatoid arthritis experienced by these people. Not only was no such study ever conducted, but Ward used the 30mL of blood conducted from 883 Nuu chah nulth as the basis for his groundbreaking research on the genetic distinctiveness of the Nuu chah nulth. The obvious moral question is should Aboriginal communities have the right to dictate what type of research is performed on their data and materials?

As I read this case, not only was I alarmed by the lack of informed consent involved in Ward’s research, but the complete disregard for the Nuu chah nulth people. While genetic research is hot and flashy, studies show that such research can be damaging to the group, resulting in the questioning of group membership, and the abandonment of the value of culture and oral history (W & G 290). As a result of such controversial studies, researchers such as Dr. Judy Putt propose necessary ethical guidelines that must be followed when conducting research with Aboriginal groups. She writes, “safeguarding participant privacy, which may require special measures with the sharing of research with community organizations…should be negotiated with participants, partners, and/or collaborators” (Putt). She goes on to list values that should be considered when conducting research with Aboriginal peoples such as honesty and integrity, appropriate acknowledgements of the role of others, and responsible communication of results. Due to the fact that none of these values were honored in the present study, I would argue that Ward’s complete disregard of the Nuu chah nulth nation was unethical.

This case reminded me Dr. Peter Provonost’s work in evaluating the infection-control of ICUs in 67 Michigan hospitals. Provonost’s research was halted by the Office for Human Research Protections on the grounds that Provonost was conducting his research without the informed consent of the ICU’s patients. After much review, the OHRP permitted the continuation of the study based on the belief that the work was being used solely for clinical purposes and not medical research or experimentation (B. 157-158). Given that Ward’s work does qualify as medical research, the informed consent of the Nuu chah nulth people seems requisite.

When conducting research, especially research with a unique cultural group, not only is it important to uphold the value of informed consent but respect for the customs of the cultural group, neither of which occurred in the present case.

Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 1994. 125-31. Print.

Putt, Judy. Conducting Research with Indigenous People and Communities. Sydney: Indigenous

Justice Clearinghouse, 2013. Indigenousjustice.gov.au. Indigenous Justice Clearinghouse, 2013. Web. 25 Feb. 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 10.3 Should Patients Be Informed of Remote Risks of Procedures?” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 300-02. Print.

This case tells the story of Amira Mullens, a woman hit by a drunk driver in a multi-vehicle accident while driving with her partner, Casey, and three-year-old daughter Samantha. While suffering the repercussions of the accident including extensive blood loss, discoloration of the face and lips, a collapsed lung, compromised breathing, and kidney damage, Mullens inquires about the state of her family members. Unbeknownst to Mullens, Casey past away. Afraid of negatively impacting Mullens’ surgery and post-operative care, the Nurses are hesitant to tell Mullens of Casey’s recent passing (Yeo). Should the nurses tell Mullens about the death of her partner, or should they refrain from doing so in an effort to increase her probability of survival?

Last week we read a case on Joe Mulroney, an individual that suffered a fatal reaction to an angiogram, a routine procedure with an extremely high success rate. Mulroney’s son argued that while the procedure may be wildly successful, his father deserved to know the complications prior to consenting to surgery (Thomas et al., 300-301). Like Mulroney’s son, I too thought that Joe deserved to know. I cited an example from my QTM class this past semester in which the professor asked us if we would like to know our risk of contracting cancer whether it be a 30% chance of risk or a 5% chance. The majority of the class said 5%. I argued that while I don’t think it would change my decision to go through with the procedure considering the alternative is death, I would like to make an informed decision.

At first glance, I thought that the case at hand mirrored Mulroney’s case, and that the physicians was obligated to tell Mullen’s the wealth of information they possessed. Mullen’s case is unlike Malroney’s in that Mullens’ case falls under the category of an emergency. Emergency, incompetence and waiver are the three categories in which health professionals are allowed to proceed without consent. In addition, “a physician may legitimately withhold information based on a sound medical judgement that divulging the information would potentially harm a depressed, emotionally drained, or unstable patient” (Beauchamp et al., 127). Since Mullens not only experienced a dramatic car crash, but is in dire need of surgery, she most definitely meets the qualifications to be considered as an unstable patient. Furthermore, numerous studies have investigated the effect of psychosocial factors, such as depression, social support, stress, etc. on surgical outcomes and have discovered a clear relationship between the two.

While it is true that nurses and physicians must build trustworthy relationships and that truth telling is important, I think that deception can be argued for if it falls in line with the patients’ best interests.

Beauchamp, Tom L., and James F. Childress. “Respect for Autonomy.” Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 1994. 125-31. Print.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 10.3 Should Patients Be Informed of Remote Risks of Procedures?” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 300-02. Print.

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