Moral Dilemma:

In the case of “Ethics and Humanitarian Aid: Vertical Aid Programs”, Dr. Asadour works in a non-governmental organization (NGO) to help in a “global vertical aid anti-cholera program” (Thomas 267). Dr. Asadour and his team travel to South Sudan with a Memorandum of Understanding to treat cholera exclusively. Patients, with and without cholera, line up at the admissions tent. His moral dilemma arises when deciding who to admit into the hospital.

Analysis:

First, we need to understand the nature of the disease. Symptoms of cholera include watery diarrhea, vomiting, and dehydration. People can die within hours without treatment, so Dr. Asadour will need to act quickly. Also, according to the CDC, cholera “is not likely to spread directly from one person to another”. So long as his team is methodical in their actions with disposing wastes, Dr. Asadour should not worry about cross-contamination. (Center for Disease Control and Prevention)

Dr. Asadour’s moral dilemma involves the ethics of rationing. According to Beauchamp, rationing is “a form of allowance, share, or portion” and is linked to limited resources (Beauchamp 284). This means Dr. Asadour will need to exclude some people from these resources in order for other patients to receive full care. He must set priorities or guidelines as to who is and isn’t admitted to hospitals. Specifically, Dr. Asasdour must set criteria “to determine a qualifying pool of potential recipients” and decide the “final selection of recipients” (Beauchamp 288).

Dr. Asadour needs to assess the symptoms of the incoming patients to see if their symptoms match those of cholera. Although the work station has the supplies to treat other illnesses, the team has a legal obligation to treat patients with cholera only. They could send the extra supplies to the local hospital, but it not ethical to violate the original mandate. “If word gets out that the NGO will treat non-cholera conditions”, the work station will become overcrowded, lose supplies, and must shut down while those inflicted with cholera will remain untreated (Thomas 267).

As for treating patients with cholera, there are many types of rationing to consider. Rationing by age is the most straightforward policy because it includes numerical categories. There are still unethical issues to this method. For example, Dr. Asadour may deem it unethical to admit a seventeen-year-old boy with mild symptoms and refuse admission to middle-age woman with severe symptoms. The “first come, first serve” and the lottery methods are also unjustified in this case because symptom severity varies from person to person.

Dr. Asadour should consider a type of rationing that is involves a direct assessment of each individual patient and their symptoms related to cholera. He can assess each patient individually and personally. Dr. Asadour can use medical insight to determine the needs of each patient. Specifically, he interview the patients and collect information on the severity of their symptoms to determine who is admitted. There are some downfalls to this method. It will be time-consuming and qualitative, meaning Dr. Asadour will have difficulty comparing and ranking patients without numerical values.

Conclusion:

The best solution for Dr. Asadour is to stick to the original mandate of only treating patients with cholera because it is unethical and illegal to abandon the mandate. The NGO made the effort to send the team to South Sudan to treat cholera only, and it will be hazardous if the team abandons their original obligation to treat other diseases. They will risk losing supplies and the work station in its entirety.

Next, Dr. Asadour should assess each patient and determine the severity of their symptoms. Dr. Asadour will then make the decision of who to treat and ration the resources from person to person. Overall, there is no clear and fully ethical policy of rationing resources in vertical aid programs. However, all humanitarian aid workers must understand the joys and the consequences that can come with these programs. Due to scarce resources, workers will have to turn away some to treat others.

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.

Center for Disease Control and Prevention. “Cholera – Vibrio Cholerae Infection.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 03 Oct. 2014. Web. 12 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.

Childhood immunizations is an important public health measure in the U.S. Each state establishes its own vaccination requirements for children attending school and day care. The moral issue lies within the mandatory and compulsory nature of giving immunizations. There are many health-related benefits with immunizations, but compulsory immunization distorts parent autonomy in making decisions about their child’s health. After reviewing the principles of beneficence and autonomy in this case, we can determine which principles outweighs another.

Beneficence is the “moral obligation to act for the benefit of others” (Beauchamp and Childress 203). In this case, the physician is administering a vaccination that will result in an immunization from a disease. Thus, the physician contributes to the patient’s welfare. Furthermore, immunized patients benefit their community and “protect the common good of society” (Isaacs 394). Patients protect other individuals from contamination from diseases and possibly death. An idea of protecting the common good of society is also cogent to the issue of smoking. One of the arguments against smoking is the negative consequences of second-hand smoke. Beneficence comes into play when an individual has the duty to promote patient and community health.

A principle under beneficence is utility, which “requires that agents balance benefits, risks, and costs to produce the best overall results” (Beauchamp and Childress 202). Benefits are risk reduction, and risks prevent patients from interest in life, health, or welfare. In the case of childhood immunizations, the benefit outweighs the risks. Specifically, the probability and magnitude of vaccine-related injury is less of a risk than the probability and magnitude of a wild-type disease. Paralytic poliomyelitis, for example, occurs “once in every 2.4 million doses of oral poliovirus vaccine” (Isaacs 393).

Another principle of beneficence related to the immunization case is precaution. Scientists and physicians understand the magnitude of the possible negative outcomes from not administering vaccinations. We determined this from the smallpox epidemic in 1775-1782. Immunizations are a process rather than a genuine principle or gesture. Immunizations will prevent less disease and less suffering.

However, routine and mandatory procedures override the freedom of the parents and their choices. Parents act as surrogate decision makers for their children because they are not fully autonomous. Physicians are declining the parents right to make decisions about child rearing. They have responsibility over the child’s future wellbeing and act in the child’s best interest. In most cases, physicians do not have the authority to overrule the parents’ decisions.

State coercion is another ethical dilemma to parent autonomy. Immunization is required by law in the U.S., and there is no room for alternative considerations. For example, parents are unable to reject immunization based on their thoughts on vaccine-related injury if they want them to continue in school.

Overall, I believe the principles of beneficence outweigh the principles of autonomy in the case of immunizations. The benefit to the individual child and the community overrule the small risks of vaccines and disregard for parent autonomy. There is no compelling evidence on all types of risks. Physicians may overrule parent autonomy if they deem the parent’s decision harmful to the child.

Citations

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.

Fenn, Elizabeth. “Small Pox.” Small Pox. ESRI, n.d. Web. 23 Mar. 2017.

Isaacs, D., HA Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Paediatrics and Child Health. Blackwell Science Pty, 22 June 2004. Web. 23 Mar. 2017.

Moral Dilemma:

In the case “The Nuu chah nulth Nation and Arthritis Research”, Dr. Ward and his research team collected blood samples from the nation of Nuu chah nulth, a group of aboriginal people with the permission of the nation’s Council. The case presents a moral dilemma regarding the way in which Dr. Ward conducted his research. The question is brought up, “Should Dr. Ward and his team apologize for their actions?”

Analysis:

Informed consent in research is important, especially amongst a large group of participants. Dr. Ward received an overall consent for the arthritis testing, but he did not seek consent for anything else. The Council agreed to the research, with the hope that Dr. Ward would discover a genetic predisposition and help search for a cure.

In the case for Dr. Ward and his research team, the nation understood that he was already working on the general area of the evolutionary history of First Nations by studying their DNA. From this, it seems like the individuals were competent, so they could understand the risks of giving blood for research. Also, Dr. Ward continued to run tests on the samples after the first failure of tests. This demonstrates his dedication to the research.

However, Dr. Ward and his research team fell short in disclosing information about the results with the nation. Dr. Ward promise, but failed, to notify them on the progress of his research within the year. After gaining world recognition, he allowed other researchers to use the samples in studies unrelated to arthritis, without the consent of the nation. Although the team returned their samples after outrage among the nation and other researchers, the team has yet to apologize for misusing the blood samples.

This case deals with the major moral principle of nonmalefience: “one ought not to inflict evil or harm”. We can specify this to “not harming or exploiting the research participants’ rights”. In the “Consent of Adult Experimentation” case, we learned about the dangers of medical research from the Nazi experiments. One of the dangers is violating the participants’ rights in research. The community has a right to dictate what type of research is performed on their blood samples and the right to understand the consequences of the type of research. For example, there is a possibility of sharing identifying information through the blood samples. The research team violated the community’s autonomy when they withheld information on the type of research being done with their samples. Overall the research should be based on the consideration of the rights of the patients, like the consideration used in the case of “Research Involving Alzheimer’s Patients. The director of the patients focused on behalf of the patients rather than herself.

Another moral principle is “one ought to do or promote good”. Specifically, one should promote good with righteous intentions. It seems as if Dr. Ward got distracted in the midst of his own research on evolutionary genetics, rather than working on the Arthritis case for the Nuu chah nulth nation. The growing popularity about his work may have facilitated this distraction. He failed to help the nation efficiently and to do right by them to the best of his ability. He also failed to protect the individual privacy and confidentiality of his participants by allowing other researches to use the samples.

It is important to consider the understanding of the nation, in its entirety. Most likely, they lack similar communication system, so the information may be manipulated between the research team and the population. They may also lack the same resources or knowledge to understand all medical and genetic terms of arthritis. An example of this situation is experimentation on prisoners. In his article, Reiter says that unhealthy prisoners are more likely to desperate wanting for any type of medical care. This can lead them to taking desperate measures they may not otherwise take. Like prisoners, the individuals of the nation may have a compromised ability to understand the potential consequences of the research.

Overall, I believe Dr. Ward and his research team should apologize for exploiting the samples of the participants and violating their right to know what research is conducted on their data.

Citations

Broady, Baruch, and Tristram Engelhardt. “Consent of Adults to Experimentation.” (n.d.): n. pag. Web.

Reiter, Keramet. “Experimentation On Prisoners: Persistent Dilemmas In Rights And Regulations.” California Law Review 97.2 (2009): 501-566. Academic Search Complete. Web. 20 Feb. 2017.

Thomas, John E, et al. “Case 3.1: Research Involving Alzheimer’s Patients.” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 289-92. Print.

Thomas, John E, et al. “Case 9.1. The Nuu Chah Nulth Nation and Arthritis Research.” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 289-92. Print.

Dilemma:

In the case of Amira’s and Casey’s  car accident, the moral dilemma is whether to inform Amira of her partner’s death before she loses consciousness. It is the conflict between the patient’s autonomy, including her understanding of the situation, and nonmalefiecense, avoiding harm to the patient.

Analysis:

Amira ‘s right to know about the condition of her family is important. They should tell the truth and respect the patient’s autonomy, not limit the understanding of the patient. Trust between a physician and patient is essential. It is similar to the case, “Integrity and Nurses’ Relationship with Colleagues and Employers”. Nurses are expected to develop therapeutic, honest relationships. By telling the truth, according to Edwin in his medical journal, the doctor will help the patient “understand and deal with the difficult situations they may be facing thereby benefiting them and upholding the ethical principle of beneficence”.

In this case, it is important to specify the moral norm of “tell the truth”. Timing in disclosures must always be considered. Poor timing of difficult conversations may have a deleterious effect. Specifically, one should tell truth, at the right time. Another way to specify this moral norm is to “tell the truth unless the physician has compelling evidence that the consequences may cause severe harm to the patient”. With this specification, it is important for the nurses to balance the idea of whether the news will “cause severe harm to the patient”.

In this specific case, Amira is in a critical state and fighting for her life. Any more stress could “impair her capacity to survive the surgery and post- operative care in a coma” (Moorhouse and Khan 233). It is important to specify that the medical staff should avoid causing harm that is long- term and on a more serious degree. The nurses may be going against her right to understand the situation and causing some harm by performing the surgery, but they are doing so to increase the likelihood of her survival during and after the surgery.

Anxiety is common before surgery and causes mild symptoms, like irregular heartbeat and shortness of breath. According to Evans, anxiety before surgery is common, yet “excessive preoperative anxiety is associated with unfavorable physiologic responses, such as tachycardia, hypertension, cardiac arrhythmias, hyperventilation, and postoperative pain”. It is important for the surgeon and his or her team to be fully active and engaged with the patient during the surgery to ensure a safe procedure. An anxious patient may distract the staff or unintentionally answer questions incorrectly, thus misdirecting or misleading the staff during pre-and post-operative care. This could worsen the outcome. (Dr. Joseph M Rosenwald)

Another ethical concern to consider is the nurses’ role in informing Amira. The nurse may feel it is out of his or her focus of practice to release the information to the patient. It is up to the primary doctor of Casey to inform Amira. As Amira’s healthcare provider, the nurse may call upon the doctor to inform Amira herself or himself. In this case, the time is limited, so it may be more likely that the news would be handled after the surgery.

Finally, a therapist, has an overriding duty to give their patients the best chance of surviving a medical crisis. Informing the patient of the death of a loved one, while seeming urgent to the patient, may threaten their chances of survival in a difficult procedure. Disclosing information of that sort is best done by one professionally trained and in the most optimum fashion. It is important to mitigate the harm this news can cause. Moments before a critical surgery is probably not the right time for that conversation.

Citations

Davis-Evans, Chassidy. “Alleviating Anxiety and Preventing Panic Attacks in the Surgical Patient.” AORN Journal 97.3 (2013): 354-64. Association of PeriOperative Registered Nurses.AORN Inc., Mar. 2013. Web. 30 Jan. 2017.

Edwin, AK. “Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is It Ever Justified?” Ghana Medical Journal. Ghana Medical Association, Dec. 2008. Web. 30 Jan. 2017.

Moorhouse, Anne, Pamela Khan, and Patricia Rodney. “Case 3: Emergency and Trauma Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics. By Michael Yeo. 3rd ed. Peterborough, Ont., Canada: Lewiston, NY, USA, 1991. 232-42. Print.

Rosenwald, Dr. Joseph M., DDS. “Anxious Patients in Surgery.” Telephone interview. 29 Jan. 2017.