Though vertical aids programs directly assist groups in dire need, such as individuals with Cholera as discussed in the case study, these programs don’t aid in global health as effectively as alternative programs. Instead of providing funding to provide better hospitals and better training of health care professionals in order to develop an overall more supportive health care system in these impoverished areas, organizations create programs to only address one issue or ailment. Vertical aid programs essentially make these needy areas continuously dependent on outside help, rather than establishing better systems to address as many needs of the community as possible.

The issue lies in supporters of vertical aid programs. Rather than sacrificing some of the praise they will receive for providing financial aid that directly aids in a global health issue, supporters would rather maintain their image and support vertical aid programs despite a great amount of evidence indicating that these programs are not as effective as other options. I would compare vertical aid programs to putting a Band-Aid on a deep wound, without properly stitching the injury. Instead of exploring the root problem of the situation, which often implies a vast socio-economic inequality, proponents of vertical aid programs would rather throw money and resources at an issue with a clear ‘solution’ so they can claim to eradicate some issue. In order for there to be real change in the world, financial supporters will need to swallow their pride and contribute aid in order to help improve global health, instead of contributing aid in order to make a name for oneself or claim to be an advocate for a disease.

Despite the fact that I think resources can be better allocated than in the use of vertical aid programs, vertical aid programs are a necessity of our world. Even though, ideally, people should contribute aid for the benefit of society, I fear this is not human nature and not the reality we live. The human race is a selfish one and because of this we strive to benefit ourselves before others, especially when the benefit is for a group that is vague and distant from our lives. If contributing financial aid doesn’t directly have a benefit that one can visualize, “the money might well dry up” (Levine). Like the infamous Nigerian prince email, I think the reasoning behind this is that people want to see their money put to use so they know its not being abused and wasted. Additionally, living in a first world country, its difficult to imagine living somewhere where basic health care isn’t accessible, and death is around the corner for most. As we live in our little bubble of a world, we need “advocates” to raise awareness of global health issues so that we can help—global health advocacy is “active[ly] support[ed by] organizations and individuals who are associated with particular health causes” (Levine). Without these vertical aid programs, our global health initiatives would not have nearly as much support, and might not even be in existence.

Works Cited

Elzinga, Gijs. “Vertical–Horizontal Synergy of the Health Workforce.” World Health Organization, Apr. 2005, www.who.int/bulletin/volumes/83/4/editorial10405/en/. Accessed 14 Apr. 2017.

Levine, Ruth. “Should All Vertical Programs Just Lie Down?” Center for Global Development, 5 Oct. 2007, www.cgdev.org/blog/should-all-vertical-programs-just-lie-down. Accessed 14 Apr. 2017.

Thomas, John, et al. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed., Broadview Press, 2014. “Case 8.2 Ethics and Humanitarian Aid: Vertical Aid Programs.” 267-268

There is an ongoing debate about whether women should be allowed to receive silicone breast implants for breast augmentation. They definitely should be allowed to do so–preventing women from receiving implants that over a million women have received and only ruptures in 4% (Angell) of cases would be an overstep of paternalism from the FDA.

For starters, even though a breast augmentation is not technically a treatment of a disease, many women feel that it helps them live the life they want to live and it vastly improves their quality of life. Speaking from personal experience, and I bet the experience of most people, having a body part that stands out to other people or makes you uncomfortable consumes people’s lives. When there is a feature that is constantly attached to you, you can’t help but obsess over it and do anything you can to change it. For some, surgery is the only solution to live a normal life and regain their confidence. Doctors and the FDA should not be allowed to prevent someone from being happy and satisfied with their own body.

An overstep like preventing the use of silicone implants is a violation of paternalism. Like the well and good case involving patients in clinical trials, if patients are informed of the risks of a procedure and still wish to go ahead with it, then they should be allowed to do so (Thomas 256-258). Patients can easily be informed of the risk of the implants rupturing, and make an informed decision to continue or not. Especially because the risk of the implants rupturing is such a low percentage, I don’t think that such paternalism is justified. Another issue regarding paternalism is involved in weighing the costs and benefits. I believe that it is the role of doctors and the FDA to conduct studies and inform the public/patients of the risks, costs, and benefits of a procedure. However, I don’t believe that it is the role of doctors and the FDA to decide if the benefits outweigh the costs and risks–they serve to inform the patient but it is ultimately the right of competent, autonomous patients to decide for themselves what to do. If doctors and the FDA begin to overstep their role and not allow patients to use silicone implants, doctors will not respect the autonomy of a patient’s. Especially in an era where patients are given more and more choice, extreme paternalism is unacceptable and should be stopped.

Finally, even if the FDA did indeed have the right to prevent the use of silicone implants for breast implants, it makes no logical sense because there are so many other procedures that have higher risks and extremely lower regulation. For example, with body piercings, another form of body modification that has no medical benefit but is still common, studies show that there is a “22 percent infection rate for body piercing overall and a 34 percent infection rate for cartilage piercing” (Eisner). This infection rate is so much higher than the chance of a breast implant rupturing, and it also affects a much greater percentage of the population because many more people get piercings than breast implants. However, despite the high infection rate, the FDA hasn’t prevented people, or even children (I got my ears pierced when I was only a few months old) from getting piercings like they have with breast implants. And they shouldn’t, because it would be a violation of autonomy and a case of extreme paternalism. People should have the right to make their own informed, competent choices, even if it does mean a risk of rupture or infection.

Works Cited

Angell, Marcia. “Breast Implants–Protection or Paternalism?” The New England

    Journal of Medicine, 18 June 1992, www.nejm.org/doi/full/10.1056/

    NEJM199206183262510.

Eisner, Robin. “Body Piercing Can Be Life-Threatening.” ABC News, 27 Sept. 2016,

    abcnews.go.com/Health/story?id=117058.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study

Approach to Health Care Ethics. N.p.: Broadview, 2014. Print

Colorado, one of the first states to legalize marijuana back in 2012, approved a bill last year to legalize assisted death (“Colorado”). This came as a shock to many people not in support of assisted death, but, recently, more and more people have begun to support the idea of a doctor prescribing medication that will result in the death of his patient. As a quick background on information, doctors can’t just prescribe anyone these lethal drugs: the United States has set guideline for who is eligible to receive them. Patients must be terminally ill, have to be able to take the drug on their own, and, dealing with competency, must “have the mental capacity to know what they are doing and what the consequences are,” as well as make “two verbal requests, 15 days apart, and one written request with two witnesses” (Jaret). Additionally, more than one doctor must verify that the patient fits all these criteria. This ensures that the patient is competent to make the decision to end his or her life and also that the patient is not being coerced by a third party.

Assisted suicide should be a viable option for patients like Suzie Rodriguez. One of the Canadian Judicial System’s reasoning behind denying Ms. Rodriguez’s plea to have assisted suicide was that assisted suicide would “deprecate” human life (Thomas 215). I think it’s the opposite—people who have reached the end of their life and don’t want to die in an undignified and painful way should be allowed to do have assisted suicide in order to make their life as fulfilling as possible. Based on the principle of autonomy, patients should have the right to decide to die. Death is a major event in someone’s life, and if they aren’t able to carry out their final wish of how they want to die, then a medical professional should help them. I still believe, however, that doctors that don’t feel that same way should be able to refuse to ‘treat’ the patient. If I was a doctor in this position, I wouldn’t be able to carry out assisted suicide because of my own personal religious beliefs. Similar to the policy on abortion, doctors in this position should be allowed to maintain their own sanctity of life and refer the patient to a doctor willing to help them.

Many people argue that rather than suicide, modern medicine should enable patients to manage their pain instead of ending their lives. But what if in order to properly manage the pain, the medicine must be extremely strong and will affect the patient’s cognitive abilities and ability to have a satisfying, pleasurable, stimulating life? This starts to creep into the realm of deciding someone’s quality of life. I agree with previous readings that we shouldn’t judge the value of someone’s life based on our own perception of their quality of life, but I think that if a person thinks his or her own quality of life is below worth it, and they are terminal with no hope of change, then they should be allowed to have PAS.

Another argument against PAS is that it can result in a ‘slippery slope’ where involuntary patients or patients that are coerced are killed against their will. However, I disagree that PAS will lead to a slippery slope. As seen in the beginning of this blog, countries have already passed bills to regulate PAS so that only a very specific population of terminally ill, consenting, competent, and non-coerced people can participate in PAS. By instating bills like this, we prevent the possibility of a slippery slope developing. Weighing all of these factors, PAS should be legalized.

Works Cited

“Colorado.” Death with Dignity, www.deathwithdignity.org/states/colorado/.

Accessed 23 Feb. 2016.

Jaret, Peter. “Is Physician-Assisted Suicide Ethical?” University of California

Berkeley Wellness, Remedy Health Media, 26 Apr. 2016,

www.berkeleywellness.com/healthy-community/health-care-policy/article/

physician-assisted-suicide-ethical. Accessed 23 Feb. 2017.

Thomas, John, et al. Well and Good: A Case Study Approach to Health Care Ethics.

4th ed., Broadview Press, 2014.

In medicine there’s often a debate about whether to tell a patient about a current situation, or to lie if it might be in their best interest. In the case about Amira, nurses were dealing with the moral conflict on whether to tell her that her partner, Casey, had died in the accident, or to wait until after the surgery. The moral dilemma that the nurses face is deciding between nonmaleficience and telling the patients the truth. On one hand, the nurses don’t want to do the patient any harm. By telling Amira that her spouse died, the nurses can weaken her health even more, potentially causing her death. When people learn of a sudden death of a loved one “they can experience symptoms of shock” which can affect mental state, blood pressure, or breathing (“Sudden Bereavement: Responses in the Early Weeks”). Because of her extremely fragile state, it may be detrimental to Amira’s health if the nurses were to tell her about her partner. As she has already lost a lot of blood, a drop in blood pressure because of the news of her partner could lead to her death. But, how do we know that Amira would react to the news in this manner, entering into a state of shock? Amira may take the news better than other patients—is it then obligatory for the nurses to tell Amira the news if they think she would handle it better?

On the other hand, many medical professionals find it obligatory to tell patients the whole truth, regardless of the outcome. One of the main jobs of a nurse is to build a good relationship with his or her patient in order to act as the patient advocate, advising them on procedures and making sure the patient’s best interest is in mind. A major key to establishing this relationship is building trust with the patients. If the nurse isn’t upfront with Amira from the beginning, how is Amira to trust the nurse in further discussions? Another concern the nurses had was that Amira “might die…without knowing the truth about Casey” (Yeo, 233). Though this isn’t really a concern for Amira’s well-being (if Amira dies, it won’t matter to her that she didn’t know), it’s a concern about the nurses and their own conscious, which should be considered when deciding on what to do.

Weighing both of these factors, the best decision for Amira would be to not tell her about Casey until after the surgery. One must also keep in mind the impact this decision has on their daughter: if there is any chance that not telling Amira at the present moment about Casey might increase her chances of surviving, then we shouldn’t tell Amira in hopes of giving Samantha a better chance of not being an orphan. Additionally, it’s not uncommon to withhold information. According to Thomas Smith, only “37% of terminally ill patients have explicit conversations with their doctor about the fact that they are going to die from their disease” (Schwartz). If it’s acceptable to not tell most terminally ill patients the inevitable, then it should be acceptable to not tell Amira about Casey, especially if it gives her a better chance of survival. Additionally, there are no benefits for telling Amira about her partner sooner rather than later. For example, there are benefits for telling terminally ill patients that their death is soon: they can write their wills, decide power of medical attorney, etc. But, if the nurses tell Amira about Casey, there is nothing she can do, because she’s currently fighting for her own life. Therefore, the best course of action is to tell Amira about Casey after she wakes up from surgery, and to remind her that Samantha is perfectly healthy and needs a mom.

Works Cited

Schwartz, Shelly K. “Is It Ever OK to Lie to Patients?” Physicians Practice, UBM

Medica, www.physicianspractice.com/difficult-patients/

it-ever-ok-lie-patients.

“Sudden Bereavement: Responses in the Early Weeks.” Sudden: Supporting People

after Sudden Death, Brake: The Road Safety Charity, www.suddendeath.org/

help-for-professionals/online-guidance/2-uncategorised/76-earlyweeks.

Accessed 31 Jan. 2017.

Yeo, Michael, et al. “Case 3: Emergency and Trauma Nurses: When to Give Bad

News.” Concepts and Cases in Nursing Ethics, 3rd ed., PDF ed., Broadview

Press, 2010.