Martha and her partner are both unemployed parents of three children. After the failure of home remedies and realizing that she may have a serious oral healthcare situation, Martha decided to see a physician. To her dismay, though, she understood that she was not going to be able to get the real help she needed as she did not have dental care coverage or the government supplement to reduce the cost of the medical treatment. Martha decided to stick with her home remedies and hope for the best. In the more recent years, a serious issue amongst low-income families has arose. With the costs of healthcare rising and the rate of employment declining, more and more people are becoming uninsured and unable to afford healthcare for themselves and their families. This leads to the question of what to do about this rising issue. Currently, there are policies in place that help offset costs/provide minimal healthcare for children and disabled persons. Unfortunately, though, many people do not qualify under these circumstances to receive help. This leaves people stranded and without insurance.

Utilitarian arguments point in the direction of support for public funding that provides healthcare for all of these people. Which, if agreed upon, is absolutely doable and has been done before in other countries. One of the largest counterarguments to this, though, is the overwhelming “inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition” (Pampel). There has been enough credible research done that points out the fact that the vast majority of people that fall under lower socioeconomic status are less likely to carry out healthy practices. Essentially the argument is that they bring the health problems onto themselves. Many anti-supporters of this movement believe it would be a waste of money to invest in healthcare for these persons, as they are going to cost the people and the government too much money due to their unhealthy habits.

While this argument is not necessarily invalid, it is important to realize the correlations between low socioeconomic status and lack of education. It is very likely that many of these people who practice these unhealthy habits are not educated in what is healthy and what is not. I’m sure many of them wouldn’t smoke a pack a day if they were aware of the severe health risks. Ethically, it is wrong that people must be excluded from receiving healthcare to keep them healthy and alive just because they cannot afford it. The right to be a healthy individual is not and should not be considered something that only the wealthier members of society are entitled to. Providing healthcare to all citizens of your government should be a top priority for all countries, as health people are happy people and you have the potential to stop this epidemic of unhealthy poverty stricken areas.

There is even research that shows children with low socioeconomic status are more likely to get sick. This is why it is unethical not to provide healthcare for people of low SES.

Works Cited:

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

Pampel, Fred C., Patrick M. Krueger, and Justin T. Denney. “Socioeconomic Disparities in Health Behaviors.” Annual Review of Sociology 36.1 (2010): 349-70. National Library of Medicine. Web.

Thomas, John E, et al. “Case 2.2: Social Determinants of Health.” Well and Good: Case Studies in Biomedical Ethics, Broadview P, 2014.

Do you think it is acceptable for health professionals to decide which patient is more important to save based on QALYs, quality-adjusted life-years? Using this method the number of years an individual can live is favored over the number of lives that can be saved. “QALYs are calculated by estimating the years of life remaining for a patient following a particular care pathway and weighting each year with a quality of life score” (Beauchamp and Childress 239).

The article “QALYfing the value of life” gives the following example: “Andrew, Brian, Charles, Dorothy, Elizabeth, Fiona, and George all have zero life-expectancy without treatment, but with medical care all but George will get one year complete remission and George will get seven years’ remission” (Harris 118). Using QALYs, George would be treated over the other six patients since he has a longer remission than the other patients. By valuing life-years, QALYs may require the physicians to sacrifice six lives in order to save one. This situation exemplifies the tension that can form between QALYs and beneficence. QALYs instructs the physician to assist the patient with the highest QALY score, while they are also obligated to help all of the patients due to their duty to rescue and help. Using this example as a baseline of how QALYs would be implemented in health policy, I think that QALYs should not be implemented into the system because it is ageist, favors patients that require relatively cheap treatments, and does not make a distinction between life-saving and life-enhancing treatments.

QALYs is ageist because younger individuals tend to have higher QALYs on average than older people. As a result, if there were ever a situation in which a physician had to choose to assist one of two patients, an older and a younger individual, the physician will always choose the younger patient. I believe that this is unethical and brings into question the issue of justice in bioethics. This method of valuing one’s life requires the disregard of the generalized assumption that every individual is considered equal, and no one person should be regarded as more important than another. By using QALY, physicians are obligated to prioritize younger patients over others, and thus consider those patients more important.

In addition to being ageist, this particular way of valuing one’s life also favors patients that require cheap treatments. Using this system, “the quality of life of those with illness or disability is ranked, on the QALY scale, below that of someone without a disability or illness” (Singer). In general, under QALY “if a ‘high priority health care activity is one where the cost-per-QALY is low, and a low priority activity is one where cost-per-QALY is high’” then individuals with conditions that are cheap to treat are prioritized over individuals that require more expensive treatments (Harris 119). This system discriminates against groups of patients that unfortunately suffer from a disease that is expensive to treat. QALY requires physicians to systematically save specific groups of patients, at the expense of others.

Lastly, this method of valuing life does not create a distinction between life-saving and life-enhancing treatments. In general, most people think that life-saving treatments should take priority to life-enhancing treatments; however, that is not the case with QALYs. Instead, QALYs prioritizes individuals that have higher QALYs on average, meaning that they can live longer and at a higher quality of life. As a result, if a patient who is seeking a life-enhancing treatment has higher QALYs than a patient seeking a life-saving treatment, the patient with the higher QALYs would be prioritized regardless of the treatment that they are seeking.

Calculating QALYs is also a debated topic because in order to calculate it, one must decide what the patient’s potential quality of life will be. As we have discussed earlier in this class, it is impossible for one to know how another individual would value their quality of life since we all have different experiences and values. Reflecting upon that, I think that the method of calculating QALYs is unethical because it involves making assumptions on another’s behalf that may not be entirely accurate.

Taking everything into consideration, while using QALYs would be beneficial in deciding which patient to treat first when the two patients in question are in all regards considered equal, it is not realistically practical since most two patients are not alike. Using QALYs as a method to decide which patient to treat first or which patient should be prioritized is not ethical as it discriminates against certain groups of individuals and forces an outsider to determine what the patient’s quality of life is. As a result, QALYs should not be used in health care.

Works Cited:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2013. Print.

Harris, John. “Qalyfing the Value of Life.” Journal of Medical Ethics 13.3 (1987): 117-23. JSTOR [JSTOR]. Web. 30 Mar. 2017.

Singer, P., J. McKie, H. Kuhse, and J. Richardson. “Double Jeopardy and the Use of QALYs in Health Care Allocation.” Journal of Medical Ethics. U.S. National Library of Medicine, June 1995. Web. 30 Mar. 2017.

Sometimes in healthcare, the value of someone else’s life must be placed over another person’s life when deciding who does or does not receive treatment. It seems unethical to decide who lives and who does not; however, sometimes it is necessary no matter how difficult. So, how do healthcare professional make such difficult decisions? One way these decisions can be made are by using QALY’s which are controversial in the field.

QALY stands for the Quality Adjusted Life Year and it is often used in a situation where resources are few. The QALY method is “a new measure of quality of life which combines length of survival with an attempt to measure the quality of that survival” (Harris, 1987). With this system, a year of healthy life expectancy is worth one, but a year of unhealthy life expectancy is worth less than one. The general statement behind this system is that if a person were given the choice, they would prefer a shorter and healthier life rather than to live a long life of suffering.

In this article, the author argues against the use of QALY’s. He believes that by using this system, everyone is ok with choosing death so that another person can live because they have a better chance at having a higher quality of life. QALYs acknowledges an individual situation but does not acknowledge a situation in which an individual’s quality of life is compared to another person’s quality of life. The author does make another point that QALYs can be ageist because it is typically easier and more productive to save the life of a young person than an older person. So, using the QALY’s can be quite biased in such a situation.

Initially, when reading about QALY’s, I thought that the system was reasonable; however, the author does make a good point that it may not be the most fair system to be used. However, in my opinion, in a situation where resources are scarce, choices like these have to be made and evaluated somehow and I believe that the use of QALY’s is efficient and logical. There are other alternatives to using QALY’s such as discounted future earnings (DFE’s) and willingness to pay (WTP). DFE determines a person’s quality of life based on what a person could be expected to earn if they survived. WTP considers how much a person would be willing to pay for treatment (238). I do not agree with these alternatives. They place the value of a person’s life on monetary matters which I do not believe have a place in the medical field. QALY’s takes into account a person’s potential length and quality of life after survival if they receive treatment. These are reasonable considerations that could be very useful in a case, such as an organ transplant, where resources are scarce.

Beauchamp, T. L., & Childress, J. F. (2013). The value and quality of life. In Principles of

biomedical ethics (pp. 238-239).

Harris, J. (1987). QALYfying the value of life. Journal of Medical Ethics, 13(3), 117-123. Doi:

10.1136/jme.13.3.117

Child vaccinations are now mandatory in the United States if the children want to attend public schools. A lot of parents disagree with child vaccinations, because there have been reports of the negative effects of vaccinations on the child’s life. A lot of the parents that I work with through summer camps do not want their children to be vaccinated because there is a lot of unknowns when it comes to vaccinations. I think the main reason why vaccinations are a problem for a lot of parents is because they do not fully understand the purpose, mechanism, and desired effect of the vaccinations, which to be is a limitation on their autonomy because they do not fully understand, and they don’t really have a choice.

I also think that in some cases, doctors are not transparent with their patients in terms of the purpose of the vaccinations. I know that within the African American community, in 2012, there was a lot of distrust in vaccinations in Atlanta because the CDC was conducting a study on the effects of a measles vaccine, specifically looking at African American children, who they suspected were at a higher risk of developing autism from the vaccine. The authors of the study manipulated and hid data that proved that black babies were more than three times more likely to develop regressive autism if they were given the vaccine before the age of three. The parents of the children who were administered the vaccine were not made aware of their increased risk, and it was only through a leaked source that they were made aware. Information such as this deters parents from vaccinations and should serve as a basis for why parents should have the choice of vaccinating their child.

Source:

Journal of Paediatrics & Child Health; Should Routine Childhood Immunizations be Compulsory? 

5 Unethical Medical Experiments That Used Black People As Guinea Pigs

I disagree with the conclusion “routine childhood immunization should not be compulsory if adequate levels of immunization can be achieved by other means,” by Isaacs, Kilham, and Marshall [will be referred to as “Authors”] in “Should routine childhood immunizations be compulsory?”

If I’m being honest, I feel troubled by my own opinion because it contrasts with that of published scholars affiliated with the Departments of Immunology and Infectious Diseases, the Children’s Hospital at Westmead, the Paediatric Trials Unit and the Department of Paediatrics, the Women’s and Children’s Hospital. Nonetheless, in this blog post, I will outline the reasons for my disagreement.

The Authors base their conclusion on “ethical and practical reasons” (Issacs). Ethical concerns they mention include: autonomy, parental rights, coercion, trust, and weight of risks-benefits. And, the only practical reason they mention is difficulty enforcing.

“Practical” Reason: Enforcement

Because the Authors only present one practical reason, I choose to address this point first. The authors frame the physical restrainment of a child for immunization as an aggressive act comparable to assault. This comparison, in my opinion, is exaggerated and dramatic as no threat is posed and there is no intent of physical harm or injury. This opinion is made considering assault as “an act that threatens physical harm to a person, whether or not actual harm is done” (Oxford Dictionary). The Authors say restrainment for immunization is only “justifiable in a situation of extreme risk,” but they fail to provide criteria of what is considered ‘extreme’ and ‘risky’ (Issasc). Infectious diseases can definitely be considered a potential risk, and in the way I see it, immunization is actually preventing extreme risk.

Ethical Reasons

Parental Rights and Autonomy. The arguments for parental rights and autonomy are weak. Immunizing one’s child does not make or break a parental style of child rearing. Receiving an immunization(s) does not directly shape a child’s habits, values, morals, or beliefs. The Authors, themselves, even mention the ethical consideration that “ people who are afraid of harming their child by immunization …[generally tend] to be more worried about causing damage to one’s child by doing something to them rather than by not doing it” (Issacs).

The Authors counter their very own argument the “protection of the community only applies for transmittable disease” with the concepts of herd community and free riders. They say “an important implication of herd community is that failure to immunize a child against a transmissible infection may not only render that child susceptible to infection, but may imperil other children” (Issacs). Perhaps it is okay (not terribly harmful and dangerous for the community) if a small handful of people are not immunized. Even then, we cannot all be the exception to the rule; we cannot all be free riders because as “the number of free riders increases, the population becomes more susceptible, and disease will start to circulate” (Issacs).

Risk-Benefits and Trust. The Authors do not specify which routine childhood immunizations should not be compulsory. So, assuming their argument encompasses all routine childhood immunizations, their argument for risk-benefit is ineffective. Although the “risk benefit equation varies from disease to disease,” the overall benefits of immunizations outweigh the risks for the diseases. Vaccines are scientifically proven to be effective. It is the very reason why immunizations are worthwhile. In fact, “most childhood vaccines produce immunity about 90 – 100% of the time” (U.S. Department of Health and Human Services).

The Authors claim “making immunizations compulsory renders trust redundant,” which implicitly claims there is a problem with redundancy (Isaacs). To that end, I ask, is there a problem with redundancy? Is it hurtful or inappropriate for health care professional to repetitively give reassurance? I do not think so. Also, does the enforcement of immunization invalidate physician-patient trust? Nope.            The Authors associate enforcement with coercion, which is paradoxical to their saying if “high levels [of immunization] can be maintained through encouragement and incentives, this effectively achieves the aims of the moderate communitarian, without the need for legislation” because incentivizing can be considered a form of coercion as well. In fact, when talking about inducement, the Authors pose the question: “Could this be seen as a form of coercion, particularly to poorer families who are far more dependent on such welfare payments”(Issacs)? I think, yes. Enforcement of immunizations, I think, would be an act of paternalism by the government.

Alternatives to compulsion

Education. While I disagree with the Authors overall conclusion, I do agree with their idea we should increase education re: benefit of immunizations. However, dispersion of information and health care education can be a difficult and challenging process. For example, there may be “unreliable funding and resources,” and we need to consider “long duration [is] needed to create lasting change” (World Health Organization). Perhaps eventually we will reach a point where everyone is educated, but in the meantime, I believe it better to implement compulsory immunization.

Outbreak Legislation. While it is possible to “enact emergency legislation to compel immunization,” in the event of an outbreak, pandemic, or bioterrorist attack, it would be a race against the clock or a matter of luck for those who are not immunized. Would it not be better to have received the immunization ahead of time? We should not view this only as a matter of planning for what might or could happen, but also for the sake of matters such as communitarianism, consequentialism and community rights. It’s true; “a circumstance of risk involves a possible occurrence of something that has been valuated as harmful along with an uncertainty about its actual occurrence” (Beauchamp, 230). But we ought to wonder: is it worth the risk?

No-fault and compensation schemes. While I do acknowledge vaccines sometimes harm people, I still believe the benefits of immunization outweigh the slim risks. I do not find it necessary for me expand on the effectiveness of vaccines which counters the few cases. That being said, monetary compensation is viable as the amount spent on treating vaccine preventable diseases is incredible. I defer to the following to prove my point: https://www.cdc.gov/vaccines/programs/vfc/pubs/methods/

Closing-thoughts

The Authors have made several strong and valid points in favor of compulsory immunization. They have even made arguments for compulsory immunization, which counter the very arguments they make against compulsory immunization. Now that I have expressed my opinion and provided the facts and personal sentiments to why I disagree with the Authors, I’d love to hear what you guys think. Do you agree with the arguments against compulsory immunizations the Authors make?

Citations

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

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. 26 Mar. 2017.

“Types of Healthy Settings.” WHO. World Health Organization, n.d. Web. 26 Mar. 2017.

U.S. Department of Health and Human Services. “Vaccines.gov.” Vaccines Are Effective. U.S. Department of Health and Human Services, 11 Oct. 2006. Web. 26 Mar. 2017.

“VFC Publications: Supplement.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 23 Apr. 2014. Web. 26 Mar. 2017.

Mandatory vaccinations have become an increasingly hot topic in the realm of health. Some patients and families argue that insurance companies and health care providers are becoming too paternalistic, and insist on a voluntary vaccination model, whereas the opposing argument is that mandatory vaccinations are leading to decreased prevalence of diseases in the population. Proponents of voluntary vaccinations cite evidence of other countries vaccination rates as proof of the success of a voluntary-based model. In this post, I will be advocating for the support of mandatory vaccinations and their effectiveness, as well as addressing the vaccination rates of other countries.

One of the reasons for the support of mandatory vaccinations is that they prevent the risk of greater harms. For instance, many low-income families may not have access to quality medical care. They may have access to the basic standards of care, such as vaccinations and general prescriptions, but they are not in a position to afford things such as expensive medications for chronic diseases. By making vaccinations mandatory, the risk is decreased for at-risk populations contracting a disease such as the measles, and therefore, lowers their overall cost of care. Although it should be mentioned that certain risks are associated with the use of vaccines, the rate of injury is small and is outweighed by the possible benefits.

Secondly, mandatory vaccinations are seen as cost-effective. Health organizations, such as the World Health Organization and Center for Disease Control, generally have to make executive decisions on whether to promote the use of a certain vaccine or not. One of the variables they use to assess the strength of a decision is the cost, which is used in calculating the cost-benefit analysis (CBA). As Beauchamp and Childress discuss, the CBA “measures both the benefits and the costs in monetary terms” (231). The CBA can be used to factor out variables such as the ethical or moral values associated in making one decision over another. This way of reasoning could be used in demonstrating to patients that the costs to themselves are greatly reduced when they receive vaccinations compared to when they do not.

Thirdly, mandatory vaccinations are seen as the best option in the United States in terms of results. Several proponents of alternative forms of compulsory immunization make the claim that other countries who engage in alternative immunizations, such as through education, have similar rates of immunization compared to countries who engage in mandatory immunization. The country they use in the vaccination reading is Australia, whose rates of immunization are around 90%. One of the issues I have with this way of thinking is the inherent assumption it makes that Australia and the United States are equal countries apart from their differences in vaccinations. This is a false assumption, as Australia and the United States differ in several ways, one major way being how Australia has universal health coverage, something the United States does not have. This could greatly impact the rates of immunizations in itself, regardless of whether Australia participates in alternative or mandatory vaccinations. Secondly, the claim could be drawn that a 90% vaccination rate is equal in terms of results in comparison to the United States vaccination rates. This is also false, since having a 90% vaccination rate would expose the United States population to a host of diseases that are currently kept under control, such as the measles.

In conclusion, vaccinations are not risk-free. Most decisions come with their own risk of complications, and as such, should always be taken to account. Vaccination may be seen as one of the greatest public health interventions, whereas some say their infringement upon patient autonomy must be considered. I believe that mandatory vaccinations are mandatory, however, I am not opposed to change. In the future, I would like to see a vaccination model that incorporates results with the ability of patient choice.

Citation:

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

Isaacs, D., Ha Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Paediatrics and Child Health 40.7 (2004): 392-96. Web. 24 Mar. 2017.

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.

https://i.reddituploads.com/16ebf7dfa4cb4a63bb1ef6ade97efa43?fit=max&h=1536&w=1536&s=43def47049db763c04ab2809cd2e743c

Beauchamp and Childress bring up a very interesting point about the value and quality of life. They show that it is possible to quantify human life. There are many different ways of analyzing the value of a human’s life. The two ways that Beauchamp and Childress argue for are discounted future earnings (DFE) and willingness to pay (WTP). DFE is an analysis of a person’s condition and then potential monetary gain that they are expected to earn if they survive. WTP is an analysis of the how much individuals would be willing to pay to reduce the risks of death – either in real life or hypothetically. Both WTP and DFE are heavily monetary based, completely sidelining the persons well being. Beauchamp and Childress then go on to talk about Quality Adjusted Life Years (QALYs), a system currently being used in the UK, to determine who gets treatment. QALY is mainly based on a cost benefit analysis: balancing the age, type/cost of the procedure, and the amount of years that can be gained if the procedure is done to the patient. (Beauchamp & Childress 237 – 241)

I appreciate the ethical concerns of QALY brought up at the end of the chapter. For the most part I do not agree with Beauchamp and Childress; I believe that life is invaluable. There is already so much inequality in the world—but to separate the value of peoples lives so blatantly only breaks down the characteristics that separate us from other animals. QALY takes a utilitarianism standpoint that heavily biases against those that are old and already impaired. The cost and benefit for treating those who are younger and healthier heavily outweigh treating the old and weak. Younger and Healthier people have more to contribute to society as well as will survive longer after the procedure.

I believe that a balance needs to be achieved, for there are many flaws on both sides. In society today there are two systems that are present: one of universal healthcare and the other of privatized healthcare. In each system respectively, QALY heavily biases the either young or the rich. If following QALY in such a universal health care system – such as in the UK— the younger, healthier generation are often treated before the older solely due to the fact that a younger person will have more of an impact in the world than an older person of the same disease. In a privatized health care system such as ours, the old is no longer biased against, rather it is the poor. Rich people can afford procedures than those who are poor. A perfect, semi-recent example of this is AIDS. Magic Mike was able to afford medication for AID at a time the cost was too great for many another people(PBS). Due to his large amount of wealth, he was able to survive while many others died. Only to further the same point… with the increase in technology the cost of the AIDs pill decreased to an affordable rate for average civilians, until 2015, CorePharma sold the U.S. rights of Daraprim to Turing, which raised the price to a whopping $750 a pill. (CNN) In privatized healthcare system, only the wealthy is safe from death while the commoners must fend for themselves. We need a system that neither is bias against the young nor the rich. We need a system that follows the spirit of the Hippocratic oath. The field of medicine was created to save people; to prioritize anything above saving people would seem counter intuitive.

That being said, there is one place I believe QALY is acceptable to use, the military. In military there are situations where time and resources play a larger factor in the decision making of who get treated and when they get treated. At times three categories were created: those who would live, those who needed help to live, and those who would die. These three categories outline what QALY stands for—they have grouped injured people based on the procedure needed and the outcome/quality of life is received medical attention. This utilitarian standpoint when treating combat related injured helps save the most amount of lives without wasting resources.

Alex

Citations:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2016. Print. pp 237 – 241.

Hillary Clinton tweeted that the 5,000% spike was “outrageous”, and Amounted to “price Gouging.” Nothing about the Drug Itself Had Changed except This: a New Company — Turing Pharmaceuticals — Had Bought the Rights to Distribute It. The Daily Beast Dubbed Turing’s CEO “the Most Hated Man in America.” “What happened to AIDS drug that spiked 5,000%.” CNNMoney. Cable News Network, n.d. Web. 25 Mar. 2017.

“20 Years After HIV Announcement, Magic Johnson Emphasizes: “I Am Not Cured”.” PBS. Public Broadcasting Service, n.d. Web. 25 Mar. 2017.

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.

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