All posts by Joyelle Fleming

Soft Paternalism & Obesity Prevention

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In Holm’s article “Obesity Interventions and Ethics” he discusses whether or not it is appropriate to have public health policies that intervene to promote a person’s health. In this essay, Holm’s focuses on obesity interventions as the public health issue. Holm states that there are two main problems with this are when and if it is actually justifiable to have such policies that intervene in order to promote someone’s health and if it justifiable to have policies that can negatively affect people but benefits the common good.

Public health policies always have a paternalistic side to them, it’s just a matter of how much paternalism a policy wants to utilize. Holm’s defines three different forms of paternalism including hard paternalism, soft paternalism and maternalism (392). All three forms use different methods, to achieve a certain end. Soft paternalism, which includes “providing unwanted information or foreclosing some options for action”, should be utilized in public health policy (Holm, 392). In this way a specific decision is not forced onto a person, however they are given the information to make better (and maybe easier) decisions about maintaining their health. Some of these policies include changing food labels and changing advertising methods.

Recently the FDA has suggested new changes to food labels in order “to bring attention to calories and serving sizes” which are important in addressing problems related to obesity. Changes include writing calories in a larger font, adjusting amount per serving, and updating the necessary daily values for various nutrients and vitamins (United States). Here is a picture of the differences between our current food labels (right) and the suggested future one (left).

UpdatedLabelLabel

The main goal of these changes is to “make people aware of what they are eating and give them the tools to make healthy dietary choices throughout the day” (United States). Changing food labels will just help people become more aware of what they are eating. Even though the label may be providing “unwanted information” people can still choose to disregard the information therefore it would benefit the common good without negatively affecting people (392).

Chile has also recently changed their food labels to be more representative of the foods contents. The Law of Food Labeling and Advertising was passed in July 2012 and focuses on regulating and labeling critical nutrients, adding warning messages to foods and reducing the amount of food marketing toward children (Corvalán, Reyes, Garmendia, Uauy, 2013).  Chile is still surveying their new changes and augmenting them, however the ideas that they suggested fall under soft paternalism. If the policies prove successful, they could be utilized in United States obesity prevention efforts.

Children are group that is often referenced in paternalism debates. The same is true in regards to obesity prevention. Children are bombarded with food advertisements while watching television, which can increase their consumption of such foods. Andreyeva found that “Exposure to 100 incremental TV ads for sugar-sweetened carbonated soft drinks during 2002–2004 was associated with a 9.4% rise in children’s consumption of soft drinks in 2004. The same increase in exposure to fast food advertising was associated with a 1.1% rise in children’s consumption of fast food” (2011). The increased associated risk may seem small, but you have to think about the number of children that it is affecting and the long-term effects of this exposure. A 2008 study found that the amount of fat on a child directly increased with fast food advertising exposure (Andreyeva, Kelly, Harris, 2011). The same study suggests that reducing the amount of exposure could reduce adiposity by 18% (Andreyeva, Kelly, Harris, 2011The evidence provided suggests that merely reducing the amount of fast food commercials directed at kids could help maintain their current and future health.

All of the solutions that I have suggested have scientific evidence behind it, and have been implemented. The policies also maintain their paternalistic roots allowing no negative consequences to be forced on anyone but simultaneously is improving the health of the general public.

Sources:

Andreyeva, T., Kelly, I.R., Harris, & J.L. (2011). Exposure to food advertising on television: Associations with children’s fast food and soft drink consumption and obesity. Elsevier, 9(30): 221-233. http://dx.doi.org/10.1016/j.ehb.2011.02.004

Coravalán, C., Reyes, M., Garmendia, M.L., & Uauy, R. (2013). Structural responses to the obesity and non-communicable diseases epidemic: the Law of Food Labeling and Advertising. Obesity Reviews, 14(2): 79-87. Doi: 10.1111/obr.12099.

Holm,S. Arguing about Bioethics. Ed. Stephen Holland. Routledge: New York, NY, 2012. Print.

United States. U.S. Food and Drug Administration. Nutrition Facts Label: Proposed Changes Aim to Better Inform Food Choices. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm387114.htm#different.

 

 

 

 

 

Reforming Informed Consent

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Robert M. Veatch’s article argues that informed consent should be abandoned due to its uses as a “transitional concept” and ambiguity (Veatch 317). Veatch provides several examples to support his argument, among these include the “best interest standard”, how a person defines well-being, and physician bias (322-334). All of Veatch’s examples are accurate; with our current health care system it is difficult for physicians to make recommendations or conduct procedures on patients. Two important supporting facts of Veatch’s argument are that “actual consent is not obtained in all cases” and that the concept of informed consent is a relatively recent occurrence (317-318). Patients may also misinterpret the benefits and risks of a procedure (Krumholz 1190). However, in present day Western society I do not think that we would be able to eliminate informed consent. There are too many legal ramifications that could occur which will only require unnecessary spending. In order to find a median between informed consent and the best interest of the patient I suggest that the physician-patient relationship be adapted.

Many of the information against consent were rooted in the physician-patient relationship. American health care does not place great emphasis on time spent with the patient, which does not allow physicians to get to actually know their patients. Many of the issues Veatch present deal with this lack of relationship. This suggests that improving and strengthening the relationship between the two parties would be beneficial for both.

An article by Dr. Harlan M. Krumholz poses a potential solution to improving the consent process. Dr. Krumholz suggests a patient centered approach. Patient centered care focuses on “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” (Krumholz 1190).  This means that the physician must have a minimal understanding of who their patient actually is. By acknowledging and working with the patient based on their values, many of the issues that Veatch brings up become irrelevant. To improve patient knowledge about procedures and to improve the process of giving consent Krumholz suggests that patients should receive a “brief standardized and personalized informed consent document” that would cover the risks, benefits, alternatives, experience and cost of the procedure (1190).  This document can facilitate discussion between physician and patient, and allow the patient to ask more questions and receive the doctor’s opinion. Consent forms will be standardized, and be at an average reading level and reasonable length (Krumholz 1190). Consent forms will not be written by the institution but by experts from the Department of Health and Human Services. One health system in Kansas City has tried out Krumholz’s solution, which led to “improved reading and satisfaction with the consent process, less patient anxiety, and a sense of partnership in the decision-making process” (1190). Krumholz’s solution agrees with one of the last points of Veatch’s article, “the concept of consent will have to be replaced with…active patient participation” (Veatch 327).

This change to patient-centered care could be added to current health care reform. President Obama’s Patient Protection and Affordable Care Act is attempting to improve health care by reducing the amount spent on health care and providing quality care that is affordable (Health Care Reform Timeline). Including active patient participation into the reform (or as a result of it) can also be beneficial. People may take a greater interest in their health, and could be more proactive in maintaining healthy lifestyles.

Sources

Health Care Reform Timeline. http://obamacarefacts.com/health-care-reform-timeline.php

Krumholz, H.M. “Informed Consent to Promote Patient-Centered Care.”  JAMA. 303.12 (2010):1190-1191. Web. 24 Feb 2014.

Veatch, R.M. Arguing about Bioethics. Ed. Stephen Holland. Routledge: New York, NY, 2012. Print.

Blog Post 1:Dolly & Eugenics

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One of the over arching questions of cloning is obviously whether or not we should clone animals or humans, which can filter down into the question of just because we have the ability or technology to do it should we? Dolly was one of the first animals to be cloned, and the first animal to be cloned from an adult cell (“Cloning Dolly the Sheep”). Dolly wasn’t cloned for the sake of seeing if it could be down. Researchers were looking into the transfer of human genes into animals to produce certain proteins that are helpful in the treatment of human diseases (“Cloning Dolly the Sheep”). Other reasons for animal cloning include animals that produce higher-quality meat or milk, to use as breeders, and making potential drugs or vaccines (“Why Clone?”). The picture brings up an interesting consideration about improving the food safety and quality of our meat (http://animalscience.ag.utk.edu/utcloneproject/).

CloningCardFront

The above reasons don’t necessarily apply to human cloning, but are interesting nonetheless. It does not seem that animal cloning is a popular or common occurrences, however this viewpoint may change. Kass and Elliott both provide examples of other reproductive technologies that were originally seen as inappropriate that have become acceptable today. From this evidence, one could propose that cloning will become mainstream in the future.

Both authors bring up the moral issue of eugenics. Elliott mentions that cloning could allow for “many more opportunities for ‘positive’ or ‘negative’ selection” (Holland 151).  Kass mentions an article in The Washington Post where the author states, “cloning could help us overcome the unpredictable variety that still rules human reproduction, and allow us to benefit from perpetuating superior genetic endowments” (Holland 131). The evidence that Kass provides focuses on the possibility of forming a homogeneous super species, one that has all the best genetic qualities. There would be great benefit in having predictability in reproduction, something that could be positive or negative. Elliott’s evidence suggests that there are positive and negative sides to cloning an individual with desired characteristics. I agree with Kass’ statement in the fact that it would be great to have the healthiest and most robust genotype to survive, but how would we keep evolving as humans? Darwin’s experiments with finches would not have worked unless there were a variety of phenotypes to utilize. Darwin was able to notice which birds survive which conditions and how they adapted to their environment. Hypothetically speaking if we had an entire population of clones (neither pieces of evidence state this, but Kass’ support seems like it could support mass cloning) how would we as humans evolve and adapt to new surroundings? Just because a specific genotype is beneficial at this current time does not mean that it will be the best genotype twenty years later. “Evolution by natural selection benefits considerably from individual genetic diversity” therefore we will never know the best genotype because it will keep changing based on our environment (Holland 159). My conclusion may be a bit dramatic because it is based on the presence of an entire population of clones, but I believe it is still something that should be addressed. Cloning would reduce the amount of genetic variation within the species, which could have positive or negative effects down the line.

Sources:

“Cloning Dolly the Sheep.” AnimalResearch.Info. 1996. Web. 27 January 2014. http://www.animalresearch.info/en/medical-advances/151/cloning-dolly-the-sheep/

“Why Clone?” Learn.Genetics. University of Utah Health Sciences. Web. 27 January 2014. http://learn.genetics.utah.edu/content/cloning/whyclone/