Medical_Ethics.ppt

8/14/2019 Medical_Ethics.ppt

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Medical Ethics

A Case Study:What to Do About

Thomas?

C

TE

Introduction

U

tah

StateOffice

ofEducation


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Medical Ethics

In discussing ethics, rarely is there onlyone answer, rarely is it comfortable, andrarely is it enough.

Ethics is the study of right and wrongconduct.

Ethics focus on moral situationsa choiceof behavior involving human values.


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Medical Ethics

3 criteria for judging ethical dilemmas:

1. Obligationsrights, rules, oaths.

2. Idealsgoals, concept of excellence,fairness, loyalty, forgiveness, peace.

3. Consequencesmay be beneficial orharmful effects that result from the action

and the people involved. Can be physical,emotional, obvious, or hidden.


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Basic Principles of Medical Ethics

Saving of life and promotion of healthabove all else.

Make every effort to keep the patient ascomfortable as possible and preserve lifewhen possible.

Respect the patients choices when alloptions have been discussed.

Treat all patients equally.


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Basic Principles of Medical Ethics

Provide for all individuals to the best ofyour ability.

Maintain competent level of skill.

Stay informed and up-to-date.


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Facts about

Low Birth Weight Infants

1. Any baby born weighing less than 5.5 lbs.

2. Most common cause of serious illnessamong newborn infants.

3. Threatened by problems such as brainbleeds, poorly developed lungs, poor bodytemperature control, malfunction of liver.

4. High likelihood of birth defects, heartdisease, mental deficiencies, poor nervoussystem development, susceptible toinfections.


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Facts about

Low Birth Weight Infants

5. Smoking, drugs, poor nutrition, stress allincrease a pregnant womans chance ofhaving a low birth weight infant.

6. Intensive hospital care exceeds $50,000.

7. Care of the smallest exceeds $150,000.

8. 7% of all babies born in U.S. each year.9. Require more community and school

resources for their education.


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Cast of Characters

Dr. Fisherpediatrician; developed newprocedure that has an 80% survival ratefor extremely low birth weight infants (< 1

lb) costing $450,000 per baby. Joy SmithMother, still smoking and

drinking socially, plans to not work for 2years after baby.

Michael SmithFather, family justbought new home, works a lot ofovertime.


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Cast of Characters

Emily SmithSister, 12, in band, drama,trying out for cheer leading, has lots of toys andwants to go to a private college.

Dennis CopaOwner of electronics companyfather works at, needs to decrease amount ofovertime worked by employees, and reducehealth benefits.

Joseph SullivanCEO of health insurancecompany, profits have been decreasing,increasing number of procedures not beingcovered.


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The Case

Joy goes in to premature labor, has babyboyThomas. He weighs 15 ounces atbirth.

Parents informed about Dr. Fishersprocedure.

Hospitals policy on high cost procedures is

that they will do it only if it is covered bymedical insurance or if parents agree tofull financial responsibility.


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The Case

Otherwise, Thomas will be put in theNBICU where chance for survival is verysmall.

Father contacts health insurance companyand finds out they will not cover.Maximum payment to NBICU is $150,000.

Parents need to come up with $300,000.Also told that even if Thomas does

survive, the chance of him being a normal,healthy child are


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The Case

Smiths total savings is $20,000. Have rich family member that can help them get

a loan for the remaining $280,000. Decide to involve Emily in decision. Will require a drastic change in lifestylesell

home, move to less expensive home; Emily willhave small room and will have to baby-sit to payfor own expenses; will have to take care of

Thomas after school so mom can go back towork so no after school activities and no privatecollege.

Dad needs to see if boss will let him continue towork overtime.


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Questions

1. Is it ethical for a hospital to provide atechnically feasible treatment only to thosewho can pay for it?

2. Under the circumstances described, shouldMega Insurance be required to pay for theFisher procedure?

3. Does Dr. Fisher have any moral responsibilityto try to make his procedure available to thosewith limited financial resources? If so, howdoes the hospital pay for it?


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Questions

7. If the Fisher treatment could provide a100% guarantee of Thomas survivingand living a full life as a normal

individual, would your answers to any ofthe preceding questions be different.

8. When the Smiths make their decision,should they take into account how theywould feel if they agreed to pay for thetreatment and then Thomas either diedor became severely handicapped?


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Questions

9. What moral responsibility should Joy feelfor creating this predicament, since herdrinking and smoking increased the

chances that it would occur?

10. If Thomas survives, but is severelyhandicapped, should he have the right to

either sue his mother for child abuse orto sue the hospital or his parents fortreating him, rather than letting him die?


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Additional Questions

1. Using intensive care procedures onchildren who would otherwise die resultsin larger numbers of mentally disabled

and handicapped children. What is yourresponse to this ethical problem?

2. Should decisions about whether to use

expensive medical techniques be basedon some form of comparison of costsand benefits?


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3. According to a U.S. Child Abuse law that wentinto effect in 1984, all infants with disabilitiesare to receive nutrition and other medically

indicated treatment with 3 exceptions:1. Irreversible coma

2. Treatment would only prolong dying

3. Treatment would be futile in terms of survival and

would be inhumaneDo you agree with this law? Do you think that it would

require a hospital to use an expensive experimentalmethod like the Fisher procedure on all very low

birth weight infants?


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4. Some obstetricians will not make a greateffort to resuscitate a severelyhandicapped newborn infant that

experiences cardiac arrest. Do you thinkthis is ethical?

5. Would it ever be ethical to withdrawtreatment from an infant with a poorchance of survival in order to provideintensive care for an infant whosechances of surviving are greater?


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6. Some medical policy makers haveproposed that public funds that are nowmade available to provide intensive care

to infants with poor survival chancesshould be reduced in order to providemore funds for prenatal care for women

who are at risk of giving birth to a lowbirth weight infant. What do you thinkabout this proposal?


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7. Wrongful life lawsuits brought againsthospitals, doctors, and even parentsinvolve a claim that a severely

handicapped childs life is worse thandeath or non-existence. What is youropinion about such lawsuits?

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Medical_Ethics.ppt