chapter 14: ethical issues in health and health care

Question 1

when was physician-assisted suicide made legal in Canada

Answer 1

in January 2015, the Supreme Court of Canada overturned the 1993 ruling that prevented Canadians with irremediable medical conditions from ending their life with the assistance of a physician

Question 2

countries that legalized physician-assisted suicide

Answer 2

Netherlands, Belgium, Canada, and Oregon, Washington, and Vermont in the US

Question 3

criticism of physician-assisted suicide

Answer 3

argued that honouring the “right to die” misrepresents the lives of people living with severe disabilities and could lead to a serious misuse of end of life directives

Question 4

ethics

Answer 4

a dynamic decision-making framework that allows individuals to act in a way that aligns with their personal values, religious beliefs, or other important guiding principles

Question 5

two components of ethics

Answer 5

1. involves well-founded standards of right and wrong that prescribe what humans ought to do in terms of rights, obligations, benefits to society, fairness, or specific virtues
2. standards of right and wrong situated in a societal context and enforced by the rule of law

Question 6

bioethics

Answer 6

defined by Reich as the systematic study of human conduct in the area of the life sciences and health care, insofar as this conduct is examined in the light of moral values and principles

Question 7

critical approach in bioethics means

Answer 7

investigate power differences and their impact on everyday ethics and bioethics scholarship, and emphasizes the use of empirical approaches to understand bioethical issues

Question 8

what are the ten ethical challenges facing citizens in most Western industrial nations

Answer 8

1. conflicts over treatment decisions
2. determining essential services
3. the lack of services for vulnerable populations
4. a shortage of health care workers to provide care
5. medical error
6. decisions about end of life care
7. the ability to give informed consent prior to receiving care
8. the risks and benefits of participation in medical research
9. determining who can make health care decisions on behalf of another
10. the emergence of new medical technologies

Question 9

bioethicist

Answer 9

their job is to explore, study, and support the resolution of ethical issues, they have the power to influence society’s understanding of, and response to, ethical issues

Question 10

what is one common reason that causes disagreement over treatment decisions

Answer 10

• religious beliefs, making it a primary ethical challenge
• the rise of CAM can also create ethical challenges with patients seeking treatments that an allopathic physician seemed as harmful or unnecessary

Question 11

lack of accessibility

Answer 11

especially among vulnerable populations, represents a major ethical challenge in situations where universal access is implied and expected

Question 12

what are the two contexts where availability of care is compromised

Answer 12

1. an individuals’ living circumstances can create barriers to health care (social stigma)
2. cultural barriers can prevent or limit access to health care

Question 13

primary care physicians

Answer 13

medical doctors who function as the first point of contact for a patient

Question 14

what two effects does poor access to provider has

Answer 14

spatial - distribution of providers is lower across regions that are underserved
social - there are not necessarily providers available to assist those who are marginalized or required a greater degree of care

Question 15

medical error / malpractice

Answer 15

physician error that breaches their legal contract with the patient, the physician is held culpable

Question 16

adverse event

Answer 16

an unintended injury or other negative consequences that results from an issues within the medical system

Question 17

Baker landmark study

Answer 17

reveals that 7.5% of hospital admissions in Canada were associated with adverse event, where about 38% of those events were preventable, advocating for the need to create a safer and more accountable health care system

Question 18

the Canadian Patient Safety Institute (CPSI)

Answer 18

created to raise awareness and develop best practices to support patient safety

Question 19

what does regulatory guidelines that require health care providers disclose errors do

Answer 19

• foster transparency, accountability, and trust
• promotes a more equal physician-patient relationship
• provides opportunities for carers to learn from their mistakes

Question 20

Patients for Patient Safety Canada

Answer 20

developed by CPSI, encourages the public to become involved at the institutional and policy levels

Question 21

end of life decisions

Answer 21

choices an individual must make regarding their medical treatment at the end of their life (an issues across the entire life course)

Question 22

two aspects regarding the end of life care

Answer 22

• the notion of competency
• when the end of life should occur

Question 23

improvements made to ease the end of life care process

Answer 23

• raising awareness of the importance of planning ahead for end of life care
• recognition by health care professionals that perspectives on end of life and the burden on families and loved ones is socially and cultural variable
• calling for a broader public discussion and debate about issues regarding end of life care, arguing that through public engagement, death and dying can be de-stigmatized

Question 24

informed consent

Answer 24

providing all individuals who are being treated, or participating in research studies, with all information that could possibly affect their wellbeing, allowing individuals to actively participate in a decision that could greatly affect them

Question 25

morals

Answer 25

ideas we believe about right and wrong (honesty, compassion, and understanding)

Question 26

four elements to the access to health care

Answer 26

• coverage: facilitates entry into the health care system
• services: having a usual source of care is associated with individuals receiving recommended screening and prevention services
• timeliness: ability to provide health care when the need is recognized
• workforce: capable, qualified, culturally competent providers

Question 27

triage systems

Answer 27

methods for systematic prioritizing of patients’ treatment according to how urgent they need care

Question 28

palliative care

Answer 28

care that aims to improve the quality of life for those living with a life-threatening disease

Question 29

medical assistance if dying (MAID)

Answer 29

occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a patient’s death, at that patient’s request (legalized in Canada in Jun 2016, Bill C-14)

Question 30

substitute decision-maker

Answer 30

a person who is authorized to give or refuse consent to treatment, admission to a care facility, or personal assistant services, on behalf of an incapable individual

Question 31

first nations nutrition experiments

Answer 31

a nurse takes a blood sample from a child at the Indian school in BC in 1948, during a period when nutritional experiments were being conducted on children in residential schools

Question 32

Nazi human experimentation (WW2)

Answer 32

child victims of Nazi experimentation show incisions where body tissue had been surgically removed after they were deliberately infected with tuberculosis

Question 33

the nuremberg code

Answer 33

included the principle of informed consent and required standards for research, created in the aftermath of the discovery of the camp experiments and subsequent trials to address abuses committed by medical professionals during the Holocaust

Question 34

Henrietta Lacks

Answer 34

• 1920-1951, she was a Southern African-American tobacco farmer
• visited a hospital in 1951 and was diagnosed with cervical cancer, prior to treatment, cells from the tumour were removed for research purposes (done without her knowledge or permission)
• the sampled tumour cells would become the HeLa immortal cell line

Question 35

HeLa Cells

Answer 35

• vital for developing the polio vaccine and uncovering secrets of cancer, viruses, radiation effects, and other scientific pursuits
• been used to test human sensitivity to many commercial products
• Henrietta’s family did not learn of her “immortality” until 1973