MHA 511 Ohio State University Giving Human Growth Hormone to Children HW MHA 511 Summer 2020 Assignment Due Tuesday, June 10. Listen to the audio at the fo

MHA 511 Ohio State University Giving Human Growth Hormone to Children HW MHA 511 Summer 2020 Assignment Due Tuesday, June 10. Listen to the audio at the following link: https://www.thisamericanlife.org/687/small-things-considered This piece discusses giving human growth hormone to children. The segment starts at about five minutes into the audio and is approximately 30 minutes in length. The second half of the audio is not related to the topic. Discuss the various related ethical issues. You can choose the style and content of your paper. Relate the subject to topics in the six chapters that we have covered. (Chapters summaries and notes will be attached if needed). Suggested length is 3-4 pages doubled spaced. MHA 511
Summer 2020
Assignment Due Tuesday, June 10.
Listen to the audio at the following link:
https://www.thisamericanlife.org/687/small-things-considered
This piece discusses giving human growth hormone to children. The segment starts
at about five minutes into the audio and is approximately 30 minutes in length. The
second half of the audio is not related to the topic.
Discuss the various related ethical issues. You can choose the style and content of
your paper. Relate the subject to topics in the six chapters that we have covered.
(Chapters summaries and notes will be attached if needed). Suggested length is 3-4
pages doubled spaced.
Chapter 2
Principle of autonomy: You shall not treat a patient without the informed consent of the
patient or his or her lawful surrogate, except in narrowly defined emergencies.
Conditions necessary for informed consent:
1. The patient or appropriate surrogate must be competent or have decision-making
capacity.
2. The health care professional must provide the necessary information and make sure
that it is understood.
Informed Consent is a recent concept for American medical ethics, and has been the law
in the U.S. since the 1960s.
Competence – the ability to make choices based on an understanding of the relevant
consequences of that choice on oneself and others.
The ability to understand the relevant is to be judged by common sense, rather than a
technical or professional standard.
All physician-patient encounters must begin with the presumption that the patient is
competent.
There must be freedom from coercion and undue influence.
Information in informed consent:
Four conflicting rules or criteria for the disclosure of information to the patient
1. The patient preference rule dictates that the health care professional tell the patient
what the patient wants to know.
2. The professional custom rule says that the health care professional shall tell the
patient what is normal or customarily told patients in similar situations.
3. The prudent person rule rests on the assumption that the physician’s disclosure to
the patient should be measured by the patient’s need for information material to the
decision to refuse or accept treatment. Factors to be considered include:
HSA 406/506
page 2
a.
b.
c.
d.
e.
f.
g.
Diagnosis
Purpose of treatment
Risks
Benefits
Alternative treatments
Prognosis if no treatment
All costs – pain, life-style, and financial
4. The subjective disclosure rule calls for the health care professional to describe to the
patient everything that would be material or important to the particular patient and not
merely to a fictional reasonable and prudent person. This rule demands that the HCP
really get to know the patient and determine what is important to him or her.
Therapeutic Privilege – the privilege of withholding information from the patient when
the physician believes that the disclosure will have an adverse effect on the patient’s
condition or health.
Conditions for use:
a. Must be applied on a case-by-case basis.
b. HCP must have belief based upon knowledge that disclosure will have a
significant adverse effect on the patient.
c. Reasonable discretion must be used in the manner and extent of the disclosure.
Informed Consent Exceptions in Emergencies
1. Patient must be incapable of giving consent and no lawful surrogate in available.
2. There is a danger to life or of a serious impairment of health.
3. Immediate treatment is necessary.
Informed Consent Exceptions in Nonemergencies
When no surrogates are present the legal system should be used to appoint a guardian.
Courts
– Can provide a guardian for a specific instance.
– Can be used when HCP thinks that surrogates are not acting in the best interests of the
patient.
– AHA Committee guidelines.
AHA Committee Rules on informed consent:
HSA 406/506
1.
2.
3.
4.
page 3
Ensure informed consent has been obtained
Develop educational programs that teach ways of obtaining consent
Ensure that patients are aware of their right to consent or reject treatment
The patient has the right to refuse treatment to the extent permitted by law and to be
informed of the medical consequences of his actions.
Institutional Ethics Committee Characteristics
– multidisciplinary
– frequently have community representatives
– help develop policy
– act as consultants
– legal status is not clear
Problems with Institutional Ethics Committees
– Goals not clear
– Limited participation by patients and families
– Tendency to operate in secrecy
Paternalism involves acting without consent or even overriding a person’s wishes,
wants, or actions in order to benefit the patient or at least to prevent harm to the patient.
Two elements of paternalism:
1. Absence of consent or the overriding of consent
2. The beneficent motive.
Strong paternalism – attempts to overrule the wishes of a competent person.
Weak paternalism – consent is missing or the HCP overrides the wishes of an
incompetent or a doubtfully competent patient
Surrogates – are people who are authorized by law or custom to make decisions when
the patient is incompetent or doubtfully competent. In our society, the surrogates follow
the kinship lines.
The physician has the primary and principal obligation to inform. Other legally
independent practitioners also have obligations. Providers should not go beyond their
professional competence.
Chapter 3
Beneficence – do good
Nonmaleficence – avoid evil
Impossibility of doing all good
– limited talents
– limited by state-of-the-art in any field
– limited by our obligation to avoid evil
Ethicists have devised various general rules to help people decide what evils can be
tolerated.
Principle of Double Effect – page 64.
Principle of Proportionality – page 65
Wedge Principle or Camel’s Nose Principle – page 67
Patient’s Obligation – page 69
Health Care Provider’s Obligation – page 70
Surrogate’s Obligation – page – 73
Professional Power and Benevolence – page 76
Unnecessary Surgery – page 77
Chapter 4
Definition of Disease — social context
Lobbying groups for a specific disease
Goals of health care:
– prolong life
– alleviate suffering
– optimize the patient’s chance for a happy and productive life as defined by the
patient.
Health Care Limits:
– American exaggerate power of health care and medical knowledge- science in
general.
– Many diseases controlled in the 20th century.
Needs:
– inherent
– subjective
– socially induced – ever increasing demand
Distributive Justice page 95
– based on need alone
– contribution – to society
Public health vs. private health
Page 98 – public health saves statistical lives rather than identified lives
Microallocation
Triage –page 100
Cases at end of chapter
Chapter 5
Confidentiality and Truthfulness
Telling the truth is not the same as telling the whole truth.
Some truths should be kept confidential.
Ethics of Truthfulness
– Do not lie.
– You must communicate with those who have a right to the truth.
Lying – a lie is traditionally defined as
1. Speech against the mind or
2. A falsehood in those circumstances in which the other has a reasonable
expectation of the truth.
A lie may depend upon:
1. The place of communication
2. The roles of the communicators
3. The nature of the truth involved
Confidentiality
Secret – knowledge that a person has a right or obligation to conceal.
Natural secret – the information involved is by its nature harmful if revealed.
Promised secret – knowledge that we have promised to conceal.
Professional secret – knowledge that if revealed would hard the profession.
Exceptions to confidentiality
1. Statute Law
2. Legal Precedent
3. Peculiar Patient-Provider Relationships
4.
Proportionate Reason

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