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31 Cards in this Set
- Front
- Back
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Equipoise |
"A balance of focus or interests" The researcher/physician is in a state of being rationally balanced between alternatives (treatment/non-treatment or placebo/treatment). |
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Why are placebos an issue in medical research? |
They can be a means for bias on the side of both the researcher and subject. Generally considered unethical if an established, beneficial treatment is available. |
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What is single-blind? |
Single-blind (individual subjects don’t know whether they are being so-called test subjects) |
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What is double-blind? |
double-blind studies (both the researcher and subjects don’t know) can be utilized in order to attempt to eliminate some of this bias. |
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How do you implement placebos ethically? |
1. Give informed consent 2.Minimize risks and balance benefits 3.Subject selected fairly 4.Protect privacy 5.IRB review |
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IRB Review |
Institutional Review Board: A committee that makes sure any research being done is ethical. |
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Why are control groups important to medical research? |
-To learn anything useful about the treatment, researchers must study the relevant differences that arise between the experimental group and the control group |
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Issue: is it ethical to recommend a patient to a clinical trial if they could wind up in the control group? |
The patient is not receiving the best care they could be getting, Only being used for the purpose of obtaining viable results/as a means to an end of an experiment. |
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Why is informed consent important? |
Patients have the right to practice their autonomy, consent has to be given freely. Patients have ultimate right to their bodies, they should not be treated without their voluntary and informed agreement |
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Therapeutic Privilege |
with holding of info when the doctor believes it could lead to harm |
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Sense 1: |
patient actively authorizes proposal in act of consent |
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Sense 2: |
refers to legally effective authorization from patient |
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Identify historical studies in which informed consent was not honored, and have been cited as inappropriate. |
1. Tuskegee trials- syphilis testing in african american males 2. Henrietta Lacks- took her cells for research without family’s consent (HeLa cells) 3. Nazi human experiments- Medical experiments on imprisoned individuals within concentration camps. - Nuremberg Trials 4. Prison studies |
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What groups were these uninformed studies typically conducted on? |
Many of these were inappropriate because the groups studied were typically in a place of low authority, status, limited autonomy, etc. Taken advantage of! Vulnerable groups |
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How do egalitarian and libertarian theories of justice differ? |
Egalitarian theory of justice- important benefits and burdens of society should be distributed equally. Libertarian theory of justice- the benefits and burdens of society should be distributed through the fair workings of a free market and the exercise of liberty right of noninterference. |
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What does the Milgram Study inform our study of medical ethics? |
Series of psychological experiments conducted by Yale University. Measured willingness of the study participants to obey authority figure who instructed them to perform acts conflicting with their personal conscience, the experiment found, unexpectedly that a high proportion of people were prepared to obey even if apparently causing serious injury and distress |
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How does the Milgram Study inform our study of medical ethics? |
the role of authority over moral conscience, will people give up their autonomy -demonstrated the power of authority, professions higher up in the medical field have an incredible amount of influence over their fellows and must not take advantage of that power -Used this to make a comparison and attempt to develop an understanding of genocide during WW2. |
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What medical ethics issues came up in the Tuskegee Syphilis Study? |
No informed consent, used individuals in a place of lower power or status while taking advantage of them. |
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How did the Nuremberg Trials address issues of authority? |
-Nazi physicians infected unwilling victims with cholera, smallpox, typhus, malaria and other diseases that caused deadly results -Voluntary consent was blatantly violated by Nazi doctors -Twin trials -No patient autonomy, authority figure in control of others |
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How is deception an issue in medical research? |
Researches may abuse power or control over subjects within their experiments for the sake of getting what they desire out of their research. |
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Why would a researcher wish to use deception? |
Manipulate subjects into doing specific things or taking certain drugs without the full understanding of what is occurring. Deception would allow the researcher to make results to favor their personal bias |
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What are the objections to the use of deception? |
-Abusive, manipulative, sneaky, unethical -Could result in physical, emotional, or mental damage over the individual -Sometimes also necessary, especially in some psych studies, if the participant knew everything about the study (full aim of study) it could compromise results |
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Identify medical ethics issues in medical studies conducted in other countries (especially third world countries). |
The use of placebo-treated control groups in studies that already know there is an effective treatment (not in equipoise) |
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What are QALYs and how do they inform the issue of access to health care? |
-Quality Adjusted Life YearAn often-used objective measure of benefits -Discriminates against older people and the disabled - children have more years of life than the elderly -Objective measurements can’t accommodate the subjective nature of people’s assessments of the value of their own lives |
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One is one QALY equivalent to? |
One QALY is equivalent to one year of life in good health, and a year of life in poor health is equal to less than one QALY |
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Identify major issues in the debate about the right to health care. |
-Right or a privilege? - How to ensure everyone can receive health care regardless of finances, living conditions, social class, etc. - Increases in costs; new technology, progressions in pharmacology, shift towards preventative medicine. - In terms of organ transplants, whose life is more valuable to receive the transplant first since it is such a scarce treatment. |
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Daniels offers a libertarian perspective to support the right to health care. What are the main points in this argument? |
-Government have less control over health care insurance -Each individual has right to their own medical decisions- libertarian vs. egalitarian viewpoint -People have the positive right to health care, since it can equalize opportunities (egalitarian) -managing resource scarcity -health care can protect or restore one’s normal range of opportunities - preserves the range of opportunities available to us were we not ill or disabled -equality vs. liberty |
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What solutions does Deber’s article suggest? |
Problem: providing universal health insurance to large populations requires a large and cumbersome bureaucracy to manage Solution: “A US model organized at the state (or even substate) level would allow for flexibility to account for local circumstances and would probably result in a less bureaucratic system than at present” (762). |
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16. What five issues does Rescher identify in the fair allocation of scarce medical resources? |
1.The relative likelihood of success of the therapy 2.The life expectancy of the patient 3.The nature of the patient’s relationships with his/her immediate family 4.The patient’s likely pattern of future services to be rendered to society The patient’s past services and contributions (found on pp 765) |
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5 factors that have determined health throughout history: |
1.Environment 2.Lifestyle choices- access to food 3.Social influences/Restrictions 4.Genetics 5.Medical Care <6% |
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The looking glass self |
The victim role could be taken on as part of a patient’s identity Might set themselves up for failure, adversity, struggling, etc. If we own ideas/messages they become part of who we are |
