Biomedical ethics: assignment week 6
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Biomedical Ethics: Assignment Week 6
Discussion Exercise: Chapters 21, 22, 23
Objective: The students will complete a Virtual Classroom Discussion Exercise that will Extend your knowledge beyond the core required materials for this class, Engage in collaborative learning with other students to improve the quality of the learning experience for all students and Apply the higher cognitive skills associated with critical thinking to your academic and professional work.
ASSIGNMENT GUIDELINES (10%):
Students will judgmentally amount the readings from Chapters 21, 22, 23 on your textbook. This assignment is prearranged to help you to learning in all disciplines because it helps student’s process information rather than simply receive it.
You need to read the PowerPoint Presentation assigned for week 6 and develop a 2-3 page paper replicating your appreciative and competence to apply the readings to your ethics knowledge. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words that will apply to the case study presented.
2. Discussion Challenge (65%)
Imagine an event of catastrophic proportion involving mass casualties, disrupted or non-existent services (power, transportation, and communications), scarce food and water, limited emergency personnel and medical supplies, overwhelmed hospitals, perhaps contamination from biohazard materials or nuclear fallout, etc.
Now imagine that a new set of rules has been established to guide first responders in the field whenever a “catastrophe” occurs. A system of “response triage” is required, whereby precious and limited resources will be directed to those who could most probably contribute to continued survival and eventual recovery of the community. Those who would require a disproportionate share of resources to live, and those who will most likely not survive the event, are given lower priority for distribution of assistance, including food supplies and medical treatment.
Without any formal discussion of what ethics are and how ethical decisions might be made in the field, we can see that the ethical problems are endless, but are basically summed up by asking:
1. IS EVERY HUMAN LIFE OF THE SAME VALUE AS OTHERS?
IS EVERY HUMAN LIFE OF THE SAME VALUE AS OTHERS?
· If decision-makers were to set criteria for determining the “fittest” for survival, upon what criteria would those decisions be based?
o The richest and most powerful men?
o Young men and women with the highest sperm and ova counts?
o Mature thinkers who might carry forward lessons that are likely to help humans survive in changing circumstances?
· How would these criteria be measured?
o How would we “value” people who work in health care, education and food production, as opposed to sanitation workers, truck drivers and musicians?
o How would we account for discrimination based on race, ethnicity, religion, sexual orientation, etc.?
o How would we deal with the sick, aged, institutionalized, and immobilized? The poor? Illegal immigrants? Orphans? AIDS patients? Others?
Would we leave these more vulnerable segments of society behind, so to speak, instead of giving them preferential treatment? Is this approach “ethical”? Is this approach “moral”? Is this approach legal?
ASSIGNMENT DUE DATE:
The assignment is to be electronically posted no later than noon on Sunday, August 4, 2019.
Chapter 21
Ethics Issues in Disaster Relief
3
Definitions
• A disaster is an unexpected claustrophobic
event or situation that depletes the survival
resources and supplies in a relatively short
timeframe.
• Disasters are generally divided into two
categories: natural and anthropogenic.
• Disasters not only influence the environment,
and society but also the human experience.
4
Government Disaster Planning and
Response
• September 11, 2001 created a movement to
upgrade America’s ability to plan for all future
disasters that continues to this day.
• When there is a disaster, programs require the
partnership of government (regional, state,
and local), voluntary organizations, health care
systems including first responders, and
individual citizens to work as a massive team.
5
Government Disaster Planning and
Response
• One response was the creation of the
Department of Homeland Security (DHS).
• DHS is responsible for security at airports,
protecting cargo, and sharing information.
• The DHS now includes several emergency
management agencies.
6
Government Disaster Planning and
Response
• FEMA responds to both local and national
disasters.
• It coordinates resources for disaster
responses.
• It is also involved in helping people be
prepared for disasters.
• FEMA provides direct assistance to qualified
disaster survivors.
7
Government Disaster Planning and
Response
• The CDC tracks natural and human-made
disasters and conducts research on ways to
respond to the aftermath of these events.
• It provides information on a wide variety of
topics to help businesses, hospitals,
communities, and individuals prepare for
disasters.
8
Government Disaster Planning and
Response
• The CDC is also involved in researching the
aftermath of disasters to improve response
times.
• It has also developed an national stockpile of
pharmaceuticals to respond to needs in a
disaster.
• The CDC also provides education on disaster
preparedness.
9
Government Disaster Planning and
Response
• The American Red Cross (ARC) responds to
immediate needs and relieves suffering
particularly when disaster strikes on a local,
regional, and national basis.
• Volunteers are trained by the ARC to provide
services in a variety of disaster situations.
10
Other Voices on Government
Response
• Redlener suggests that governments have
much more to do.
• A plan is needed to set benchmarks, correct
methods of overseeing disaster planning,
create accountability standards, and make the
reduction of threats a priority among its
features.
11
Ethics Issues and Government Disaster
Planning and Response
• Ethical responsibility begins with the plan
itself.
• Conflicts of interest must be addressed.
• The plan must balance utilitarian ideas with
the deontology of protecting individual rights.
12
Ethics Issues and Government Disaster
Planning and Response
• Triage is an example of an utilitarian ethics
application to a disaster situation.
• Categorization of injuries is needed.
• Even when triage is needed, the community’s
view must be considered.
• Humanitarianism does not allow some to be
left behind without treatment.
13
Ethics Issues and Government Disaster
Planning and Response
• Autonomy is another ethical issue for disaster
planning.
• How far do the rights of the individual go
when they can negatively affect the
community?
• Balance between utility and autonomy needs
to be a part of the plan.
14
Ethics Issues and Government Disaster
Planning and Response
• Social justice is also an ethics issue.
• For when large amounts of capital (in the
billions of dollars) are involved, the potential
for fraud, abuse, and corruption exists.
• Communities do not find it just if individuals
profit unethically from disasters.
15
Health Care Organizations and
Disaster Planning
• Hospitals and health care systems respond
when disasters occur.
• The Joint Commission mandates a disaster
management plan with standards and
requirements.
• Plans are developed using a hazard analysis
and are based on six capability areas.
16
Health Care Organizations and
Disaster Planning
• The ASPR provides guidance for implementing
the Hospital Preparedness Program (HPP).
• The ASPR identified eight areas that are
needed for disaster preparation.
• Guides are provided for assessing and creating
preparedness plans for all eight areas.
17
Ethics Issues for Organization Disaster
Planning and Response
• Concepts of utilitarianism and deontology
must be balanced when dealing with the use
of scarce resources.
• Using the “greatest good for the greatest
number” alone can lead to severe ethical
problems for organizations and first
responders.
18
Ethics Issues for Organization Disaster
Planning and Response
• Conflicts of duty can exist for those who
respond to disasters?
• To whom do they owe a primary duty: the
community or their own families?
• Planning needs to consider the families of
staff so that the conflict can be reduced.
19
Ethics Issues for Organization Disaster
Planning and Response
• Social justice is also an ethical issue.
• The community’s values and concept of
fairness must be considered in disaster
planning and response.
• Plans must also address autonomy,
nonmaleficence, beneficence, and justice.
20
Individual Response to Disasters
• Despite news coverage of disasters, the
American public continues to be unprepared.
• It seems to be part of human nature to think
about worst-case situations.
• Vulnerable populations such as low income
families are often the least prepared for
dealing with emergencies.
21
Individual Response to Disasters
• American should be “Red Cross Ready’ in the
event of an emergency.
• The Red Cross gives guidelines on what an
individual or family needs to be prepared.
• Preparedness also requires that individuals
develop a plan in the event of an emergency.
22
Individual Response to Disasters
• The CDC suggests that individuals may have to
shelter-in-place when a disaster occurs.
• Choose a room in the home or business as a
prepared shelter.
• The room should be equipped to be “Red
Cross Ready” for emergencies.
23
Individual Response to Disasters
• Citizens be physically prepared and also
mentally ready for disasters and for survival.
• They need to be physically fit to survive and
be CPR and first aid trained
• They also need to be aware of their situation
at work, home, and the community.
24
Individual Response to Disasters
• There also needs to be a family plan for
dealing with emergencies.
• The plan should address how to care for the
elderly or disabled.
• Families should be prepared for evacuation or
sheltering in place.
• Communication issues should also be
addressed.
25
Ethics Implications for Individual
Response to Disasters
• Disasters can cause a retreat to survival mode
where dignity and rights of others are ignored.
• People also tend to expect their governments
to respond in whenever any type of
emergency occurs.
• People may have to handle emergencies on
their own because help may not be eminent.
26
Ethics Implications for Individual
Response to Disasters
• Autonomy is another ethical issue for
individuals.
• Government and organizations use higher and
higher levels of technology as prevention for
potential disasters.
• How much privacy and autonomy is lost
versus the benefits gained?
27
Ethics Implications for Individual
Response to Disasters
• Beneficence is also an issue for individuals.
• Without the acts of beneficence, many will
not survive.
• However, an ethics issue exists concerning the
boundaries of beneficence.
28
In Summary…
29
- Slide Number 1
- Chapter 21
- Slide Number 3
- Definitions
- Government Disaster Planning and Response
- Government Disaster Planning and Response
- Government Disaster Planning and Response
- Government Disaster Planning and Response
- Government Disaster Planning and Response
- Government Disaster Planning and Response
- Other Voices on Government Response
- Ethics Issues and Government Disaster Planning and Response
- Ethics Issues and Government Disaster Planning and Response
- Ethics Issues and Government Disaster Planning and Response
- Ethics Issues and Government Disaster Planning and Response
- Health Care Organizations and Disaster Planning
- Health Care Organizations and Disaster Planning
- Ethics Issues for Organization Disaster Planning and Response
- Ethics Issues for Organization Disaster Planning and Response
- Ethics Issues for Organization Disaster Planning and Response
- Individual Response to Disasters
- Individual Response to Disasters
- Individual Response to Disasters
- Individual Response to Disasters
- Individual Response to Disasters
- Ethics Implications for Individual Response to Disasters
- Ethics Implications for Individual Response to Disasters
- Ethics Implications for Individual Response to Disasters
- In Summary…
Chapter 22
A New Era of Health Care: The
Ethics of Health Care Reform
3
Health Care Reform in the U.S.
• HR 3590 and HR 4872 signed into law in 2010
by President Obama.
• These acts represent a century of efforts to
provide access to high quality, affordable
health care.
• Access, cost, and quality are the triumvirate
mantra of health care reform.
4
Health Care Reform in the U.S.
• There are three ways to provide universal
coverage for populations:
– The Bismarck Model.
– The Beveridge or National Health Service
Model.
– The National Health Insurance Model.
5
A Bit of History
• Otto von Bismarck introduced universal
healthcare insurance in Germany in 1883.
• Other European countries provided universal
health care for a variety of reasons.
• European plans evolved from wage protection
motives to providing medical and hospital
coverage.
6
A Bit of History for the U.S.
• Theodore Roosevelt was the first to support
universal health care insurance.
• His ideas were not supported by labor,
medical societies, the insurance business, and
business interests.
• Universal coverage was excluded from the
Social Security Act of 1935.
7
A Bit of History for the U.S.
• In 1939-1943, attempts were made to create
national health insurance, but they were not
successful.
• In 1948, President Truman campaigned
strongly for national health insurance.
• 71% of Americans were in favor of universal
coverage, but it never passed in Congress.
8
A Bit of History for the U.S.
• In 1960, there was a new effort to address the
healthcare coverage of a new group: the
elderly.
• President Johnson’s political skills contributed
to the passage of Medicare in 1965.
• Medicaid, designed to provide care for needy
children, was also passed in 1965.
9
A Bit of History for the U.S.
• In 1971, President Nixon proposed a plan for
compulsory employment-based health
insurance that died a quick death.
• The Clinton administration attempted health
care reform with the Clinton National Health
Security Plan.
• This plan had endorsements, but died in
committee.
10
What Contributed to PPACA?
• The percentage of the population without
insurance reached 16%
• Shortages of professionals lead to
compromised access to care.
• Costs for health care continued to rise and
quality lapses continued.
• Health care reform sought to: increase access,
improve quality and control costs.
11
Ethics and Health Care Reform
• Numerous groups conclude that there is
fundamental right to health care. Including:
• WHO, The United Nations, The Organization of
American States, and The U.S. Declaration of
Independence.
• Religious traditions also support it.
12
Key Areas of PPACA
• All Americans and legal immigrants must have
health insurance.
• Businesses must provide health insurance.
• Medicaid eligibility is extended.
• Medicare benefits are improved.
13
Key Areas of PPACA
• Insurance reform is extensive.
• No lifetime limits are allowed.
• Preventive care must be provided with no
copays.
• Minimum loss ratios are required.
• States can receive assistance to set up
insurance exchanges.
14
Key Areas of PPACA
• The Act supports quality efforts.
• New research is supported.
• Coordination and integration of services is
required.
• Incentives are based on quality efforts.
15
Key Areas of PPACA
• The Act is concerned with adequate workforce
an coverage for underserved areas.
• Incentives are provided to increase the
balance of health care professionals.
• The Act is funded by new taxes, savings, and
penalties.
16
PPACA Is Phased In
• The provisions of the Act will be phased in
through stages beginning in 2010.
• Note the changes by year given in the Chapter.
• The Act will not be fully implemented until
2020.
17
Justice and PPACA
• A just system would provide access to high
quality care for those who need it.
• How does PPACA increase access, improve
quality, and control costs?
18
Justice and PPACA
• Access is increased because more people will
be insured.
• Supply and distribution of personnel to meet
the needs of the newly insured is addressed.
• Insurance reform and subsidies addresses
cost.
19
Justice and PPACA
• However, PPACA does fall short in some areas.
• There will still be 18-20 million uninsured
Americans.
• The effectiveness of workforce incentives and
quality programs remains to be seen.
20
Justice and PPACA
• However, PPACA does fall short in some areas.
• PPACA is predicted to slow the costs of health
care.
• However, costs are predicted to continue to
rise faster than the GDP and inflation.
21
Is Health Care Reformed?
• Given the need for addressing the three areas
of access, costs, and quality, PPACA will
continue to be a work in progress.
• The healthcare system will continue to be
refined and reformed in the years to come.
22
In Summary…
23
- Slide Number 1
- Chapter 22
- Slide Number 3
- Health Care Reform in the U.S.
- Health Care Reform in the U.S.
- A Bit of History
- A Bit of History for the U.S.
- A Bit of History for the U.S.
- A Bit of History for the U.S.
- A Bit of History for the U.S.
- What Contributed to PPACA?
- Ethics and Health Care Reform
- Key Areas of PPACA
- Key Areas of PPACA
- Key Areas of PPACA
- Key Areas of PPACA
- PPACA Is Phased In
- Justice and PPACA
- Justice and PPACA
- Justice and PPACA
- Justice and PPACA
- Is Health Care Reformed?
- In Summary…
Chapter 23
Health Care Reform: What
About Those Left Behind?
3
Ethics Concerns for Three Populations
Without Health Insurance
• Individuals who are not documented.
• Individuals eligible for Medicaid but not
enrolled.
• Individuals exempted from purchasing
insurance because of financial burden.
4
Ethical Analysis
• Analysis includes
• Nonmaleficence.
• Beneficence.
• Paternalism vs. autonomy.
• Distributive justice.
• Code of Ethics of American Nurses
Association.
5
Review the Case Studies
• Population needing renal dialysis.
• Population of women who are pregnant &
non-documented.
• Ethical analysis applied.
6
Review the Ethical Guidelines for RNs
• ANA Code of Ethics.
• ANA’s Social Policy Statement.
• ANA & other specialty nursing association’s
standards of practice.
• Analysis of 5 of 9 provisions of ANA Code.
7
Ethical Analysis with Other Ethical Theories
• Deontological analysis.
• Utilitarianism analysis.
• Use of religions’ stances on ethics.
8
Case Study—Medicaid State
Differences
• Proposed changes in Medicaid accessibility &
services.
• Rationale for proposed changes.
• Tension between Affordable Care Act
provisions & state Medicaid rules.
• Concerns of non-access to Medicaid services.
9
Advocacy Strategies
• Work on electoral campaigns.
• Have intentional relationships with elected
representatives.
• Be self-educated.
• Engage in lobby activities.
• Invest time, money, & energy in one’s
professional associations.
10
Application of Advocacy Strategies
• Discuss the listed examples in the chapters.
How could you apply them?
• Make parallel conclusions with your own
professions.
11
What About Those Left Behind?
• There are concerns about populations not
covered by the PPACA.
• Be sure to analyze the ethics of such non-
access.
• Be able to describe policy interventions to
accompany your ethical analyses and stances.
12
In Summary…
13
- Slide Number 1
- Chapter 23
- Slide Number 3
- Ethics Concerns for Three Populations Without Health Insurance
- Ethical Analysis
- Review the Case Studies
- Review the Ethical Guidelines for RNs
- Ethical Analysis with Other Ethical Theories
- Case Study—Medicaid State Differences
- Advocacy Strategies
- Application of Advocacy Strategies
- What About Those Left Behind?
- In Summary…

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