Give an account of the different models of the nurse/patient relationship, including the pros and cons of each one.

Midterm Examination: Choose three of the following questions to answer, due March 31st

1. Compare and contrast the utilitarian teleological and the Kantian deontological interpretations of the moral obligation of a biomedical professional to respect patient autonomy. Should the professional respect the patient’s choice even if it is arbitrary, irrational, self-destructive, or deviates from the professional’s view of what a rational, competent person should do if ill? Or should the professional act paternalistically to either decide for the patient or to encourage him/her to accept what the professional thinks is necessary to restore the person to health or preserve his/her life? Deal not only with the choice of means but also the choice of ends, i.e. should the professional try to force the patient to reevaluate his/her value-orientation if it is standing in the way of cooperating. Use the example of an addiction to a substance to make your view concrete, so that the addict’s unwillingness to quit is the main obstacle to doing what the professional thinks is best. Give reasons for holding your view.

2. Deal with the different models of the physician/patient relationship, i.e. paternalistic, consumerist, collegial, contractual, respect for patient autonomy, and the pros and cons of each one. Apply this analysis to the issue of truth-telling v. lying or using deception, if the physician believes it is in the patient’s best interest. Give examples of when you think veracity seems to be right and when either lying, deception, or withholding information seems warranted. Given that each case is unique and that there is no general rule which can be applied indiscriminately to all cases, which general approach should be presumed to be the proper moral stance on truth-telling, which should only be broken when there are very compelling reasons for doing so? Why do you hold your view? Give reasons that refer to universal moral principles, which should determine what the physician’s moral attitude should be concerning voluntary informed consent within the context of a fiduciary relationship based on trust. Give reasons for holding your view.

3. Given that the nurse is sometimes caught between his/her duty to serve the patient’s best interest and act as a patient advocate on the one hand and the duty to follow doctor’s orders or hospital policy on the other hand, what should be the guiding principle in dealing with such moral dilemmas? Use examples to make your view clear. Deal in general with the nurse’s responsibility and rights. What do you think of the idea that nurses should act as social advocates promoting patient’s welfare rather than restricting advocacy to the bed-side? Should social advocacy be regarded as an individual duty of each individual nurse, or more as a collective obligation of the nursing profession as a whole? Is it enough to pay one’s dues to a professional organization, which lobbies congress on legislation concerning healthcare, or should one be out on the picket line passing out leaflets? Give reasons for holding your view.

4.Give an account of the different models of the nurse/patient relationship, including the pros and cons of each one. What do you think of the idea of existential advocacy? Do you think it is part of the nurse’s responsibilities to encourage and foster authenticity on the part of patients and fight patterns of denial, self-deception, and running away from responsibility which often accompany a major illness like cancer? Or should the nurse respect the patient’s right to be treated like a child if they so choose and thus avoid the burdens of informed consent? Should the nurse be willing to play the maternal role the traditional model advocates in such cases or insist on challenging such patients to decide for themselves even if they would rather not? Give reasons for holding your view.

5. Deal with the issue of the right to privacy and the obligation to guard confidentiality when it comes up in situations in which biomedical professionals are discussing patient’s cases in public places like a cafeteria or elevator or having access to patient records. What should they always keep in mind to prevent such violations of privacy? Give an account of the Tarasoff case. Do you agree with the majority or the dissenting opinion in this case? Give reasons for holding your view. Deal with guarding confidentiality in the case of AIDS patients and consider what makes it particularly difficult and problematic. Finally, do you agree with Siegler that confidentiality in medicine is a “decrepit concept”? What developments have led to this assessment? Give concrete suggestions of how confidentiality could be guarded more effectively so that it won’t have to be abandoned as a realizable goal. Give reasons for holding your view.
6. Deal with the ethical problems that come up in the treatment and care of geriatric patients. Particularly deal with determining incompetence to justify weak paternalistic intervention. Since incompetence due to dementia and loss of mental functioning which often accompanies old age seems to be a prime example of when it is justified to abrogate the patient’s right to self-determination, does the fact that elderly patients sometimes evaluate things differently than younger ones constitute good grounds for questioning their competence? Does the presence of a general temptation to stereotype the geriatric patients create a serious problem, which requires a special geriatric ethics? Of what should it consist? Do you think that more stringent institutional constraints are needed to prevent overly hasty determinations of incompetence? Or is it even more dangerous to go on treating the truly incompetent patients as though they were still competent? On which side is it better to err? Give reasons for holding your view.
7. Deal with the issue of voluntary informed consent in the case of recruiting research subjects to test a new drug, Consider the elements of informed consent of conducting AIDS drug research by asking: Is the recruit competent? Are they given adequate information to decide? Is the consent truly voluntary? And are the recruits authentically willing? Are the recruits typically in a coercive situation because they are so desperate due to AIDS being terminal in most cases? How do you think one should counteract the tendency to have false hopes of being cured? If a control group was to be given a placebo in double-blind testing, would this be ethically problematic, if the recruits were warned ahead of time that they might be in the control group? If one drug proved to be beneficial halfway through the study, would you keep this hidden from the recruits, or re-inform them and allow them to volunteer again? Give reasons for holding your view.

8. Deal with the definition of health by the World Health Organization. Is it too broad, vague, and utopian to be realistically applied or even to be useful? Or do you think that it expresses a profound truth? Should medicine pursue not just freedom from disease, but also general well-being in all of its aspects? Is social injustice and the stress it causes a healthcare issue? Should doctors diagnose and recommend treatment for it, or leave this to politicians and social activists? What of the right to healthcare globally considered? Should doctors be concerned enough to advocate redistribution of scarce medical resources? Or is this beyond their competence? Use the example of making AIDS drugs available to third world people to make your answer more concrete. Give reasons for holding your view.

9. Deal with informed consent in the cases in which doctors are asked to treat patients, not to restore health, but rather to enhance the body to achieve questionable goals, which are socially determined, such as cosmetic plastic surgery to achieve an unrealistic standard of beauty, use of steroids to enhance sports performance beyond the normal, etc. Should doctors be willing to offer such services? Is it a corrupting influence if it becomes very lucrative to do so? If offering such services is legal, does this make it all right ethically speaking? How responsible should the doctor feel if such treatment actually has negative side effects or even undermines the patient’s health? Use the example of steroids or artificial breast enhancements that go wrong to make your point concretely. Give reasons for holding your view.

10. Deal with the issues of race and gender and how they influence medical treatment. Should medical professionals have an obligation to treat people fairly without bias no matter what their race, gender or sexual orientation? If so, why? Pick a case where bias has played a role, and say why it is objectionable for you. Do you think that there is class bias as well, which often complicates an issue in which race and gender bias also play a role? If so, what do you conclude from this. Deal with fidelity as a traditional biomedical virtue. Does it entail fair and equal treatment of all patients? Give reasons for holding your view.

11. Researchers have mapped the genome and we will soon be able to replace problematic genes with healthy ones, which will eliminate many types of genetic diseases and thus allow us to banish such people from our midst by making them into normal ones. Do you see anything morally problematic in this? Or is it an unmitigated good thing? Do we learn lessons from having to become sensitive enough to those with genetic abnormalities that we make accommodations for them? Would this learning experience, which makes us more tolerant and humane, become obsolete because such people would be cured before they are even born? What of the suffering such people often go through not just due to their inherited condition, but also because of discrimination by fellow human beings? If this suffering could be eliminated, shouldn’t that be the main concern? Give reasons for holding your view.

12 Deal with the moral issue of whether we should ever clone human beings. What is morally problematic about this, and is it worrisome enough to ban cloning of humans altogether? What do you think would happen to our society if cloning were to be allowed? Would clones be exploited? Why or why not? What makes a clone different from naturally occurring identical twins? What do you think of the idea of a clone being deliberately made brain dead so that the original can harvest its organs as it own give out? Would this be inhumane or does the original have a right to copy his own DNA? Give reasons for holding your view.

13. Deal with the promise of stem cell research, and whether it should be restricted so that the embryos of aborted fetuses will not be used. What is the concern of many pro-life advocates on this? Should the promise of such research, which could perhaps help many people who are suffering today, be the main deciding issue? Or are you too concerned about sliding down the slippery slope here? Give reasons for holding your view.

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