Volume II Issue ii
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- Methods to Identify and Address the Ethical Issues Associated with
Managed Care by Courtnee Lundy, University of Pennsylvania Read Abstract
There are many benefits of managed care, such as its focus on disease prevention and health promotion, its integration of healthcare services to minimize inefficiencies, and its ability to restrict healthcare costs; however, there are also some ethical concerns that arise from managing care. In the context of managed care, ethics is a method for examining conflicts of values and obligations where there are competing interests, each of which presents a reasonably justified position. The principles of procedural, commutative, and general justice are particularly applicable to the ethical issues associated with managed care. Through a review of relevant literature, this paper will examine different methods and principles of justice to consider in establishing an ethical managed care organization and it will offer some examples of plans that have established policies to meet their ethical goals. By setting common goals, plans and enrollees can minimize ethical conflicts and collaborate to ensure that plans consistently use just procedures to ensure that quality care is available.
- The Role of Bioethics in the International Prescription Drug Market:
Economics and Global Justice by Shelby E. Newland, University of Pennsylvania Read Abstract
In terms of health care access, bioethics has an important role to inform and shape policy issues and develop interdisciplinary ideas and interventions. The rising price of prescription drugs presents one of the most looming barriers to health care access in the world today. Including both theoretical and practical features of the pharmaceutical industry’s behavior is necessary to find ethical solutions towards increasing access. Bioethics can evaluate global justice by weighing human rights theory and future innovation at the macro level, and by addressing market forces and responsibilities at the micro level.
Inherent structural features of pharmaceuticals, such as its reliance on research and development, cause the industry to employ pricing strategies that seem counter-intuitive to conventional wisdom, but that result in producing a just allocation as defined by market forces. Parallel trade and drug exportation/ reimportation threaten the saliency of the industry’s differential pricing scheme; a case-study of a single “Euro-price” within the European Union illustrates how this will actually create harm to the most needy member states.
This complex situation requires solutions weighing arguments from human rights theory with those from economic theory to arrive at the most globally just allocation of prescription drugs in the global marketplace, as well as to ensure future innovation and scientific progress. Bioethicists as well as economists need to partake urgently in this discourse for the betterment of the global injustices in the international prescription drug market.
- The Moral Implications of Prenatal Genetic Testing by Peter Chipman, Dalhousie Univeristy Read Abstract
The advance of medical technology now permits many genetic tests to be administered to a fetus in the womb. The goal of this testing is to determine the potential for genetically based disorders and disabilities. The use of these tests has major implications on the decision of a parent to abort a child based on what information they find in the prospective child’s genes. Advocates of prenatal testing argue that it enables the families of these prospective children to make an informed decision when faced with the possibility of disability.
I argue that this choice is drastically limited by social coercion through a discriminatory and stereotyped perception of the disabled community. Permitting an uncontrolled barrage of prenatal genetic tests will further promote the stereotype of a disabled life, and thus hinders our societal goal to recognise and promote equality and individuality. Which disabilities to test for, or what genes to search for, is a judgement that should be made only through extensive consultation with members of the disabled community, including individuals who have suffered from or who have been directly associated with the disability which is to be tested.
Justified Paternalism: The nature of beneficence in the care of dementia patients by Kashina Groves, University of Washington Read Abstract
The issue of patient autonomy in cases of permanent dementia has recently received a great deal of philosophical attention. Specifically, many have worried about ethical issues surrounding advance directives in which people specify how they shall be treated when they are no longer competent to make their own medical decisions. Ronald Dworkin has been a staunch defender of what he calls precedent autonomy in these cases, believing persons have a right to control, to some degree, how their lives will end, despite the common intuition that the principle of beneficence requires us to improve the experiential quality of patients’ lives. Objections have been brought against Dworkin on a number of fronts, including worries about personal identity theory and informed consent. Here, I offer an objection to Dworkin’s assessment of the nature of paternalism as it relates to cases of permanent dementia.
- The Ethics of Placebo-Controlled Studies on Perinatal HIV Transmission and its
Treatment in the Developing World by Shi (Mark) Gu, Duke University Read Abstract
Perinatal HIV transmission in the United States has been greatly reduced since the 1993 discovery of zidovudine, known as protocol 076. However, a feasible treatment in developing countries has not yet been found due to the high cost and medical standards needed to implement protocol 076. This presents an ethical question: whether placebo or active control should be used in testing new treatments. Proponents of a placebo control argue that a placebo control is the only method that provides definitive evidence of efficacy and side-effects, especially important given the scarce financial resources present in developing countries. Critics, however, argue that the use of a placebo controlled study when an effective treatment exists would be jeopardizing the health of individuals in developing countries. The key to resolving this debate is realizing that protocol 076 would not necessarily be effective when transplanted to developing countries due to the lack of adequate medical infrastructure, malnutrition, prevalence of disease, and low standard of living—it is not certain that protocol 076 would be better than placebo at all. Following this line of reasoning, quite a few placebo-controlled studies on perinatal HIV treatment have already been performed. Upon examination of this accumulated evidence, one finds that protocol 076, and shortened courses of it, are indeed effective in non-breastfeeding participants in developing countries; however, no treatment has been proven effective for breastfeeding populations. Therefore, it would be ethical to conduct placebocontrolled studies on breastfeeding populations, but not on non-breastfeeding populations.
Abortion: Pro and Contra by Laura Jebereanu, Victor
Babes University of Medicine and Pharmacy Read Abstract
To kill a new life before it’s born, to do an abortion. This is a problem of many generations. In the evolution of human civilization, the attitude concerning abortion was different in different cultures, periods, societies. The aim of our study is to evaluate the actual opinion and attitude about abortion of young persons, students, and residents in medicine in Timisoara city, and the situation of the whole country. We performed a questionnaire for 400 people between the ages of 19 and 28 with superior studies. The group is composed of 320 (80%) women and 80 (20%) men. We accepted for recording and analyzing all the completed questionnaires. The questions referred to the topic of abortion in the antecedents, and asked if they had had one, how it affected the life of the women and her family, the circumstances of acceptance of abortion today, religious aspects and different other aspects.
Kant’s Assessment of Motivation in the Fulfillment of Social Obligations by Jackie Knupp, University of Richmond Read Abstract
This paper explores the motivations of physicians who promote the health of their communities through the fulfillment of social obligations beyond the boundaries of their own patients. Based on the assumption that physicians do have social obligations, this paper looks at the normative, motivational question, namely “How should physicians be motivated to fulfill social obligations?” The paper traces the Kantian view of morality and motivation. The distinctions between required, merely permissible, and forbidden actions is drawn. Furthermore, Kant’s view that required actions done in accordance with duty are of no moral worth is critiqued from three stand points. First, it is argued that just because motivations outside of Kantian-based duty are not as good, it does not follow that these motivations are of no moral worth. Second, it is argued that there are some motivations behind required actions that are clearly better than other motivations. Third, it is argued that required actions done in accordance with duty are clearly better than those actions done without relevance to duty. The paper concludes that many required actions done in accordance with duty are performed from motivations that do have moral worth.
Childbirth in Modern Athens: The Transition from Homebirth to Hospital Birth by Julie Nusbaum, University of Pennsylvania Read Abstract
The transition of birthing practices in Greece from a homebirth culture, in which women deliver at home surrounded by family and under the supervision of a typically female birth attendant, to a biomedical birth model, in which women deliver in a hospital with numerous forms of medical intervention and under the control of a physician, has been unusually rapid. Today, Western biomedicine not only dominates the health care system in Greece but has an essential hegemony on women’s health care. My research examines whether the pervasive utilization of biomedical environments for birthing can be explained by a lack of alternatives or by women’s satisfaction with the technology and care available in hospitals. I also examine how women retain control over their experience of pregnancy and childbirth within the biomedical context and attempt to explain the emerging construction of a “natural” discourse on pregnancy and childbirth in Athens. Major themes that emerged from interviews with Athenian women were the lack of consent for medical intervention during birth, limited infrastructure to support women who seek non-medical alternatives, and limited emotional support and collective education for mothers in the urban environment of Athens. Also, women described choosing the right caregiver as essential to maintaining a sense of control over their pregnancy and, more generally, over their life. In light of women’s apparent interest in improving women’s experience of pregnancy and childbirth in Athens, it is recommended that researchers further explore the interaction of medical and non-medical discourses on pregnancy and childbirth.
Xenotransplantation: A Rational Choice? by Ololade Olakanmi, Grinnell College Read Abstract
There are many potential benefits that xenotransplantation (cross-species transplantation) might afford us, but there are also many weighty biological hurdles which must be surmounted if this procedure is ever to become a clinical reality. Many of these biological concerns are being addressed by specific and novel therapies; however, we must still determine the point at which xenotransplantation could be considered safe enough for clinical implementation. Many members of the scientific community believe that we should strive to make xenotransplantation products as safe and effective as possible, whereas others argue that we should not need to optimize the safety and efficaciousness of xenotransplantation products for them to be deemed acceptable for human use. In this paper I take the latter position, I argue that “the scientific community should move from the paradigm of…trying to indicate to society optimal solutions to that of…trying to help society in finding ‘satisficing’ solutions” which, although not necessarily optimal, are, nevertheless, good enough (Giampietro, 2002, p. 466).
For Your First Born Child: An Ethical Defense of the Exploitation Argument
Against Commercial Surrogacy by Brendan Osberg, Dalhousie University Read Abstract
In this essay I explore two arguments against commercial surrogacy, based on commodification and exploitation respectively. I adopt a consequentialist framework and argue that commodification arguments must be grounded in a resultant harm to either child or surrogate, and that a priori arguments which condemn the practice for puritanical reasons cannot form a basis for public law. Furthermore there is no overwhelming evidence of harm caused to either party involved in commercial surrogacy, and hence Canadian law (which forbids the practice) must (and can) be justified on exploitative grounds. Objections raised by Wilkinson based on an ‘isolated case’ approach are addressed when one takes into account the political implications of public policy. I argue that it is precisely these implications that justify laws forbidding commercial surrogacy on the grounds of preventing systematic exploitation.
The Two-Faced Angel: Do Phase I Clinical Trials Have a Place in Modern Hospice? by Daniel S. Ross, University of Pennsylvania Read Abstract
Increasingly, bioethicists have been exploring the possibility of making phase I clinical trials available to hospice patients. Phase I clinical trials are designed to test a drug’s safety and dosage, not its effectiveness. Participants in these studies generally do not understand that the purpose of the investigation is not to benefit them, thus challenging the notion of informed consent. But furthermore, the idea that patients believe experimental drugs will help them is contrary to the principles of hospice. Also, the very nature of the research in phase I conflicts with hospice’s methods. For these reasons, this paper finds that the two models must remain distinct.
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