Healthcare Ethics

1. Define Natural Lottery – from Rawls. 2. Explain the Veil of Ignorance. 3. Define Underinsured. 4. Define the Concept: Fairness – from Rawls 5. Define Legal Moralism. 6. Please respond to two of the following questions. Specify which question you are responding to in your response. 1. Which of the “Further Problems” in Distribution and Access do you think contributes most to the problems of healthcare costs in the US? Why do you think this? Give at least three reasons. Do you think this can be remedied? If so, how? 2. Doctor was the on-call physician covering the unit for the weekend and was called to see a patient whom Nurse described as having difficulty getting rest: a 20-year-old girl named Elih who was dying of ovarian cancer. As Doctor approached the room, she could hear loud, labored breathing. Elih had nasal oxygen, an IV, and was sitting in bed suffering from what was obviously severe air hunger. Elih weighed 80 pounds and had not eaten or slept in two days. Elih had not responded to chemotherapy and was being given supportive care only. Elih’s only words to Doctor were, “Let’s get this over with.” Doctor asked Nurse to draw 20 mg of morphine sulfate into a syringe. Doctor took the syringe into the room and told Elih she would give her something to rest and asked if Elih wanted to say goodbye to anyone. Elih looked at the syringe then laid her head on the pillow with her eyes open. Doctor injected the morphine intravenously, and within seconds Elih’s breathing slowed to a normal rate, Elih’s eyes closed, and her features softened as she seemed restful at last. Doctor waited for the inevitable next effect of depressing the respiratory drive. With clocklike certainty, within four minutes the breathing rate slowed even more, became irregular, then ceased. Doctor felt that this was a great teaching case and shared the details (omitting any identifying information) with the rest of her department. Adapted from “It’s over Debbie,” JAMA, 1988 o Part A: Did Doctor commit medical malpractice? Explain the four elements and apply each one to facts of this case. In answering this question be sure to explain whether Doctor violated the standard of care or the standard of practice. (more points) o Part B: Did Doctor violate HIPAA by sharing Elih’s case with other hospital staff? Why/why not? (less points) 3. Rawls is attempting to construct a view of procedural justice. What does this mean? Explain the concepts of fairness and the veil of ignorance. How are these concepts connected in Rawls’ view of justice? Does Rawls’ view of fairness rule out any inequalities in distribution? Why or why not? Lastly, apply Rawls’ procedural view of justice to our current system of healthcare distribution. Would our current system “pass the test”? Why or why not? 4. On Sunday morning, Elih came to the Emergency Department (“ED”) complaining of abdominal pains, nausea, and headaches. Elih was an otherwise healthy 26-year-old, so the ED team checked Elih for food poisoning and influenza. Since Elih was four (4) months pregnant, however, they also confirmed that the fetus was not showing any signs of distress. After five hours, Elih was back to her old self, and feeling much better. Due to a massive outbreak of H1N1 influenza virus, the hospital beds were all full, so the ED team discharged Elih with instructions to return if the symptoms should arise again. By Monday night, Elih was having the same symptoms as before, and returned to the ED. The ED team again checked both Elih and the fetus. This time, Elih was experiencing contractions, and the ED team determined that the fetus’ heart rate and oxygen levels decreased with every contraction. Elih said she was in pain, and the ED team told her she needed to have an emergency caesarian-section to deliver the baby. Within minutes, the obstetrics team was in the ED, and anesthesia was administered as Elih groggily nodded her agreement. An hour later, Elih awoke in a recovery area where a nurse told her that the baby had been born extremely premature (pre-26 weeks) and was in the neonatal intensive care unit (“NICU”). Two weeks after the incident, Elih is feeling better, but the baby has respiratory problems, infections, cerebral hemorrhaging, and will be in the NICU indefinitely. Pediatricians agree that the baby’s conditions are all due to prematurity and not some other developmental issue. Elih trained as a hair stylist, but she has been out of work for the past three months. Faced with mounting hospital bills (NICU care costs approximately $10,000 a day) and still recovering, Elih is trying to find a new employer that has very good health insurance benefits. Unfortunately, all of the local hair salons are small businesses (less than 15 employees) and most do not offer any insurance benefits. Elih is beginning to panic and is losing sleep with worry for herself and her baby. o Part A: Did the hospital violate EMTALA after the physicians initially discharged Elih on Sunday? Describe the main components of EMTALA and how each component was/was not met in this scenario. o Part B: If the baby’s condition deteriorates further, who should make the decision about whether to stop treatment? Why? o Part C: Will the Affordable Care Act help Elih obtain insurance? Would she be eligible for Medicaid or some other form of government assistance? Explain your answer. 7. Define a Prospective Payment System. 8. Define Positive vs. Negative Eugenics. 9. Define Justice – From Rawls 10. Define Publicly Funded Healthcare. 11. What did Thomas Malthus argue?