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Ethical issues public health
Ethical issues in health research
Ethical issues in health research
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Within public health, the issue of paternalism has become a controversial topic. Questions about the ethics of public health are being asked. The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied context (Med J Aust. 1994). Clinically, patients are treated on a one on one basis, but public health’s obligation is toward the protection and promotion of an entire population’s health. So, based on this difference, the gaping questions targeting public health now becomes, under what conditions is it right to intervene and override an individuals’ autonomy? And if so, is the paternalistic intervention justified? Part of the concern …show more content…
Rather, Buchanan proposed the field of public health to gain the public’s trust, needs to expand individual autonomy by promoting social justice while discussing the common portrayals of justice. The rationale behind Buchanan’s work is to bring understanding to an ethical issue of paternalism v. autonomy in public health. Paternalism can be justified given it protects the interest of the people and autonomy is an individual’s freedom from external control or influence. There are valid arguments for both sides, but in public health, paternalism is very useful situationally, while autonomy must be preserved and respected as it is an individual given right. Aiming for an ideal range where public health policy and individual freedom can overlap, no matter the inconsistencies, is the …show more content…
Buchanan mentions the Model State Emergency Health Powers Act (MSEHPA). Paternalistic actions are justifiable when there is an impending threat to health due to something, like bioterrorism, presenting the likelihood of significant harm (Buchanan, 2008). MSEHPA does well by showing limitations on paternalistic actions of public health officials. Limiting paternalistic input and increasing individual freedoms to form opinions and act according to one’s own desires, values, and ideals, better health outcomes can be achieved (Buchanan, 2008). While some support the idea of government intervention, this view of paternalism upsets some. The Centers for Disease Control and Prevention suggestion that a pregnant woman should not drink alcohol during pregnancy (Advisory on alcohol use in pregnancy 2005) has been widely criticized as being unnecessarily paternalistic, but the CDC goes further into explaining that, “Alcohol consumed during pregnancy increases the risk of alcohol related birth defects, including growth deficiencies, facial abnormalities, central nervous system impairment, behavioral disorders, and impaired intellectual development” (Advisory on alcohol use in pregnancy
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
According to Terrence F. Ackerman, as of the 1980s the American Medical Association had to include the respect for a person’s autonomy as a principle of medical ethics (Ackerman 14, 1982). This includes having the physician provide all the medical information to the patient even if the information could cause negative implication onto the patient. The physician is also expected to withhold all information of the patient from 3rd parties (Ackerman 14, 1982). Although it is seen as standard in today’s world, in
In the realm of medical ethics, there are many topics that are debated and discussed, but there is not necessarily one clear, correct answer. One of these topics is paternalism. Many questions are bandied back and forth: is it beneficial, should it be disallowed entirely, are there instances when paternalism is good and beneficial, and the list goes on. For each of these questions there have been authors who have provided their comments. One such author is Alan Goldman. He draws a very firm line on paternalism, simply put: medical paternalism is deleterious to a patient because it intrudes on their primary rights of liberty and autonomy. This paper is going to expound upon Goldman’s viewpoint in detail, going through point by point how he presents his argument. There will then be a critique of Goldman’s viewpoint that will counter his main points. The counterpoints will show Goldman’s views on paternalism are incorrect and should not be considered valid.
Patient autonomy was the predominant concern during the time of publication of both Ezekiel and Linda Emanuel, and Edmund D. Pellegrino and David C. Thomasma's texts. During that time, the paternalistic model, in which a doctor uses their skills to understand the disease and choose a best course of action for the patient to take, had been replaced by the informative model, one which centered around patient autonomy. The latter model featured a relationship where the control over medical decisions was solely given to the patient and the doctor was reduced to a technical expert. Pellegrino and Thomasma and the Emanuel’s found that the shift from one extreme, the paternalistic model, to the other, the informative model, did not adequately move towards an ideal model. The problem with the informative model, according to the Emanuel’s, is that the autonomy described is simple, which means the model “presupposes that p...
Wilson , James G. S., “Rights”, Principles of Health Care Ethics, Second Edition, eds. R.E. Ashcroft, A. Dawson, H. Draper and J.R. McMillan. John Wiley & Sons, Ltd. 2007. pp. 239.
Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
Medical and Public Health Law Site (2009). Paternalism in Medicine. Retrieved from http:// www.biotech.law.lse.edu/ Clash of Cultures.
Informed consent is the basis for all legal and moral aspects of a patient’s autonomy. Implied consent is when you and your physician interact in which the consent is assumed, such as in a physical exam by your doctor. Written consent is a more extensive form in which it mostly applies when there is testing or experiments involved over a period of time. The long process is making sure the patient properly understands the risk and benefits that could possible happen during and after the treatment. As a physician, he must respect the patient’s autonomy. For a patient to be an autonomous agent, he must have legitimate moral values. The patient has all the rights to his medical health and conditions that arise. When considering informed consent, the patient must be aware and should be able to give a voluntary consent for the treatment and testing without being coerced, even if coercion is very little. Being coerced into giving consent is not voluntary because others people’s opinions account for part of his decision. Prisoners and the poor population are two areas where coercion is found the most when giving consent. Terminally ill patients also give consent in hope of recovering from their illness. Although the possibilities are slim of having a successful recovery, they proceed with the research with the expectation of having a positive outcome. As stated by Raab, “informed consent process flows naturally from the ‘partnership’ between physician and patient” (Raab). Despite the fact that informed consent is supposed to educate the patients, it is now more of an avoidance of liability for physicians (Raab). Although the physician provides adequate information to his patient, how can he ensure that his patient properly ...
In his essay, “The Refutation of Medical Paternalism,” Alan Goldman discusses his argument against differentiation in the roles between physicians and patients. He says the physician may act against a patient’s will in order treat the patient in their best interest. Goldman makes his whole argument around the assumption that a person’s right to decide his or her future is the most important and fundamental right, saying, “the autonomous individual is the source of those other goods he enjoys, and so is not to be sacrificed for the sake of them.” His claim is that most people agree that they are the best judges of their own self-interest and there is an innate value in the freedom to determine their own future. On these principles, Goldman starts by discussing conditions under which paternalism may be justified.
The principle of autonomy states, that an individual’s decision must be respected in all cases, also an individual can act freely in accordance to their plan. For example, in a case where a patient and family demands to continue medical or surgical care and a physician want the patient to stop further treatment. In this case the patient’s choice will matter the most. According to the principle of autonomy it will be the patients and family choice whether to continue or discontinue treatment. The principle of beneficence which states, “one must promote good” comes into play in this case. In accordance to beneficence the patient will not benefit from the physicians responses personally. He/she will not benefit from harming her body with more surgeries. The patient will be going against the principle non-maleficence, which states that “one must cause no harm to an individual” by causing harm to herself. In this case the physician is justified in his/her actions by discontinuing medical or surgical care to the patient because it will not it her. These principles are what healthcare provider use to help and guide patients with the ...
Steinbock, Bonnie, Alex J. London, and John D. Arras. "’Rights- Based’ Approaches." Ethical Issues in Modern Medicine. Contemporary Readings in Bioethics. 8th ed. New York: McGraw-Hill, 2013. 23. Print.
First and foremost, I would like to explain the difference between paternalism and autonomy and talk about their differences. Paternalism is defined when doctors restrict their patient’s opinion for their own good, tricking them into thinking their opinion is not the right decision. In comparison to a father and child’s relationship, the father makes the decision for the child because they know what is best for them and what is not, paternalistic doctors follow the same idea with their patients. Paternalism prohibits the patient being allowed to form their own opinion, since paternalistic doctors follow the “doctor’s knows best” attitude.
When pondering ethical principals in arranging health care services, many principals are connected with each other. Utilitarianism is connected to equality and human dignity and these principals are connected to responsibility and duty. Responsibility and duty is also connected to paternalism. Also to one topic is linked to many ethical issues that make these issues many-sided and challenging to discuss.
This means that people were arbitrarily not receiving the medicine and care they needed. Farmer felt that was unconscionable and an affront to one’s basic rights. Moreover, he also felt that an individual’s “civil rights cannot really be defended if (their) social and economic rights are not” protected, too (Farmer 9). In other words, we cannot fully exercise our rights as citizens if we do not have social and economic equality. For instance, if some wealthy individuals receive heath care that is superior, while less influential patients receive inferior treatment, that is unjust and corrupt. Farmer strives to discover a way to progress towards more attainable social and economic rights so that public health care can be more widely available and effective. The author also raises the point that race and sex are large factors in why medicine is not distributed and produced the way it should be. Obviously, these factors need to be addressed when devising a public health care system that will give fair and uniform treatment to all its
In this article the authors discussion is mainly about the introduction to the compliance of patient autonomy and the contrast of physician paternalism along with the effects of regulative sustainment on the obedience of faculty and staff in the medical field to the acting authority figure. The writer then gives their interpretation in the contrast of appropriate obedience and inappropriate obedience also why the two should be integrated as well as taught to be utilized