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Chapter12 Chapter12 Presentation Transcript

  • AIDS and Health Care Practice
    • 1981 – CDC reports unusual outbreak
    • Infection control methods:
      • Decreasing susceptibility of hosts
      • Eliminating the source of the organisms
      • Interrupting the mode of transmission
    • High-risk behaviors
    • Occupational risk
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Ethical issues in an epidemic:
      • Is there a duty to treat?
      • Confidentiality and the duty to warn
      • Who should be tested?
      • What to do with the infected health care provider?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Ethical issues in an epidemic (continued):
      • Human subject research/experimental treatments
      • How far does duty extend in a global epidemic?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Provide service consistent with skills
    • Obtain skills as needed by patient population as consistent with scope of practice
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Provide accurate and up-to-date information
    • Promote the patient’s best interest regardless of personal feelings
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • The ethic of the Good Samaritan does not require that the rescuer take unacceptable risks in the process
    • A nonswimmer is not required to jump into pool to save another
    • The practice of universal precautions removes the unacceptable risk
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Useful guidelines for determining moral duty or moral option to treat:
      • Patient at significant risk of harm if practitioner does not assist?
      • Practitioner intervention directly related to preventing harm?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Useful guidelines for determining moral duty or moral option to treat (continued):
      • Practitioners intervention will probably prevent the harm?
      • Does the potential patient benefit outweigh harm the practitioner might incur?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • A physical therapist off duty, you stop to help at a traffic accident on the way home
    • A victim is lying on the ground, not breathing, and bleeding from the mouth
    • You are CPR-certified, but with no form of protective barrier mask with you
    • Moral duty or moral option?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Duty-oriented view:
      • Individual’s right of self-determination requires control over personal privacy
    • Utilitarian view:
      • Breaking of confidentiality would have a chilling effect on therapeutic relationship and health care in general
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Virtue-oriented belief:
      • A special patient-provider relationship exists
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • A balance between:
      • Duty to our patients
      • Legal obligations
      • Appropriate disease control within the community
      • Our duty to protect vulnerable individuals
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Review the case study “A Duty to Warn?”
      • Is there a duty to warn?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Mandatory testing for everyone:
      • Early diagnosis could lead to early treatment
      • Early counseling could lead to early cessation of high-risk behaviors
      • Better statistics to guide public health activities
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Concerns:
      • Cost/benefit ratio
      • Potential for increased discrimination (false positives)
      • False sense of security
      • Perhaps drive disease underground to avoid testing
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Dr. David Acer case – Florida dentist
    • Behringer v. Medical Center at Princeton
      • Privacy and confidentiality are also rights for a infected practitioners
      • What to do in the case of an infected practitioner? How do we protect both the patients and practitioners?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Should experimental drugs be available to dying patients?
    • Practice would not meet legal standard of “customary care”
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Difficult to assess autonomous consent in situation where patient is coerced by lack of options
    • Difficult to assess research results from desperate individuals who self- medicate
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • AIDS epidemic threatens vulnerable populations in Asia, Africa, Eastern Europe
      • Disease threatens to overcome social structure in developing nations
      • Medication costs out of reach for most
      • Developed world slow to respond
    • Moral duty or moral option?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Review the case
    • Does principle of distributive justice have meaning in an international context?
    • In a situation such as this, should American drug companies be forced to provide the needed drugs at little or no cost?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Assuming that we decided not to provide the drugs, is it reasonable or racist to conduct the study outlined in the case?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Review Exercise F in the review exercises
    • Do countries such as the United States have a duty to assist another nation in the face of an overwhelming epidemic?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • If you decide that countries such as the United States have a duty to assist:
      • To what extent can our assistance be predicated on changes in social convention and lifestyles of another people?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • Ethical issues faced by health care providers in an epidemic such as AIDS
    • Standard precautions and the issue of the health care provider’s duty
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.
    • What duty is owed to infected health care providers? What duty do they owe patients?
    • In a global epidemic, what ethical principles are involved?
    Copyright ©2009 Delmar, Cengage Learning. All rights reserved.