Concentration in Ethics and Health

Why ethics?

Ethics for medical care and treatment often take place under extremely emotional and stressful conditions. Although medical science is advancing rapidly, making sure that patients, their families and advocates receive ethical treatment is vital. Simply knowing that a treatment is the best or assuming a patient knows is not enough. Bioethics is essential for all involved in delivering health services.

This stream is intended for students in the Faculty of Health Sciences who are interested in focusing their studies around ethical issues in health, life and death.

Ethics and health in the news

  • Louise Brown, the world's first test tube baby recently celebrated her fortieth birthday. In vitro fertilisation, or IVF, was only successful after a lot of failed experiments; what ethical considerations did researchers Patrick Steptoe and Robert Edwards encounter while perfecting the technique?

Case Report (click + to expand)

Bioethics in action: What does consent to medical interventions require?

If a patient doesn’t want to talk about the risks associated with a medical procedure he needs, is it acceptable for the health care provider to proceed?  

Case report provided by Providence Health Care

Case Report: Jack arrives in emergency and presents with severe abdominal pain. The on-call surgeon decides that a laparoscopy is required in order to investigate and determine the source of the pain. When the surgeon tells Jack that he requires this procedure, Jack says that he knows he needs it but he doesn’t want to discuss it. He tells the surgeon “just do the procedure” and that he wants the surgeon to “do his best.”

  • Should the surgeon proceed with the procedure?
  • Is Jack’s consent sufficient, even if he doesn’t know all the facts related to procedure?
  • Or does he need to make a decision after he is informed about the risks and benefits of the procedure?

Healthcare providers are morally obligated to respect a patient’s autonomy by seeking a patient’s informed consent about the medical procedures that may be performed on his body. A patient can also exercise his autonomy by refusing procedures or treatments, even if they are medically recommended. In Jack’s case, however, he is not refusing treatment. Rather, he simply doesn’t want to know about what the procedure involves or the risks associated with it.

Question: It seems that Jack is making an autonomous choice about the procedure. But, is this informed consent?
Answer: The answer is no. Even if Jack tells the surgeon to “do his best” and “to just do the procedure”, informed consent is more than simply granting permission.

Discussion: In order that a patient provides informed consent, he must have decisional capacity, or the cognitive ability to understand and evaluate the nature of, and reasons for a medical procedure, and the risks involved in undergoing it (or not), in light of the relevant and appropriate information about the procedure, which any reasonable person would want to know, provided by the healthcare professional.
(The Health Care Consent Act outlines the conditions for making an informed decision http://www.bclaws.ca/civix/document/id/complete/statreg/96181_01#part2)

With these thoughts in mind about informed consent, what should we think about Jack’s case?

  1. We have no reason to think that Jack lacks capacity unless there is evidence that suggests otherwise. 
  2. However, Jack has not been properly informed about the procedure by the physician and the physician has no way of determining whether Jack is capable of understanding the implications of the procedure. 
  3. Therefore, the health care provider has a moral (and legal) obligation not to perform the procedure at this time.

However, the healthcare provider should continue to engage in dialogue with Jack, in order to determine why he doesn’t want to know about the procedure or its risks. Is Jack highly fearful? Is there a cultural reason why Jack doesn’t want to know?

Having a discussion with a patient about his reasons for not wanting to know about the procedure or risks is part of the process of informed consent between patient and health care provider, as well as crucial to establishing trust within the therapeutic relationship.

Bibliography
Johnston, Carolyn, and Penelope Bradbury. 100 Cases in Clinical Ethics and Law, Second Edition, CRC Press: Boca Raton, FL, 2015.


With grateful thanks to Providence Health Care for sharing a bioethics case report from their resources.  http://www.providencehealthcare.org/ethics_services/index.html

 

Elective Courses

In addition to three core courses in ethical theory (9-10 units), students complete three elective courses drawn from a stream in their subject interest (9-12 units). Elective courses often include courses already in their subject major.

Note: courses may change - for a complete list of the certificate requirements and the approved courses, please consult the calendar entry.

Students complete three of (click + to show courses):

CRIM 314 - Mental Disorder, Criminality and the Law (3) 
GEOG 386 - Health Geography (4) 
GERO 302 - Health Promotion and Aging (3)
GERO 406 - Death and Dying (3)
GERO 420 - Sociology of Aging (4)
HSCI 304 - Perspectives on Human Health and the Environment (3) 
HSCI 305 - The Canadian Health System (3)
HSCI 403 - Health and the Built Environment (3)
HSCI 319W - Applied Health Ethics (3) 
HSCI 402 - Substance Use, Addiction and Public Health (3)
HSCI 404 - Public Policy and Health Systems (3)
HSCI 481 - Senior Seminar in Social Health Science (3)

Read more?

The patient suicide attempt – An ethical dilemma case study
Nurses face more and more ethical dilemmas during their practice nowadays, especially when they are taking care of the patient at end of life stage. The case study demonstrates an ethical dilemma when nursing staff are taking care of an end stage aggressive prostate cancer patient Mr Green who expressed the suicide thoughts to one of the nurses and ask that nurse keep secret for him in Brisbane, QLD, Australia. https://www.sciencedirect.com/science/article/pii/S2352013215000149

Two prominent doctors in the field of pain management reflect on the malign influence of celebrity. https://psmag.com/social-justice/jackson-case-highlights-medical-ethics-3572

AMA Journal of Ethics - Illuminating the art of medicine 

Ethics and Medical Decision-making http://www.royalcollege.ca/rcsite/bioethics/bioethics-cases-e

“An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum.” http://jme.bmj.com/content/36/11/652

Journal of Medical Ethics 

“The moral, legal and ethical issues doctors face as they care for patients in the final weeks of their lives are being highlighted in a right-to-die case before the Supreme Court of British Columbia.” https://www.theglobeandmail.com/life/health-and-fitness/right-to-die-case-explores-legal-ethical-and-moral-issues/article534586/

More curated content in Ethical Dilemmas on Flipboard

Image attributions:
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