Medical Ethics

Medical Ethics

 

Author: Manasvi Dongre

 

 

1. Responsibility as an Ethical Framework for Public Health Interventions.

TUROLDO, F. proposes a responsibility-centered ethical framework that navigates between libertarianism and collectivism. This framework emphasizes individual responsibility while acknowledging the importance of community well-being. It advocates for non-coercive measures such as public education but recognizes the need for intervention when necessary, as seen in seatbelt laws. He highlights the importance of limiting the state’s role to prevent a loss of individual responsibility, citing examples from communist countries. Additionally, he emphasizes the role of third parties, including corporations, in public health delivery, advocating for corporate social responsibility initiatives. This approach balances individual choice with societal interests and suggests state intervention when corporate responsibility is lacking.

2. Ethics and Public Health: Forging a strong Relationship.

CALLAHAN, D. advocates for the integration of ethics education into the curriculum of public health schools in the United States. He notes a deficiency in ethics instruction compared to medical and nursing schools. While some public health programs offer limited ethics education, it remains insufficient. Callahan highlights a lack of systematic and sustained analysis of ethical issues in public health education, with many students not exposed to such analysis. He observes that existing ethics courses often focus more on medical ethics than public health ethics, which fails to address the distinctive ethical challenges of public health practice.

The author identifies several reasons why ethics education in public health is not more prevalent, including intellectual challenges, institutional barriers, and cost considerations. However, he argues that there is a growing demand from both students and practitioners for a more comprehensive understanding of ethics in public health. Callahan emphasizes the need for qualified faculty, institutional support, and curriculum changes to accommodate ethics education effectively. He contends that ethics education is essential for developing professionals with sound judgment, the ability to recognize and analyze ethical issues, and a moral imagination necessary for effective public health practice. Overall, Callahan stresses the importance of overcoming obstacles to integrate ethics education into public health programs.

3. Justice and Fairness in the Kennedy Krieger Institute Lead Paint Study: The Ethics of Public Health Research on Less Expensive, Less Effective Interventions

 

David R. Buchanan discusses the ethical challenges facing public health research, particularly in situations where the cost of new technologies or interventions exceeds what taxpayers can reasonably afford. He argues that the universal provision of the most effective interventions may not always be feasible. In such cases, research aimed at developing cost-effective alternatives that can benefit a greater number of people becomes ethically justified.

 

Buchanan emphasizes the importance of pragmatic considerations of justice in public health research. He suggests that focusing on interventions that are less expensive but reach a larger portion of the population can lead to overall improvements in public health. He warns against dogmatic positions that oppose research into cost-effective interventions, as this could result in policy stagnation and neglect of the needs of disadvantaged populations. Overall, Buchanan advocates for a pragmatic approach to public health research that balances effectiveness with affordability and accessibility.

 

4. Ethical Oversight of Public Health Research: Can Rules and IRBs Make a Difference in Developing Countries?

 

Leslie London discusses strategies to enhance the effectiveness of Institutional Review Boards (IRBs) in public health research, particularly in both developed and developing countries. He suggests establishing independent monitoring mechanisms and whistleblower protections to ensure research integrity. London emphasizes the importance of transparency in IRB decisions and advocates for expanding IRB membership to include representatives from vulnerable communities. However, he acknowledges the complexities of community participation, urging for measures to empower non-medical participants. Additionally, London highlights the need for ethical training for research ethics committees in developing countries and emphasizes the extension of vulnerability to include governments in such contexts. He raises ethical questions about global health research spending priorities and the broader responsibilities of IRBs beyond solely protecting human subjects. Ultimately, London argues that the ethical review process should facilitate agency among vulnerable groups and communities to address emerging ethical dilemmas in public health research effectively.

 

5. UNNECESSARY TREATMENT: WHEN FINANCIAL GAIN SUPERSEDES PATIENT CARE

 

Cheryl Patton highlights the risks associated with physicians prioritizing financial gain over ethical considerations, citing cases where this led to harm and legal repercussions. She emphasizes the importance of creating cultures of ethical behaviour within healthcare organizations through periodic training and awareness of the consequences of medical treatments. Additionally, Patton stresses the need for accountability at all levels of the organization, with top management ensuring that every employee is held responsible for their actions.

 

6. Trust Betrayed – Depraved Doctor or Negligent Hospital?

 

Madasu Bhaskara Rao and Madasu Mallika Rao discuss a significant medical malpractice case involving Johns Hopkins Hospital, which resulted in the largest settlement in the history of American hospitals. The case involved a gross violation of doctor-patient trust, where an obstetrician-gynaecologist engaged in harmful and offensive sexual contact and secretly took intimate photos of patients. Despite no fatalities or physical injuries directly caused by the doctor’s actions, the breach of trust devastated patients emotionally. This case highlights the importance of upholding patient privacy rights and maintaining ethical standards in medical practice. It also serves as a valuable learning opportunity in areas such as human resource management, hospital administration, patient rights laws, and governance ethics. This incident underscores the need for corporate hospitals to prioritize ethical conduct and patient well-being.

 

7. MAINTAINING THE VALUES OF A PROFESSION: INSTITUTIONAL WORK AND MORAL EMOTIONS IN THE EMERGENCY DEPARTMENT

 

April L. Wright, Raymond F. Zammuto, and Peter W. Liesch explore the practical implications of their study on the intersection of professional values and organizational practices for specialists and managers. They highlight how professional values can lead to conflicts within organizations, especially when translated differently across specialists or when organizational practices undermine these values. The authors suggest that specialists need to be mindful of these conflicts and reflective about the emotions they evoke. They propose that moral emotions triggered by values conflicts can drive individual and collective action to address both episodic and systemic problems. Managers can facilitate this process by providing opportunities for reflection and focusing on organizational practices rather than individual blame during conflicts. Overall, the study offers new insights into how specialists navigate the challenges of maintaining professional values in their work and suggests avenues for fostering a more nuanced understanding of professional and institutional dynamics within organizations.

 

8. MISSED OPPORTUNITIES, LYING, AND DISPARITIES IN PATIENT OUTCOMES

 

Michael J. Sacopulos, director of the Center for Bioethics and Humanities at the University of Colorado, discusses various topics related to pandemic response, vaccine mandates, physician training and practice, and bioethical issues. He reflects on the lack of effective utilization of pandemic response plans, highlighting the importance of federal coordination and the success of vaccine development efforts. Wynia delves into the ethical implications of vaccine mandates, addressing concerns about individual liberty and the role of government. He also explores disparities in healthcare as a patient safety issue, emphasizing systemic factors contributing to unequal outcomes. Additionally, Wynia examines the phenomenon of physicians being untruthful with patients, noting the systemic challenges that lead to such behaviour. He advocates for a systems approach to addressing unethical behaviour and predicts a future focus on integrating lessons from the pandemic to improve healthcare systems and address bioethical issues.

 

9. Ethics and Childhood Vaccination Policy in the United States

 

Kristin S. Hendrix explores the ethical complexities surrounding childhood immunization in the United States, particularly the balance between parental autonomy and public health benefits. She discusses key issues such as herd immunity, vaccine communication, dismissal of vaccine-refusing families from practice, and vaccine mandates. Hendrix emphasizes the importance of clinicians and policymakers taking a deliberative approach to vaccine-related discussions and policy development, considering the timing and nature of these conversations.

 

10. Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review

 

Sonali P. Kulkarni discusses the potential of the test-and-treat strategy in combating the HIV epidemic, highlighting its significance based on innovative modelling and recent empirical evidence. Despite its promise, Kulkarni acknowledges the need to address clinical uncertainties, health service challenges, and ethical complexities associated with its implementation. Until these issues are resolved, efforts should focus on achieving universal testing and treatment in line with current World Health Organization guidelines. Kulkarni emphasizes the importance of a strategic and thoughtful approach involving research, implementation, and community engagement to overcome existing concerns and move closer to realizing the potential of the test-and-treat strategy.

 

 

 

 

 

 

 

 

 

Conclusion

 

 

 

 

Medical Ethics: Exploring Diverse Perspectives

 

 

The diverse array of perspectives presented in this compilation underscores the multifaceted nature of medical ethics. From discussions on responsibility in public health interventions to the complexities of vaccine policy and the ethical challenges of HIV test-and-treat strategies, each author brings valuable insights into the ethical dilemmas faced by healthcare professionals, policymakers, and researchers.

 

Ethics education emerges as a recurring theme, with authors advocating for its integration into medical and public health curricula to cultivate professionals equipped with the moral imagination necessary for effective practice. Furthermore, the importance of accountability, transparency, and systemic approaches to address ethical lapses within healthcare organizations is emphasized.

 

As we navigate the ever-evolving landscape of healthcare, incorporating ethical considerations into decision-making processes becomes paramount. By engaging in rigorous ethical analysis, fostering open dialogue, and prioritizing the well-being of patients and communities, we can strive towards a healthcare system that upholds the highest ethical standards and promotes equitable access to care for all.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

 

1. Buchanan, D. R.; Miller, F. G. (2006). Justice and Fairness in the Kennedy Krieger Institute Lead Paint Study: The Ethics of Public Health Research on Less Expensive, Less Effective Interventions. *American Journal of Public Health*, 96(5), 781–787. [Link](https://research.ebsco.com/linkprocessor/plink?id=44710d86-71d2-3439-b21c-e901d900bcd6)

 

2. Callahan, D.; Jennings, B. (2002). Ethics and Public Health: Forging a Strong Relationship. *American Journal of Public Health*, 92(2), 169–176. [Link](https://research.ebsco.com/linkprocessor/plink?id=f6c9f1d7-8a6a-3b3f-be40-5c963cb84271)

 

3. Hendrix, K. S. et al. (2016). Ethics and Childhood Vaccination Policy in the United States. *American Journal of Public Health*, 106(2), 273–278. [Link](https://research.ebsco.com/linkprocessor/plink?id=1cc42e6a-f5fe-3cbf-acd7-2b2308a49390)

 

4. Kulkarni, S. P. et al. (2013). Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review. *American Journal of Public Health*, 103(6), e14–e23. [Link](https://research.ebsco.com/linkprocessor/plink?id=00178fb4-14d3-3dd0-a69e-af1c035bf1a4)

 

5. London, L. (2002). Ethical Oversight of Public Health Research: Can Rules and IRBs Make a Difference in Developing Countries. *American Journal of Public Health*, 92(7), 1079–1084. [Link](https://research.ebsco.com/linkprocessor/plink?id=23c98e26-ddeb-346c-a7df-af449adb2245)

 

6. Patton, C. (2016). Unnecessary Treatment: When Financial Gain Supersedes Patient Care. *Physician Leadership Journal*, 3(2), 68–70. [Link](https://research.ebsco.com/linkprocessor/plink?id=10034b4f-a92f-3791-8367-c5639fec39f0)

 

7. Rao, M. B.; Rao, M. M. (2016). Trust Betrayed – Depraved Doctor or Negligent Hospital? *IUP Journal of Management Research*, 15(2), 53–72. [Link](https://research.ebsco.com/linkprocessor/plink?id=c841c976-e3b5-34d2-9999-4a43c9ec872f)

 

8. Sacopulos, M. J. (2022). Missed Opportunities, Lying, and Disparities in Patient Outcomes. *Physician Leadership Journal*, 9(2), 59–63. [Link](https://research.ebsco.com/linkprocessor/plink?id=5a338dcb-e37d-3d6b-bc67-1f2ead6cc4e5)

 

9. Turoldo, F. (2009). Responsibility as an Ethical Framework for Public Health Interventions. *American Journal of Public Health*, 99(7), 1197–1202. [Link](https://research.ebsco.com/linkprocessor/plink?id=c2bd66d0-b23a-3976-8011-f6624e5d33e7)

 

10. Wright, A. L.; Zammuto, R. F.; Liesch, P. W. (2017). Maintaining the Values of a Profession: Institutional Work and Moral Emotions in the Emergency Department. *Academy of Management Journal*, 60(1), 200–237. [Link](https://research.ebsco.com/linkprocessor/plink?id=7a569461-656a-3438-8ca6-3db537d994ad)