HTH 423 test 3
Individual Rights and the Second Amendments
"A well regulated Militia , being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed" -there is a need to restore the ethics of health care that emphasizes individual obligations and responsibilities over rights and privileges
This stage of HIV, HIV continues to to multiply in the body but at very low levels. May not have any HIV-related symptoms, but can still spread to others.
Clinical latency stage of HIV
Are HIV infected individuals protected against the discrimination under the ADA?
ya trick
When does human life begin?
- the law is clear that neither congress nor state legislatures may adopt one theory of when human life begins -no universal accepted definition of conception -pregnancy does not happen until implantation---NOT pregnant at fertilization (just a zygote in fallopian tubes) -the US supreme court, even as it upheld women's constitutional right to aboriton, has avoided answering the ethical dilemma of when human life begins
Applying the Principle of Corrective Justice
-Balancing Social costs with Social benefits -Premium Adjustments for Health insurance
Right to and Permissible Abortion Regulations
-Competing Human Rights -Dilation and Extraction Abortion Bans -Parental Notification Limitations -Informed consent Restrictions -Mandatory In-person, informed consent requirements -Per Se Medical exceptions
Restricted Access to emergency contraception Pills
-Fabricated Entanglements: ethical dilemma along with abortion--> delay of EC has lead to many unintended pregnancies -Logistical Barriers to Access
Restricted Health insurance coverage for contraceptives
-Mandated Pelvic Exams as a condition of access to contraceptives -conscientious objections to contraceptions -religious exemptions from mandated contraception coverage -lack of all-inclusive federal legislation
The substitution effet and Public Health Determinants
-The substitution effect does not affect Gun homicides: the rates of other violent crimes do not increase when access to guns is reduced or limited; study found that gun injuries generally decline after implementation of strict gun control laws -The substitution effect does not affect life expectancy: national life expectancy increases with better gun control
Human Dignity and the Right to a Dignified Death
-There are serious economic and moral implications to the fact that the largest portion of health care costs are incurred during the last few weeks of a patient's life -There is a clear possibility that if end-of-life decisions are not guided by ethical reasoning, they will ultimately be made for economic ones
Examples of Global Gender-Base Discrimination
-Violence Against Women -Femicide -Rape(war rape) -honor killings -birth control -sex trafficking
Inadequate Education about Family Planning and Restricted Access to Contraceptives
-Where states require health insurers to cover contraceptives, women's access to contraception has significantly expanded. As a consequence, unintended pregnancies and the resulting number of abortions are much lower once contraceptives are more available
Confronting the End of Life
-While social consensus on what constitutes death is unclear, most agree that death involving considerable prolonged pain and impairment of capacities is always the least desirable option -everyone is eventually forced to confront the end of life -Although death cannot be avoided,not everyone agrees that the nation needs to step closer to becoming a society whose belief in personal autonomy and rational self-determination is manifested in opportunities for dying with human dignity; some people instead want death to take its own course
Gender -based Discrimination and Women Rights
-Women's health is increasingly jeopardized by limited access to health care -women's health insurance plans often costs more than men's for the same basic coverage with the same insurer in disregard of laws prohibiting this practice -reproductive rights of women are under assault -Women's health needs are often overlooked and understudied compared to those of men -disparities continue to widen in the treatment outcome of men and women with the same health conditions
Logistical Barriers to Access
-better access to contraception is necessary to reduce the number of unintended pregnancies and the resulting number of abortions. Too many women face financial barriers in accessing contraceptives because their right to have health insurance coverage for contraception is not guaranteed.
The Ethics of High infant Mortality
-due to unintended pregnancies and consequent lack of prenatal care -with proper prenatal care, costs after baby is born can be greatly reduces
Epidemiology of Gun Injuries
-gun injuries kill 40,000 to 55,000 adults and children every year (151 deaths per day) -almost 4x as many people suffer from gun inkuries as are killed by guns -there are 135,000 to 168,000 non-fatal gun injuries each year (19 every hour) - ~310 million privately owned guns in the US -more than half of the 36,000 yearly suicides -among 15-24 year olds, homicide rates are 43x higher than other countries -cultural war phenomenon over facts -Americans' Reduced Life Expectancy -The Substitution Effect and Public Health Determinants
Why are women's rights to reproductive care insecure?
-limited , costly access to compprehensive maternity care -constant attack on their reproductive choices
The challenge the HIV/AIDS
-people dying from preventable diseases in US -people need care but ofentn don't get it because of the cost -people delay testing because of the cost until it is too late, or they are too socially disorganized to use offered care
affordable access as an insurance problem, not simply a pricing problem
-problem of obtaining ARVs is an insurance problem -people with HIV need affordable health insurance with reasonable prescription coverage, meaning co-payments that are at an affordable level and plans that provide basic coverage for needed medications
The HIV/AIDS pandemic and health care reforms
-raised awareness about the lack of health care systems to deliver care to many amecians -highlighted the problems with the current health care system -enabled broader health care reform and the need for: health informations networks; national standards of care -helped build a foundation for: near-univeral primary care; comprehensive high-quality continuous care management of chronic conditions
Problems with the emerging threat of HIV/ TB Co-infections:
-treatment for multi drug resistant works for only about a third of those infected -some strands of TB have become resistant to antibiotics -health departments must treat TB, but care is inadequate, long term compliance is low and lower quality generics are normal
The environmental safety problem of Gun Injuries
-victims of gun injuries are likely to need medical treatment requiring high insurance payouts -this in turn raises the cost of the risk pools, thereby raising health insurance costs for everyone else -inevitably a lrge proportion of the financial burden from gun injuries falls on society through government health insurance programs and higher premium for all insured *Premium not higher or lower if you are a gun owner because they are not considered as part of the risk pool *Gun owners are more likely to be gun victims
what is the survival rate for an infant born at 22 weeks
0-10%
6 ways to contain HIV
1. Partner notification requirements 2. Punitive criminal laws 3.immigration restrictions 4.HIV as a routine communicable disease 5.adequacy of protections from stigma, discrimination, and social exclusion 6. confidentiality of HIV status
Reasons for Inadequate maternity coverage
1. Individual Insurance restrictions 2. The Ethics of High Caesarean Deliveries
Stigmas of HIV/AIDS
1. blaming the disease on the diseased 2. social determinants of health
What are the two prongs of the approach to the HIV / AIDS pandemic in the US?
1. early detection 2. treatment of the HIV infection before it progresses to full-blown AIDS
what ethical principal is relating to each of the following: 1.end of life care 2.preserving lives of mature minors 3.determining the best course of treatment 4. providing universal access to affordable health insurance
1. human dignity 2. beneficence 3.non-malfeasance 4. justice
Model that correlates with: 1. fair distribution of benefits and burdens 2.respects and guarantees the human rights of those affected 3. decision must withstand public scrutiny 4.focuses on free will and independence
1. justice model 2.rights model 3.social media model 4.choices model
3 areas the HIV/AIDS pandemic has profoundly affected:
1. medicine 2.the ethics of healthcare 3.adult mortality
types of gender- based discrimination
1. women's insurance plans cost ore than men's for the same basic coverage with the same insurer in disregard to laws prohibiting this practice 2. reproductive rights of women are under assault 3. women's health needs are often overlooked and understudied compared to those of men 4. disparities continue to widen in the treatment outcomes of men and women with the same health conditions
How how HIV/Aids been fueled reform of the US health care system (4)
1.inadequate health resources 2. unequal and uneven access to affordable health insurance 3.poverty 4.social injustice
Reduced life expectancy of America
78 yrs old (in last place with Denmark and Qatar)
Final and most sever stage of HIV infection. Happens as a result of such a damaged immune system to the point that the body cannot fight off opportunistic infections
AIDS
People tested positive with HIV are diagnosed with this when lab test show that their immune systems are severely weakened by the virus or when opportunistic diseases develop
AIDS (acquired immunodeficiency syndrome)
Treatment for HIV positive people to control the damaging progression of the virus before they become symptomatic for AIDS. Can slow down the rate at which HIV weakens the immune system to the point of being diagnosed with full-blown AIDS
ARVs (antiretroviral medications)
Competing Human Rights
Aborition is one of america's more divisive issues involving completing human rights and pro-life and pro-choice arguments. But the rate of abortion also begs the question of what kind of country the US might be of scotty encouraged its families and supported women whey they made the decision to become parents
Earliest stage of HIV infection. Generally develops within 2-4 weeks after a person is infected with HIV. During this time, some people have flu-like symptoms such as fever, headache, and rash. During this stage, HIV multiples and rapidly spreads in the body.
Acute stage of HIV
Costs of guns
An ethical gun control policy should not cost the firearms industry more than $100 billion a year (annual cost of gun violence in U.S.) -2-2.3 billion in health care costs -4.9 billion in life insurance costs -Costs of law enforcement, private security, $43 billion in criminal justice system costs (incarceration, lost productivity of victims, limits on freedoms to live or work in certain places.) -emotional costs of forced adaptations to increase risk and cost of pain and fear
Cultural War Phenomenon over Facts
Because conclusions about gun injury prevention conflict with cultural values, namely individual rights, people do not accept the consensus of environmental safety researchers that gun injuries generally decline after implementation of strict gun control laws -Heller left the door open for accepting reasonable gun control legislation is supported by findings of fact regarding the epic of gun injuries
The Right to Refuse Life-Sustaining Treatment
By definition, life-sustaining treatment: -can only sustain life -cannot save life or improve a health condition Crucial distinction in this definition of life-sustaining treatment: -medical treatment at the end of life can, at best, only prolong a slow deterioration to an inevitable and predictable death The potential benefit of life-sustaining treatment can only be measured in relation to personal values: -personal decision -decision determines: 1. time of one's death 2. the manner in which death occurs
D.C. attempted to ban handgun possession in the home and require any lawful firearm in the home be disassembled or bound by a trigger lock. Violated the second amendment because it amounted to a prohibition on an entire class of "arms" that American overwhelmingly chose for the lawful purpose of self-defense. It also violated the second amendment because the law made it impossible for citizens to use arms for the core lawful purpose of self-defense.
D.C. v. Heller
The individual right to opportunities like achieving a healthy wellbeing and maintaining one's health. Some are not available to people infected with HIV who are uninsured or are covered by the government health insurance
Entitlements
This was enacted in 1963 in the US and amended the Fair Labor Standards Act aimed at abolishing wage disparity based on sex
Equal Pay Act
The Ethics of Palliative Sedation
Ethically speaking, palliative sedation is on the continuum of palliative care; as long as the compassionate intent is not to cause death the risk of death is justifiable in palliative care. Accelerates dying process to minimize suffering.
How did women get access to ECs in 2006?
FDA finally permitted the OTC sales
Where does there need to be corrective justice?
Firearms industry
Parental Notification Limitations
Greater regulation of abortion access for minors has consistently been allowed because of parental interests and the lesser rights of minors
One stage to the retroviral infection. Destroys certain white blood cells critical to the normal functioning of the human immune system that defends the body against illness. Weakens the immune system, making people more susceptible to cancers, infections, infections. Incurable but treatable.
HIV (human immunodeficiency virus)
HIV is technically treated no differently from other communicable diseases, yet there is disagreement over whether states should report the identities of HIV-infected students to school officials or whether students and their families should decide whether to disclose their health status
HIV as a routine communicable disease
blaming the disease on the diseased
HIV/AIDS if often viewed as a fault-based disease with general belief that people with the disease were not innocently infected with HIV, but instead made poor lifestyle choices
philosophy of palliative care that provides pain management, symptom control, psychosocial support, and spiritual care to patients facing the end of their lives and their families. There has to be a terminal prognosis for death in the next 6 months
Hospice
Defining Hospice and Palliative Care
Hospice brings various ethical issues to the forefront. These include: -informed consent for hospice -palliative sedation as justified by the principles of informed consent and double effect -Personal autonomy as supporting the refusal or withdrawal of life-sustating care
Difficulties in Defining Medical Futility
If patients are terminally ill, it is debatable whether measures to prolong their lives for only a short and often painful period of time are ethical -because the medical technology exists, it tends to be used Physicians may have an ethical obligation to shift to palliative care as opposed to continuing life-sustating treatment once it becomes useless (futile) Death is part of life and should not be resisted at every turn by modern medicine No social consensus about which treatments are clearly physiologically and psychologically useless as opposed to treatments where there are simple differences about how worth while a particular intervention is
HIV test that is taken 10- 33 days after exposure to HIV
Nucleic acid test (NAT)
The Right to a Dignified Death
Issue: should the requirement for a terminal prognosis be eliminated from physician-assisted dying laws and life-threatening and chronic illness added? Assisted dying permits patients to actively choose to end their lives before their disease would most likely do so
University in VA that allows guns on campus;
Liberty
Ban on handgun possession to basically all private citizens. State and local governments may not improperly restrict the human rights granted by the second amendment.
McDonald v. Chicago
After a systematic review of HIV prevention programs advocating sexual abstinence outside a monogamous marriage, was there evidence found that these programs reduced the incidence of HIV infections over the past decade?
NO
Is Gun ownership a factor in the risk pool at this point?
NOPE
Americans' Reduced Life Expectancy
One objection to the principle that reducing gun deaths would increase life expectancy is at the argument that guns are simply a means to an end, but this substitution effect argument does not pass scientific muster -gun homicides and suicides kill mostly young people -violent injury is a major drain on American society, gun injuries have never been a nation priority
Physician -assisted Dying
One of the most controversial cultural issue in the US -Americans are almost evenly divided over whether it is ethically acceptable or ethically wrong
Social Costs: While gun injury prevention may be an ethical imperative, it also make economic sense, since gun injuries account or 2 and 2.3 billion preventable health care costs annually
One side suggests individuals right to possess guns should be balanced against the costs to society arising from exercise of that right. The other side states that social costs should never influence individual rights -see 2nd amendment as a human right
what was the first state to legalize physician assisted suicide?
Oregon
specialized area of health care that focuses on relieving and prevention the pain and suffering of patients in all disease stages, including those undergoing treatment for curable and chronic disease as well as patens nearing the end of their lives
Palliative Care
Defined as the induction of an unconscious state through the use of an opioid infusion or morphine drip to relieve other wise intractable suffering, and is frequently used accompanied by the withdrawal of any life-sustaining means
Palliative Sedation
Palliative care VS hospice
Palliative care: in all disease stages Hospice: provides psychological support to people not faced with imminent death
Congress created this to conduct comparative effectiveness research. This research compares medical interventions to discern which treatments and medical products work best.
Patient-centered outcomes research institute
The biological prolongation of life, as it transforms into a prolongation of death, worth the burdens that one will have to endure?
Personal decision
Defined as the ending of one's life through the voluntary self-administration of lethal medication prescribed by a physician for that purpose
Physician- assisted Dying
Pharmacists' Conscience Legislation
Point: the Ethical Obligation to Fill All Prescriptions Counterpoint: the Right to Conscious objection
Ethical Ideas
Restrictions on residential and commercial location decisions -Limitations in hours of operations of retail establishments -or they should spend 100 billion a year on gun injury prevention
includes sexual assault, sexual violence, sexual harassment, dating violence, domestic violence, relational violence, sexual exploitation, stalking, and all other forms of misconduct on the basis of or because of a reporter's sex, sexual orientation, gender, or gender identity.
Sexual Misconduct
The Ethics of High Caesarean Deliveries
States generally require unexpected complications during delivery, such as emergency Caesareans, to be covered by health insurance, while standard vaginal deliveries are nor covered without explicit maternity coverage. As a result, the US has the highest rate of Caesarean surgeries of any nation in the world
T/F: US has mandatory reporting requirements for HIV positive ppl
T
T/F: a physicians efforts DO NOT constitute negligence simply because the treatment is unsuccessful
T
T/F: as part of the medical ethical code ethics, physician MUST provide care with compassion and respect
T
T/F: distributive justice refers to spreading of benefits and burdens among society
T
T/F: failure to get family history and perform physical examination is violated standard of care owed to patient
T
T/F: gun owner ship is not in the risk pools
T
T/F: pelvic exams are mandatory if one is insured and wants BC
T
T/F: physicians must give reasonable notice before they leave a patient
T
T/F: ppl don't know HIV/ AIDS is a pandemic
T
T/F: staff have the right to refuse care involving elective abortions
T
T/F: the disagreement in care b/w parent and child is a ethical dilemma in relation to healthcare
T
T/F: there are 310 million privately owned guns
T
Cells that attack virus or foreign invaders in the body
T-cells
Counterpoint: the Right to Conscientious Objection
The conscience of women is rendered less important by pharmacists' conscience legislation that exempts pharmacists from dispensing contraceptive pills if doing so is against their beliefs: REFUSAL CLAUSE
Dual Role of Government and the Pharmaceutical Industry
There are suggestions that HIV/AIDS is a special disease state, one so serious that the government and the pharmaceutical industry have an ethical obligation to provide essential ARVs and AIDS medications to ameliorate this preventable disease
This Education amendment of 1972 is a Federal civil rights law that prohibits sex- and gender- based discrimination including sexual misconduct in the educational institutions receiving federal funding
Title IX
This amendment prohibits discrimination against an individual because of gender identity , including transgender status, or because of sexual orientation
Title VII
a bacterial disease that primality affects the lungs but can attack any organ in the body. happens as a result of the weakened immune system of those with HIV
Tuberculosis (TB)
Requirement of registration under the National Firearms Act of sawed-off shotguns, on the grounds that Miller limited the type of weapon to which the second amendment right applied to those in common use for lawful purposes.
U.S. v. Miller
Mature Minor's Rights to Refuse Life-Sustaining Treatment
While denial of a mature minor's personal autonomy to refuse life-sustaining treatment is a denial of the right to decide whether the biological propagation of life, as it transforms into a prolongation of death is worth the burdens that will have to be endured, the ethical issues raised are significant and in many respects unresolved; this area of medical decision-making is sorely in need of analytic clarity
Individual Insurance Restrictions
With about 4 million births in the US each year, pregnancy and childbirth related conditions account for almost 11 % of the nation's hospitalizations. Yet, comprehensive prenatal care and maternity coverage are falling out of reach for more women
Can physicians be held liable for failure, when appropriate, to seek consultations
Yes
What is the most rapid home HIV test?
antibody test
HIV test taken 18 to 45 days or 18 to 90 days after exposure. -23 to 90 days to reliably detect HIV infection
antigen/ antibody test
fair pricing of essential medications
because of the high prices of medications, people with HIV have to pay the high retail price for medications or go without treatment -while the US does NOT regulate drug prices, there is debate on whether price regulation would affect pharmaceutical innovation -problem is , is that the few successful medications must recoup the costs of all the failures, not to mention the costs of marketing those successful medication -HIV/AIDS has forced examination of the entire regulatory scheme and how to best price medications
social determinants of health
before the HIV/ AIDs pandemic,those who were already socially marginalized became at greatest risk of HIV infection. blaming the diseased for the disease ignores the social determinants of health -the primary factors that shape the health of people are not medical treatment but rather the living conditions they experience such as stigmas
a virus with genetic information in its RNA as opposed to DNA and that causes HIV infections and certain cancers. ARVs suppress these
retrovirus
public health surveillance of new HIV infections reflects the vision of protecting the public health. -virtually every state collects the names of people who test positive for HIV -many states also require physicians to report private information, such as medication use and sexual history about anyone who tests positive -the ethics of reporting of reporting new cases of HIV by full names as opposed to by codes remains controversial
confidentiality of HIV status
devices that act to prevent fertilization / or implantation
contraceptives
defined as undoing a wrong or as giving rise to specific reasons for rectifying wrongs
corrective justice
What are some social determinants impacting the incidence of HIV/ AIDS?
denial discrimination homelessness homophobia sexism racism poverty social exclusion
Conrtrolling and ending the global HIV/AIDS pandemic is as much an _________ responsibility as an ___________ one.
economical, ethical
implanted cell body up to 8 weeks
embryo
What does misdiagnosis include?
diagnosis and treatment of disease a patient doesn't have
individual right to ask others to respect them and refrain from violating their human dignity when they decide how and when they want to die
dignified death
the idea that the good effect of relief from suffering and debilitating symptoms is intended , despite the fact that death is foreseen, is a legitimate line of ethical reasoning
double effect principal
freedom from being harmed or injured by violence
environmental safety
sperm and egg uniting
fertilization
developing body after 8 weeks of gestation
fetus
moral rights are best explained when considering the ________________ that can occur if right is denied to someone
harm/ outcomes
What is the ethical principal that allows individuals to consent to PAS?
human dignity
ethic associated with dignified death
human dignity
-control against entry into the US for people with HIV infections have been eliminated -now, an emerging controversy is the ethicality of deporting HIV-positive non-US citizens who have access to medical treatment in the US but who are being deported to a country where such treatment is unavailable
immigration restrictions
pregnancy
implantation
where the nation's thinking is being adapted at different rates by different groups
inattentional blindness
values that impact Women's Health
it is necessary to understand how human dignity and respect impact women's reproductive health, values that in other health care situations are taken quite seriously
human constructs
legal rights
the ethics of government incentives
lots of money in governement incentives for taxpayer-financed research, gov provided patent protection, and gov insurance payments for its medical products are placed in the hands of the pharmaceutical industry -if the incentives to the pharmaceutical industry are too strong, more products are produced than needed and prices are too high - if incentives are too weak, prices are less, but society misses out on medical innovations
Defined as treatment that fails to end total dependence on intensive health care. No generally agreed- upon definition of what constitutes this or what ethical principles should define this treatment concept
medical futility
What is a cost related to gun injuries?
medical treatment costs
What are minors' rights to consent to HIV testing and treatment
minors can consent to testing for HIV in all states and can consent to treatment for HIV/AIDS in many states
rights not easily subject to change
moral rights
Does abstinence based teaching reduce HIV?
no
Is gun control a national priority?
no
ethics involve reasonable _____________ that people will refrain from rape
obligations
Infection that attacks people with already weakened immune systems. They may not affect pop;e with normal immune systems but take advantage of damaged immune systems.
opportunistic infections
the induction of an unconscious state through the use of an opioid infusion or morphine drip to relieve others intractable suffering, and is frequently accompanied by the withdrawal of any life-sustaining means. -a means of accelerating the dying process and enabling a dignified death
palliative sedation
Physicians and testing labs are required to report the names of newly diagnosed HIV patients to state communicable disease registries. -controversial issue is whether physicians should also disclose the HIV status of patients to known sexual partners to whom HIW is likely to be transmitted. Physicians are generally not required to investigate and notify third parties about their risk for contracting HIV
partner notification requirements
what are the 3 types of autonomy?
personal corporate autonomy from government
require action. one must act or others are obliged to act
positive moral rights
many states have _________ _______ ______ that in effect discourage HIV testing and, therefore, have a corrosive impact on efforts to combat HIV/AIDS. -EX: most states will prosecute people with HIV who engage in sexual encounters without first disclosing their HIV status to prospective partners. -all states have criminal laws that punish people with HIV for sexual encounters posing some risk of HIC transmission, even if no transmission occur
punitive criminal laws
These are example of what? -request for sexual favor -sexual advances made as a condition of employment and unreasonably interfering with an employee's work performance -creating an intimidating or offensive working environment - can be verbal or physical
sexual harassment
What costs are difficult to quantify in relation to guns?
social costs
Equality and social solidarity:
social justice
Who has the highest rate of c-sections?
the US
Dilation and Extraction abortions:
the federal gov. has made it a crime to perform these abortions during the second trimester
ethical pricing incentives
the pharmaceutical industry only provided essential ARVs and AIDS medications at affordable prices AFTER massive public pressure and the number of people directly affected by the pandemic approached 90 million worldwide -when thousands of americans die as as direct result of lack of access to available ARVs and AIDS medications , the US pharmaceutical industry suddenly faces different pressures than other industries
The idea that people who are intent on violence either toward themselves or others will find a way to achieve that objective with whatever tools are available
the substitution effect
fetus can live outside the body
viability
Compassion, courage, education, diligence, fairness, honesty, self-control are all examples of what?
virtues
a right and responsibility to report unethical connect. defined as an act of someones "who, believing that the public interest overrides the interest of the organization he severs, publicly blows the whistle if the organization is involved in corrupt, illegal,... activity"
whistleblowing
