Medical Ethical Questions

So while doing typical med school poking around on the internet I found this.

It brought up some interesting questions, which of course I have an opinion on.

What are the pros and cons to our health-care system?

Pros: According to a survey done by the Commonwealth Fund, we have the most "effective" healthcare in the world and we're the third best in "timelieness." Aside from that, Americans just tend to think we have the best everything because we're just that awesome. Also we have much more of an ability for those who can afford it to recieve much, much better care (which could be considered a good or bad thing). Percent-wise, our health-care taxes are some of the lowest in the developed world, and even if you add in the private health-care spending to that we're still only amount mid-range.

Cons: Also according to the Commonwelath Fund survey, we are last among the six surveyed developed countries in patient saftey, patient centeredness, efficiency, equity, and overall. We also have one of the lowest life expectancies and highest infant mortality rates (right up there with South Korea and Croatia) of any developed nation. Our stystem isn't free (which again could be considered good or bad). But that means about 45,000 people die here each year from lack of insurance. And beyond that, medical bills are causing 60% of bankruptcies in the US. And even if spend a reasonable amount percent-wise, if you look at the numbers per capita, it's a whole lot more.
 

If you had the power, what changes would you make to our health-care system?

Oh well that is incredibly complicated. But one fairly (in comparison) simple change I'd like to see is the privatization of the FDA drug review process.

This is still a really complicated issue and too much so for me to go very far into it. But the gist is this:

• It takes ages: an average of 12 years to get a drug approved by the FDA (the FDA says it's goal is 6 - 10 months but that never happens, you never hear of that happening, I'm not sure why their numbers are so different from the truth, but I suppose they are stating a "goal" as oppose to an actual statistic)
• It's incredibly expensive: the average cost for major pharmaceutical companies is $4 billion per drug and can be as high as $11 billion
• It's not even all that effective at screening out snake-oil: the FDA was put in place because without any kind of screening the market was filled with ineffective and dangerous "medicine." The problem is now it's not totally clear the FDA is really stopping all that stuff very well. This goes over the history of that whole thing a bit.

But what do we do about that? Well that's where it get's complicated, of course. Bascially, one solution is to privatize the system. Bascially, you have multiple competing companies that can certify drugs and the consumer can decide if they want to have their drug certified and if so by whom. (Obviously it's a lot more complicated than that, but that's an overview.)

This paper pretty effectively explores both sides of this.

What is your opinion of HMOs and PPOs?

I think a PPO is better but do what you want. I don't really find this to be an interesting discussion...

Do doctors make too much money?

I don’t think so. I think a lot of that is perception.  I mean it doesn’t really seem that unreasonable when you consider that a family practice physician makes on average $200,000 a year and medical school on average costs between $50,000and $67,000 per year including books and lab fees, depending on the school. Which leaves a young doctor with a good amount of debt to pay off to even begin with. Really, the true perception of the high cost comes from things totally unrelated to doctor salaries such as astronomical malpractice insurance rates, extremely expensive medications, and tests with soaring price tags.

Is it ethical for doctors to strike?

Yes. However, I can’t personally imagine doing so, for me the health of my patients would always come first and I think that’s true for many doctors. Aside from that, I don’t really think there are    issues so extreme for working physicians that would require a strike to solve and I would personally elect to try and discuss such matters as oppose to taking to the streets and potentially harming patients in the process. Now, with that said if a physician felt that was the right thing to do I see nothing morally wrong with that.

What is the Hippocratic Oath?

I absolutely love this oath.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter may I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

 

There's actually a bunch of them though, all of which are quite spectacular. 

What is the difference between Medicare and Medicaid?

Pretty simple when you look at it, but not something everyone knows. You should have some idea of it though. It affects us all.

http://www.medicaremadeclear.com/about/medicare-vs-medicaid/

Should fetal tissue be used to treat disease (i.e. Parkinson's)?

If there is all the proper consent and it would be thrown away otherwise, then by all means.

     
For anyone wondering what this question is in reference to, this is a pretty interesting article.

     
Though, it may be a generally moot point because most recent evidence is showing that it might not even be possible at all. So away goes the ethical dilema! For now.

If you were a doctor and an under age girl asked you for the Pill (or an abortion) and she did not want to tell her parents, what would you do?

Pill: Most definitely. I’d rather she take that then come back in a few months asking for an abortion.

Abortion: That’s trickier. I’d probably have a therapist or social worker (or someone similar depending on where I worked) speak with and evaluate the girl. In any case I’d like to see her really discuss it with someone – me at the very least – before making that final decision. Depending, on her family circumstances I’d decide whether it was best to inform her family. But in the end I’d be comfortable doing it without her parents’ knowledge or consent as I think she has a right to that and more than that I’d be afraid if I didn’t it would only encourage her to have dangerous back ally procedures which is the last thing I’d want to see happen.

Not totally related but reminded me of this (which is completely outrageous).

Should doctors be allowed to `pull the plug' on terminally ill patients?

Yes, if the patient and their family have had time to understand the circumstances and make a reasonable informed decision and thus decided that is for the best.

If a patient is dying from a bleed, would you transfuse blood if you knew they would not approve 

      (i.e. Jehovah Witness)?
Though I wouldn’t personally believe in the decision and it would pain me greatly to do so, if a patient told me they themselves would rather die than receive a blood transfusion for purely religious reasons (i.e. no suicidal intent involved) then I would allow it. I’d hate it and I would certainly try to convince them otherwise, but I believe that is their right.

However, if they asked me to allow their child (or another person under their care) to die for the same reasons I would not. I think that other person has a right to live and their caretaker should not be able to make that kind of life or death decision for them especially for a child who is not even old enough to commit to such a faith.

This also gets super confusing legally because of the laws regarding this which can be hard to follow and oftentimes are different in every state. However, in general laws and Supreme Court cases on this issue have determined that while the First Amendment gives the right to freedom of belief it does not give the right to act on that freedom of belief and more than that does not allow parents to "make martyrs of their children."

This article goes over all of this quite well.