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Medical Ethics and the Hippocratic Oath
Transcript of Medical Ethics and the Hippocratic Oath
Is this choice an extension of her autonomy?
Is the right for a patient's self-determination powerful enough to create obligations on the part of others to aid her so that she can exercise her rights? She clearly cannot kill herself.
She can't move, but should someone be FORCED to help her, or to find someone to help her?
Is the short amount of time she has to live ethically relevant?
Is there an ethical difference between her dying in 6 hours and dying in a week?
What about a year, and how do you draw this distinction?
Who do you think should receive the child, and why?
Does paying the surrogate harm her and/or the child's dignity?
Is it selfish/conceited for this couple to want children of their own genetic make-up?
If yes, does this change if you can "easily" have a child?
Do you think that the physician should report the mother?
Should we completely discount this treatment as useless, or could there be something gained from it?
Medical Ethics and the Hippocratic Oath
Euthansasia is "the act of ending the life of a person suffering from either a terminal illness, or an incurable disease." The AMA is against physicians assisting in euthanasia.
A woman was diagnosed with motor neurone disease (the samedisease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing.
In our culture, reproductive liberty, the freedom to decide when and where to conceive a child is highly protected, and this can make these cases much more difficult.
A woman, after a bout with uterine cancer had a hysterectomy (surgical removal of the uterus). Before, its removal, however, she had several eggs removed for possible fertilization in the future. Now married, the woman wishes to have a child with her husband. Obviously she cannot bear the child herself, so the couple utilizes a company to find a surrogate mother for them. The husband's sperm is used to fertilize one of the wife's eggs, and is implanted in the surrogate mother. The couple pays all of the woman's pregnancy-related expenses and an extra $18,000 as compensation for her surrogacy. After all expenses are taken into account the couple pays the woman approximately $31,000 and the agency approximately $5,000. Though the surrogate passed stringent mental testing to ensure she was competent to carry another couple's child, after carrying the pregnancy to term, the surrogate says that she has become too attached to "her" child to give it up to the couple. A legal battle ensues.
Autonomy essentially means "self rule," and it is a patient's most basic right. As such, it is a health care worker's responsibility to respect the autonomy of her patients. However, at times this can be difficult:
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother.
When should a physician step in to stop a cultural practice?
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.
The Hippocratic Oath is taken by doctors, and is a tradition where they swear to uphold the tenets of ethical medicine. They show that they understand that they are treating a patient and not just a illness, and that their actions also impact the lives of the patients families and friends.
Kate is a 17 years old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care, and then abused in that system. She is now an emancipated minor who works 30 hours per week at a service industry job while also earning a 4.0 GPA in school, ranking in the top 10% of her class. She is college-bound, with a full-ride scholarship for pre-med undergraduate studies at a prestigious university.
Kate has absolutely no family support, and the former boyfriend who is the father of her unborn child/fetus simply disappeared upon learning of the pregnancy. Your patient is scared, uninsured, and says she doesn’t want to be pregnant or a mom (“Perhaps someday, but not now!”). She rejects the adoption option, based on her own experience growing up, and requests abortion only, at this hospital where she has always received medical care.”
In your opinion, does Kate have a good enough reason to get an abortion? Does the unborn child deserve or not deserve a say in its life?