Medical Ethics - Low Birth Weight Infants

Materials

Background for Teachers

In discussing ethics, rarely is there only one answer, rarely is it comfortable, and rarely is it enough.

Ethics is the study of right and wrong conduct. Our laws are our country's conclusions about right and wrong. The focus of ethics is moral situations -- that is, those situations in which there is a choice of behavior involving human values. Medical Ethics is the study of philosophical questions pertaining to the practice of medicine and health care.

Three Criteria for Judging Ethical Dilemmas:

• What are our obligations? These include our friendships, citizenship rights and rules, business obligations, professional oaths or behavior. Obligations bind us morally to honor these. Obligations may also restrict our promises or behavior.
• What are our ideals? These include our goals, and our concepts of excellence, fairness, loyalty, forgiveness, peace.
• What may be the consequences? These may be either beneficial or harmful effects that result from the action and the people involved. These can be physical, emotional, obvious or hidden.

Basic principles of Medical Ethics:
• Put the saving of life and promotion of health above all else.
• Make every effort to keep the patient as comfortable as possible and to preserve life whenever possible.
• Respect the patients' choice to die peacefully and with dignity when all options have been discussed with the patient and/or family.
• Treat all patients equally. Bias, prejudice, and discrimination have no place in health care.
• Provide for all individuals to the best of your ability.
• Maintain a competent level of skill consistent with your particular occupation.
• Stay informed and up-to-date and pursue continuing education as necessary.

Instructional Procedures

Step 1
Students should be given the fact sheet to study as a homework assignment in preparation for this lesson. To increase the likelihood that students will take this assignment seriously, consider giving a brief quiz based on the fact sheet at the beginning of the lesson.

Step 2
Students should be divided up into cooperative learning groups of three -- four students. Use the power point to present the case study or give each group a written copy of the case study to read and discuss. Then present the questions to the groups to discuss.

Step 3
The teacher should lead the entire class in a discussion of the answers recorded by the groups to each question. Remember there are not always clear right and wrong answers to ethical questions.

Step 4
If time permits, or on the second day, lead a discussion of the optional questions.

Step 5
Discussion -- Teachers report that the student complaint "That isn't fair" is becoming increasingly common. Frequently what the student means is that some personal expectation or desire is not being met. This lesson provides an excellent opportunity to get students to confront the difficulty of meeting individual needs within the constraints imposed by a society with limited resources.

As the students should learn from this lesson, the task of developing necessary policies for prioritizing the allocation of human, material or financial resources in an ethically fair manner is extremely difficult. The rub is that there are strongly held, sharp differences of opinion about what constitutes a fair policy. For example, wealthy people will generally favor a system that allows limited resources to be purchased by anyone who can afford them, whereas poor people will demand a system that distributes these resources in a manner that provides equal access to people in all economic strata.

These are issues that will become increasingly important as rapid advances in biomedical technology continues to make it feasible to devise healthcare options that can not possibly be made available to everyone. Government officials in the Oregon have already learned how divisive it can be to attempt to define a scheme for rationing healthcare. Questions like whether a kidney transplant should go first to the patient who needs it most desperately, or to the one whose life is likely to be prolonged the most, can not be answered in ways that will be agreed to by everyone. All of today's students will be choosing governmental officials who will be faced with the task of achieving a political consensus on these vital, value-laden questions.

Bibliography

Case Western Reserve University - The Online Ethics Center for Engineering & Science (A. Coppola, J. Marr, M. Marr, D. O'Hara, and J. Piropato).