LearnWell Dental Institute

Ethics for Dental Care: Values, Obligations, Rights

 

Course Number	LW03-4263-05010
Objectives	At the end of the Health Care Ethics course, you will be equipped to make basic ethical decisions on abortions, suicide, cloning, and patient information.
Credit Hours and Fee	3.0 CE Credit Hours with a fee of $24.00
Instructor	Rudolf Klimes, PhD (Indiana University), MPH (Johns Hopkins University), Adjunct Professor at Folsom Lake College, Folsom CA.

Welcome to this 3-contact-hour Continuing Education  course with instant online processing and certification 24/7.  Study the course below, take the 12-question multiple-choice TEST, register and pay online. If you score 75% or above, you may print your CE certificate on your printer as soon as you finish. If you have difficulty printing your certificate, click here.. You may retake the test once.

 

Abortions?

Suicide?

Cloning?

Consent?

Introduction

In many ways, health care is an art and a scientific endeavor. Professionals try to act in  ways that promotes the best health of the patient. But it is not always clear what is best for the patient. Thus at times choices have to be made that focus on what is best for the mother or what is best for the unborn child, what is best for the individual or her relatives, what medical records can be disclosed and what must be held in strictest confidentiality. These issues and many more are all ethical choices and the filed of study of health care ethics. 

Health Care Ethics is the study of moral issues that concern health care professionals in medicine, nursing, law, sociology, philosophy, and theology. It deals with health care values, obligations, rights and needs. Medical ethics in particular traces its roots to the old Greek Hippocratic Oath, which required physicians above all to "do no harm."

Self-study   Explore Bioethics Resources   Ethics in Health Care   Ethics Quick Test

One short way to define ethics is to call it the study of right and wrong.  Ethics seeks answers to questions like "Is it OK to have an abortion?"

"What is usually the right thing to do?" In our study of ethical issues, we will often present the opinions of four characters, namely Small Pinker and Small Browner, and  Big Pinker and Big Browner. Later you will learn who these characters really are. Here are their four answers. Do some sound better than others?            

"I would never have an abortion"................................................."I had four abortions. What is the big deal?"

"Sometimes it may be OK to abort"........................................... "How late can I have an abortion?"   

 It's the Choice of the Mother: Abortion; Ethics or

 It's a Life of its Own: National Right to Life

The outward manifestations of Post Abortion Syndrome can include: 

1. Self-destructive behavior - suicidal behavior - drug and alcohol abuse - eating disorders - domestic violence

2. Chronic problems with relationships - marriage and family breakdown - child neglect and abuse

3. Mental health disorders - postnatal depression - depression - anxiety attacks - compulsive disorders and other mental health problems

Abortion is listed as one of the possible precipitating causes of post-traumatic stress disorder in the Diagnostic and Statistic Manual of Mental Disorder. Many women suffering abortion trauma are not consciously aware that the abortion is the root cause of their problems. Health professionals are  not being trained to identify, treat or prevent Post Abortion Syndrome. Very few counselors or health professionals are prepared to deal with abortion trauma, and even fewer are skilled to do so. Most women seriously damaged by abortion have no access to the professional help they need.

1.2 The Voice of One who had an Abortion

Description of the Abortion Procedure: A surgical abortion is usually given up to anywhere between 7 and 24 weeks of pregnancy. You are numbed by a shot that is given in your cervix, which dulls most of the pain, but not all. Then they dilate you with a metal instrument. A tube is inserted into your vagina and a vacuum sucks the the tissues (fetus and placenta) from the uterus. There are other ways of removing the fetus. If you have been pregnant for 7 weeks or less, you may be given a medication to terminate the pregnancy.  This sometimes doesn’t work and is rarely used.  This method takes anywhere from 3 days to 3-4 weeks. Another way is induce early labor. This is usually done after 22 weeks of pregnancy.  This could take anywhere from a few minutes to several days.

After Care: Right after the abortion, the woman is observed to see if her blood pressure, heart rate, and bleeding is normal.  Before she goes home she may be given an antibiotic, and a 24 hour number to call if any problems occur.  For the rest of that same day, it is required for her to keep active.  This will reduce the chance a problems.  For the next 2-4 weeks, she cant use douche, swim, take tub baths, use tampons, or have intercourse.

Abortion Post Exam: Three weeks after the abortion, it is required that you have an exam with your abortion clinic or with your own health care provider.  This exam will usually consist of a pregnancy test and cervical check.  This is to make sure the abortion is complete and to discover and treat any problems that may have developed.

Risks: Reaction to anesthesia, excessive bleeding, infection, puncture of the uterus (rare), emotional or psychological distress, increase chance of breast cancer

Cost: The cost varies with different surgeons, clinics, how far along the pregnancy is, etc. Normally if you are between 5 and 12 weeks of pregnancy with no health problems, the cost is 400-600 dollars.

Teen Pregnancy and Abortion: Each year, one million teenagers become pregnant and 85% are unintended. Of all the teenage women who become pregnant, 35% choose to have an abortion.  In some states clinics require a legal guardian’s permission to have an abortion. But in other states it is strictly confidential.  

NOTE: It is recommended that the woman makes the decision on her own and doesn’t have any doubts at all. This is to avoid emotional distress after the abortion. Although it is normal for a woman to feel happiness, sadness, relief, anger, gratefulness, disappointment, confidence, fear, loneliness, and guilt. In most clinics counselors will talk to the women about their decision and all their options that include to terminate the pregnancy, keep the baby, or adoption.   SOURCE: http://www.sydneysabortion.8m.com/    

Fact Sheet Abortion Surveillance, 1999  

In 1999, 861,789 legal induced abortions were reported to CDC by 48 reporting areas. This total represents a 2.5 percent decrease from the 884,273 legal induced abortions reported by these same reporting areas for 1998.

The abortion ratio for 1999 is the lowest reported since 1975. The ratio was 256 legal induced abortions per 1,000 live births, compared to 264 in 1998.

For 1997 through 1999, the abortion rate was 17 per 1,000 women aged 15– 44 years.

Most abortions were obtained by white women, unmarried women, and women under 25 years of age. As in previous years, about one-fifth of women who had abortions were 19 years old or younger. Of the women who had an abortion, 41 percent were known to have had no previous live births.

For 1999, 25 areas reported a total of 6,278 medical (non-surgical) procedures. This figure reflects an increase of 28% from the 4,899 medical abortions reported by 22 reporting areas for 1998. It is not known whether the number of medical abortions reported to CDC for 1999 is representative of all reporting areas.

As in previous years, more than half (58 percent) of reported legal induced abortions were performed during the first 8 weeks of pregnancy; 88 percent were performed during the first 12 weeks of pregnancy.

"I have not asked to come into this world, and I don't have a right to make the decision when I am to leave." That is a very common opinion, and it has been prevalent throughout history among most cultures. But for some, the pain of living seems too great. Can a health care professional ever go against her vow to do no harm and help a patient to end her life?

 Assisted Suicide: The person most associated with that topic is J. Kevorkian, MD. ERGO!'s Euthanasia World Directory 

 Voluntary Suicide:  Suicide by teenagers and adults is a mental health problem addressed broadly by many hotlines and volunteer organizations. SA\VE,  Suicidology,  Suicide Prevention Triangle

Some terms from the Death with Dignity National Center:

Advance Directive - a general term that describes two kinds of legal documents, living wills and durable powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.

Aid-in-Dying - a physician's response to a request from a terminally ill, mentally competent adult for the means to hasten death at a time of the patient's own choosing. This usually takes the form of a prescription for lethal medication that the patient may obtain and self-administer. Advocates stress that aid-in-dying should occur only in the context of strict guidelines and safeguards to ensure that reversible causes of despair have been addressed, and that a request is rational, voluntary and enduring.

Comfort Care - an approach to care of the dying that emphasizes the relief of discomfort rather than cure of illness or prolongation of life. Physical, social and emotional needs are the first priority, even when treatment such as high dose pain medication may have the effect of hastening death. Also called palliative care. Considered legal and ethical in all jurisdictions.

Death with Dignity - A death that is consistent with an individual's personal values and sense of integrity. This may vary considerably between individuals and clinical circumstances. What is tolerable and meaningful for one individual may be unacceptable to another.

Do-Not-Resuscitate Order (DNR) - also called a "no code," a DNR is usually placed on a patient's medical chart to indicate there should be no attempt to restart a failed heartbeat or apply cardiopulmonary resuscitation (CPR) to restore normal breathing. A DNR order can be changed and experts say it should be reviewed regularly. In a DNR situation, a patient is still provided comfort care. Without such an order, emergency medical technicians are legally required to perform CPR.

Double Effect - a doctrine established by St. Thomas Aquinas in the 13th Century that an action having two effects: a good one that is intended, and a bad one that is foreseen. The action is acceptable if the actor intends only the good effect. The doctrine is often applied to the use of high doses of morphine and to terminal sedation, in which the action is intended to relieve suffering but the predictable effect is to cause death. Sometimes called indirect euthanasia, this practice is considered ethical and legal.

Durable Power of Attorney -a document naming a person to make medical decisions in the event that the individual becomes unable to make those decisions himself or herself. Also called health care proxy.

Hospice - an organization offering comfort care for the dying when medical treatment is no longer expected to cure the disease or prolong life. The term may also apply to an insurance benefit that pays the costs of comfort care (usually at home) for patients with a prognosis of six months or less to live.

Life-Sustaining Treatment - any treatment that, if discontinued, would result in death. This includes technological interventions such as dialysis and ventilators, and also simple treatments such as feeding tubes and antibiotics.

Patient Self-Determination Act - a 1991 federal law requiring health care facilities that receive Medicare and Medicaid funds to inform patients of their right to execute advance directives concerning their end-of-life care.

Terminal Sedation - a coma-like state induced when symptoms such as pain, nausea, breathlessness or delirium cannot be controlled while keeping the patient conscious. Patients die after a number of days of the secondary effects of sedation, such as dehydration or pneumonia.

Withholding or Withdrawing - to omit or cease life sustaining treatment, such as a ventilator, feeding tube, or medication that, if used, would prolong the patient's life. Sometimes done upon patient request, but also in accordance with an advance directive or because of judgments of medical futility. Recognized as legal and ethical in every jurisdiction.

In the last few years, various forms of genetic research have yielded spectacular results. Sooner or later, someone will attempt to clone humans. Will this open the door to advance  science and produce spare human parts or send us into a bigger social mess than we can even imagine?

   Reproduction:

   Genes:  All the Virology on the WWW - Viral Vectors and Gene Therapy

The National Bioethics Advisory Commission concluded in 1997 that at this time it is morally unacceptable for anyone in the public or private sector, whether in a research or clinical setting, to attempt to create a child using somatic cell nuclear transfer cloning. The Commission reached a consensus on this point because current scientific information indicates that this technique is not safe to use in humans at this point. Indeed, the Commission believes it would violate important ethical obligations were clinicians or researchers to attempt to create a child using these particular technologies, which are likely to involve unacceptable risks to the fetus and/or potential child. Moreover, in addition to safety concerns, many other serious ethical concerns have been identified, which require much more widespread and careful public deliberation before this technology may be used.

Are there different types of cloning?

When the media report on cloning in the news, they are usually talking about only one type called reproductive cloning. There are different types of cloning however, and cloning technologies can be used for other purposes besides producing the genetic twin of another organism. A basic understanding of the different types of cloning is key to taking an informed stance on current public policy issues and making the best possible personal decisions. The following three types of cloning technologies will be discussed: (1) recombinant DNA technology or DNA cloning, (2) reproductive cloning, and (3) therapeutic cloning.

Should humans be cloned?

Physicians from the American Medical Association and scientists with the American Association for the Advancement of Science have issued formal public statements advising against human reproductive cloning. Currently, the U.S. Congress is considering the passage of legislation that could ban human cloning. See the Policy and Legislation links.

Due to the inefficiency of animal cloning (only about 1 or 2 viable offspring for every 100 experiments) and the lack of understanding about reproductive cloning, many scientists and physicians strongly believe that it would be unethical to attempt to clone humans. Not only do most attempts to clone mammals fail, about 30% of clones born alive are affected with "large offspring syndrome" and other debilitating conditions. Several cloned animals have died prematurely from infections and other complications. The same problems would be expected in human cloning. In addition, scientists do not know how cloning could impact mental development. While factors such as intellect and mood may not be as important for a cow or a mouse, they are crucial for the development of healthy humans. With so many unknowns concerning reproductive cloning, the attempt to clone humans at this time is considered potentially dangerous and ethically irresponsible.

This question does not only deal with physicians, but also with nurses and other health care professionals. Generally it is a comfort for patients to know that they can learn what is wrong with them, and that they have control about the passing on of that information. But should the health care professional  always tell the patient what is going on? And can she pass that information to others?

 Protection vs. autonomy: Physician Recommendations and Patient. 

   Patient Consent and the Human Experiment:  Medical Experiments on Human Beings  

CHICAGO (Reuters) 12-22-1999- U.S. physicians rarely fully inform their patients about the care-giving decisions affecting them, a survey of more than 1,000 doctor-patient discussions concluded on Tuesday. 

Audiotapes of 1,057 patient visits involving 59 primary care physicians and 65 general and orthopedic surgeons revealed that only 9 percent of 3,552 medical decisions made met the researchers' criteria of complete informed consent.

 

The criteria for informed decision-making was defined by researchers at the University of Washington, Seattle, as making the patient aware of his or her role in the decision, the nature of the treatment, alternative treatments, the pros and cons of the alternatives, the patient's understanding of the decision, and the patient's preferences.

 

The physicians were found to be more likely to explain to patients the nature of the planned medical intervention but were unlikely to assess the level of patients' understanding. There are quality-of-care concerns, since there is mounting evidence that inadequate patient involvement may interfere with patient acceptance of treatment and adherence with medical regimens,'' the report's author, Clarence Braddock III, wrote in the Journal of the American Medical Association. This low level of informed decision-making suggests that physicians' typical practice is out of step with ethical ideals,'' he wrote. A shortage of time, especially for primary care physicians, is part of the problem.

Consumer Control over Health Information

Patients have significant new rights to understand and control how their health information is used.

Patient education on privacy protections. Providers and health plans are required to give patients a clear written explanation of how they can use, keep, and disclose their health information.

Ensuring patient access to their medical records. Patients must be able to see and get copies of their records, and request amendments. In addition, a history of most disclosures must be made accessible to patients.

Receiving patient consent before information is released. Patient authorization to disclose information must meet specific requirements. Health care providers who see patients are required to obtain patient consent before sharing their information for treatment, payment, and health care operations purposes. In addition, specific patient consent must be sought and granted for non-routine uses and most non-health care purposes, such as releasing information to financial institutions determining mortgages and other loans or selling mailing lists to interested parties such as life insurers. Patients have the right to request restrictions on the uses and disclosures of their information.

Ensuring that consent is not coerced. Providers and health plans generally cannot condition treatment on a patient's agreement to disclose health information for non-routine uses.

Providing recourse if privacy protections are violated. People have the right to complain to a covered provider or health plan, or to the Secretary, about violations of the provisions of this rule or the policies and procedures of the covered entity.

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