Health Care Ethics & Medical Law

1. Option 2: Ethics Committee Case Study

John, a 32 year-old lawyer, had worried for several years about developing Huntington’s chorea, a neurological disorder that appears in a person’s 30s or 40s, bringing rapid uncontrollable twitching and contractions and progressive, irreversible dementia. It leads to death in about 10 years. John’s mother died from this disease. Huntington’s is autosomal dominant and afflicts 50% of an affected parent’s offspring. John had indicated too many people that he would prefer to die rather than to live and die as his mother had. He was anxious, drank heavily, and had intermittent depression, for which he saw a psychiatrist. Nevertheless, he was still a productive lawyer. John first noticed facial twitching three months ago and two neurologists independently confirmed a diagnosis of Huntington’s. He explained his situation to his psychiatrist and requested help committing suicide. When the psychiatrist refused, John reassured him that he did not plan to attempt suicide any time soon. However, when he went home, John pinned a note to his shirt to explain his actions and to refuse any medical assistance that might be offered, then, ingested all of his antidepressant medication. His wife, who did not yet know about his diagnosis, found him unconscious and rushed him to the emergency room without removing the note.

� What should the care team at the emergency room do?
� Discuss this question using the following topics and analyzing how these issues are applied to the decision made by the emergency room care team. Use at least two scholarly sources to support your discussion. Your initial post should be a minimum of 250 words.
� Review of the topics within this case:

Medical Indications: There are two diagnoses/prognoses that merit consideration. The underlying chronic disease of Huntington’s has no available treatment and a bleak long term prognosis. However, there are effective treatments available for the acute diagnosis of drug overdose.

How does the chronic diagnosis affect the team�s response to the acute condition?
Patient Preferences: We know from the patient’s suicide note that he is refusing all medical treatment. However, what do we know about these statements of preference?

Were they informed?
Was the patient competent to make that decision?
?The answers to these questions remain unclear, but we do know that the patient does not have decision making capacity for the present decision of whether to proceed with the gastric emptying.

Is there a surrogate decision- maker available?
Quality of Life: Life with Huntington’s can be difficult with the onset of spasms and dementia. John was familiar with the quality of life associated with living with Huntington’s as he watched his mother die of this disease. On the other hand, John does have a supportive family and continues to be able to work for the time being.

How should the diminished quality of life that is anticipated in the future affect the current decision?
Contextual Features: Several factors in the context of this case are significant. While the patient has a legal right to refuse treatment, he is currently unconscious and his surrogate (his wife) is requesting treatment. There are also certain emergency room obligations to treat emergent conditions.
How should the emergency staff weigh the various competing legal and regulatory duties?

2. Option 2: Patient Rights-Assisted Suicide

Review the Dr. Jack Kevorkian�s �60 Minutes� Interview video. Research and discuss physician assisted suicide. Pick a side on this argument and explain why you selected that particular side using scholarly research to support your decision. Explain how this view would address the case of Dr. Kevorkian? In your post, explain whether you believe Dr. Kevorkian was a hero or a murderer? (Remember, there is no correct answer to this question�but support your opinion with research and facts). Your initial response should be at least 250 words.

3. Read the Patient Safety and Quality Improvement Act of 2005 Then, review the information on the Core Measure Sets from The Joint Commission. Pick one of the core measures from the list at the bottom of this webpage and discuss how a hospital would typically put policies and procedures into place in order to ensure that it is following your selected core measure. Utilize at least two scholarly sources, not including the textbook, that contain research regarding how your policy and/or procedure would be put into place in a hospital setting. Your initial post must be a minimum of 250 words.

4. Watch the series of videos related to the documentary movie Hot Coffee and/or watch the full-length feature film if you are able to procure it. Each of the video clips are approximately five minutes in length. Your initial post must be a minimum of 250 words and utilize at least two scholarly sources, not including the course text. Address the following as you respond:

� Explain whether you believe that our justice system promotes frivolous law suits or protects against them.
� Analyze the various elements that people should take into consideration prior to filing a lawsuit that might be perceived as �frivolous.�
Explain the ethical considerations surrounding such lawsuits in the health care arena.

5. Work through the simulation titled Resource Allocation from the end of Chapter 8 of your course text. Review the various options in the simulation, then select �Your Own Option� to type out your own solution to the scenario. You will need to copy and paste your response from �Your Own Option� into the discussion board forum as it will not be transferred otherwise. Here is a brief synopsis of the simulation regarding the hospital�s budget and dilemma:

Hospital costs in millions for one year:

� One 35-year-old cancer patient who needs significant time with the doctor, medical supplies, tests, and around the clock care. Cost: 100
� Emergency Room operations for daily care and treatment of about 100 people (~365,000/year). Cost: 100
� 2 Senior Patients who need hip replacement surgery. Cost: 50
� 10 patients (ranging in age from 18 to 45) receiving assistance in your inpatient drug/alcohol rehab unit. Cost:100
� An MRI unit that is on the fritz and could die any day. Replacement Cost: 170
� One of your two X-ray machines is inoperable and must be replaced. Cost 100
� Ambulance drive-in area was damaged and needs to be repaired. Cost: 25
� Training needs for nursing staff for certification requirements. Cost: 55

TOTAL: $700 million

For this discussion, address the following:

� You have $700 million in expenses and only $500 million to work with. How do allocate your resources?
� Who gets treated and who has to wait?
� What about your facilities?
� Determine what you plan to do and explain your reasoning as well as the ethical considerations behind your decision.

Your initial response must be at least 250 words and must use at least two scholarly sources.

6. Imagine that you are a hospital�s compliance officer, and you are charged with making a presentation to your hospital�s board of directors regarding the moral right to healthcare. Your presentation should include at least three of the elements learned throughout this course, which could include, but are not limited to: the Code of Ethics, resource allocation, Stark Law, medical malpractice, and cultural competency. For this discussion, begin by creating a PowerPoint presentation that addresses the issue of the moral right to healthcare. Then, utilize the PowerPoint and create a presentation using a screencast program. Your presentation must utilize at least two scholarly sources. Include your references within the discussion post along with the link to your screencast.

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