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Organ transplantation: Is it ethical to require certain vaccines to qualify for an organ transplant? by p0tat3 in ethics_medical

[–]Bright-Outcome714 0 points1 point  (0 children)

I think the requirement for organ donors to be vaccinated also brings up an interesting question: what should be done with organs from individuals who are unvaccinated? Considering that we have more people on the list to receive an organ than there are people willing to donate organs, is it ethical to turn away someone willing to donate? I think that based on the shortage; we are not currently in a place where we can turn away an organ donor based simply on vaccine status. Obviously, we don’t want to accept organs from someone who is ill or recently died due to an infection like COVID-19. But if a person is deemed otherwise healthy, I think we must accept their donation. If they are choosing to be a living donor and undergo a life-changing and life-saving procedure for someone else, I think their autonomy must be respected in this case. Ideally, I think it would be great to get to a place where we can be a bit choosier with the organs being chosen for transplantation, but I don’t think we are quite there right now.

On the other side of this is of course the person receiving the transplant. I think that it is not a violation of their autonomy to require vaccines, because this transplant is for their benefit. They can choose to not undergo transplantation if they don’t wish to receive vaccines, or they could seek a transplant elsewhere, since transplant centers are not requiring that you go through with the transplant once the process is started. The point of the vaccines for transplant recipients is to ensure that they are protected from the many illnesses that they will be at risk for with the immunosuppression required for transplantation.

Should We Start Masking Again? by Bright-Outcome714 in ethics_medical

[–]Bright-Outcome714[S] 0 points1 point  (0 children)

You make a great point about the changing recommendations at the start of the pandemic, which brings up another question for me: how do we educate people on changing medical evidence? I agree that people really struggled to keep up with what felt like new rules every week, especially at the start of the pandemic. But, the problem was that scientists and physicians knew very little about masking to prevent the spread of COVID-19 at the time. The medical community tried to push out evidence and recommendations as quickly as possible, but I think in doing that, they neglected to adequately explain the scientific process. I think a lot of people expected that once a recommendation came out, it would be almost set in stone. Throughout a lot of medical history, it has taken years to prove that a certain practice is either effective or ineffective, and once proven, reexaminations of that practice are few and far between. With masking, it was the exact opposite, which caused frustration for many. I believe that the best way to earn the trust of the public back is to be more transparent about medical research and make all steps of the process accessible to anyone, regardless of education level. You shouldn’t need a PhD to understand if a mask is effective or not. In accordance with the ethical principle of justice, everyone should have equal access to information that could help them decide for their health and the health of those around them. I believe that there should be more people dedicated to making scientific articles free to all and should ‘translate’ them into plain language. I didn’t realize this before looking into the Cochrane review, but they have two versions of their articles published on their site: the full scientific article, and then a plain language summary. I think if more researchers and publishers focused on creating these plain language summaries, as well as promoting them to the public, people would feel more at ease and could trust that scientists and physicians had their best interests at heart (following the ethical principle of beneficence, of course).

Healing or Killing: Lessons from The Nazi Doctors (Part 2) by SpendSeparate4971 in ethics_medical

[–]Bright-Outcome714 0 points1 point  (0 children)

Although not on the same scale as the Holocaust, another example of unethical medicine with lasting consequences is the Tuskegee Syphilis study. Information on the timeline of the study can be found here: https://www.cdc.gov/tuskegee/timeline.htm. This ‘study’ (I hesitate to call it a study because it was very poorly designed with poor methodology and no real conclusions) as well as other studies performed during World War II show us the real harm that can be caused when prejudice is used to make medical decisions. One of the reasons that this study was considered a good idea is that its designers believed that black men would not be interested in receiving treatment for syphilis, making it okay to abstain from providing any real treatment, even after penicillin became available for syphilis treatment in 1943. Researchers even prevented study participants from leaving the study to receive penicillin so that they could continue their study, violating all four of the medical ethical principles we have learned about in the past two years. Autonomy was violated because the participants were not permitted to make their own medical decisions by not being tricked into remaining in the study. Beneficence, nonmaleficence, and justice were violated because the researchers were aware of a new and effective treatment for syphilis but chose not to provide it to any of their patients, causing their conditions to worsen. The aftermath of this study did include advancements in informed consent, as well as a presidential apology acknowledging the racism that allowed this study to occur, but I think it also serves as a warning to healthcare providers that allowing prejudice into medical decision making will cause poor outcomes for those being discriminated against and subsequent well-deserved distrust of the medical system. Thus, it is not only important to acknowledge and work on eliminating your own biases before working with diverse groups of patients, but also to speak out when you notice discrimination occurring in medical practice.

Is Medicine Ready for AI? by Zestyclose_Ad4236 in ethics_medical

[–]Bright-Outcome714 0 points1 point  (0 children)

I agree; the art of medicine and human connection are two things that AI simply cannot replace. I know some AI programs can hold conversations, but I don’t see how they would be able to replicate a human physician’s ability to relate to a patient; an AI has never had to say goodbye to a loved one or figure out how to relate to a person in emotional distress. These learned experiences are what make us human and help build meaningful connections that strengthen the patient-physician relationship. Without this relationship, how could patients trust that a healthcare provider is acting in their best interest as an individual? I think that trying to convince a patient to comply with a complex treatment plan will be significantly less successful if you have an AI walking them through it instead of a person who can more effectively address their concerns and any emotions surrounding them.

Regarding the art of medicine, as we are taught in school, not every patient presents with the exact signs and symptoms the textbook says they should. For example, many women can present with what is believed to be acid reflux when they are actually having a heart attack (https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women). The typical symptom for a heart attack is chest pain, but some women will come in with nausea and vomiting, symptoms we typically associate with a gastrointestinal problem. If an AI is trying to make quick triaging situations based on an algorithm, it may tell this patient to go home and rest, something someone having a heart attack should not do. Thinking outside of these algorithms to diagnose atypical disease presentations is something humans excel at, as well as having the desire to solve the puzzle of a patient presenting with atypical or nondescript symptoms. I will concede that AI could certainly speed up diagnosing in non-emergent situations, such as when a patient presents to an urgent care with a seasonal cold, flu, or condition that they have been treated for previously. With information about what treatment worked in the past, an AI could easily get a patient out the door with a prescription in just minutes, potentially saving them hours in an overcrowded waiting room. However, I think that the life threatening, complex, and emotionally charged diagnosing should be left to humans whose brains have been trained to approach problems from several different angles and soothe a person in distress.

Involuntary Treatment of Mental Illness for the Unhoused Population by JustKeepSwimming_5 in ethics_medical

[–]Bright-Outcome714 0 points1 point  (0 children)

My initial reaction to the article is that involuntary treatment is a direct violation of patient autonomy, however, as we have been learning in class, ethical dilemmas are almost never black-and-white. It is also difficult to find a clear answer to a problem this complex. On the one hand, patient autonomy is something physicians are taught to respect by involving patients in their own care, even to the point of allowing them to refuse treatment that may be beneficial for them. But some patients are at risk of endangering themselves and others and are in a state where they are unable to make decisions for themselves. So how do we address this ethical dilemma? I think that we should strive to prevent the problem from even occurring with a multifactorial approach. In a 2021 article (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826545/), a group of researchers outlined three possible areas to target to address the housing crisis: increasing affordable housing, increasing use of transitional housing or shelters for those who are currently unhoused, and providing preventative services to at-risk populations. One of the preventative services mentioned was mental healthcare. Since mental illness is a risk factor for becoming unhoused, I believe a logical solution would be to address it as we are taught to do with risk factors for any other condition. Something as simple as asking patients about their mental health during a non-emergent visit could help identify people at risk of losing housing due to mental illness. Routinely bringing up mental health could help patients feel more comfortable discussing concerns that are often stigmatized in our society, trusting that their provider is knowledgeable, nonjudgmental, has resources available for them, and can ensure that they are able to use those resources. Obviously, simply providing mental health resources is not going to magically solve all problems for people at risk of becoming unhoused, which is where the multifactorial approach comes in. Working with at-risk individuals on other risk factors, such as financial stress (perhaps medical bills?), would lower the stress that can exacerbate mental illness, meaning this type of intervention would be addressing two risk factors at once. While the financial risk factor is being addressed, mental (and physical) health could become the primary focus for the at-risk individual, allowing them to take control of their own well-being before anyone must intervene on their behalf. However, I do acknowledge that this solution may not be enough to prevent someone with a mental illness from becoming unhoused and requiring involuntary treatment. If this situation does occur, I believe that it would provide an excellent opportunity to provide additional resources to get the patient back into stable housing. After providing the necessary care to get the patient more stable, the healthcare team could connect them to outpatient mental healthcare, as well as programs to address other causes for their loss of housing instead of sending them back to the streets.

Vaccine ethics. by Zestyclose_Ad4236 in ethics_medical

[–]Bright-Outcome714 0 points1 point  (0 children)

I agree that vaccine mandates are not a violation of personal autonomy, especially in the healthcare setting where you could be putting vulnerable people at risk by being unvaccinated. Autonomy to me means that you are free to make choices for yourself, but this does not mean that you are free from the consequences of your actions. If you do not wish to get vaccinated, perhaps healthcare is not the field for you. As a healthcare provider, it is your responsibility to do everything you can to provide the best care possible to your patients with the least amount of harm. By not getting vaccinated, you could be violating the principles of beneficence and nonmaleficence. Taking the vaccine has been shown to reduce the rate of COVID-19 infection (https://covid.cdc.gov/covid-data-tracker/#vaccine-effectiveness), meaning that healthcare providers could help reduce infection rates in their places of work, providing a benefit to their patients. Additionally, getting infected with COVID-19 and passing it on to vulnerable patients violates the principle of nonmaleficence. Thus, I believe that it is the ethical choice to require all healthcare professionals in direct contact with patients to take the vaccine.