Cultural, Legal, and Ethical Issues in Health Care

Paternalism and Patient Autonomy

● Something significant I learned: Something significant I learned about patient autonomy and

paternalism is the direct correlation it has with the principle of agency. Everyone is born with the

ability to act for themselves or be their own agent. When applying this to individuals' healthcare,

I also believe they have a right to choose what kind of care they receive. Often, when a parent

decides on their child's healthcare—taking away their agency—the parent thinks they are

benefiting from their child. This is false it can be very damaging to the patient and their health. It

leads to a rupture in physician-patient trust, which often causes patients to be hesitant to follow

their doctor's medical advice. In the end, taking away their autonomy and making healthcare

decisions for them can end up being damaging, even if there are good intentions.

● How my opinion has been affected: I have always believed that the principle of autonomy was

important. However, my opinion has been more affected by the negative aspects of being

autonomous. My grandma is sick and doctors and medicine make her extremely nervous.

Because of this, she frequently rejects any treatment that articles on Google have told her could

be bad. She has gone on extreme diets and avoided vital medications making her even more sick.

Her doctors have granted her autonomy which has not been beneficial for her. Although her

doctors should not practice paternalism, they do need to ensure that they are doing good and not

doing harm. This principle seems to be very situational. I do believe, however, that autonomy

needs to be preserved at all costs.

● Description of how my ability to discuss/analyze issues related to this topic has improved:

Through learning about paternalism and patient autonomy I now have a better understanding of

what my choices for my healthcare are. While I have never been in a medical situation that

challenged my autonomy, I am now prepared to advocate for myself if the circumstance of my

patient autonomy is ever tested. I know the rights I have as a patient and the rules I should follow
 as a medical professional for my future patients. I will not allow a family member or physician to

practice paternalism toward me.

Informed Consent

● Something significant I learned: I learned that informed consent is an active way that we can

practice autonomy. I used to think that informed consent consisted of just signing a paper stating

you agree with the treatment that is being offered. However, there is much more to it. A patient

can only give informed consent if they are competent to decide, receive an adequate amount of

information, understand what is explained, voluntarily accept treatment without coercion, and

personally consent to receive it. This shows that receiving the consent of a patient is a serious

matter that must be addressed with delicacy and understanding. Sometimes people reject a

treatment simply because they do not understand why it would be beneficial to them. Physicians

must take time to help their patients receive the necessary information so they can make

informed medical decisions.

● How my opinion has been affected: It shocked me to know that there are moral theories that say

in special circumstances, it is permissible to disregard informed consent. I acknowledge that if a

patient is not competent to decide on treatment, a trusted individual should do so. When the

patient is fully competent to choose, they should be given adequate information and ability to do

so. The idea of therapeutic privilege does not sit well with me. I would not want a doctor to

decide that withholding relevant information would protect me from harm. I believe that

knowledge is power and no one can make a full, voluntary decision if they don’t understand the

full scope of the situation. Therapeutic privilege is a principle that should not be practiced within

healthcare.

● Description of how my ability to discuss/analyze issues related to this topic has improved: Now

that I have learned more about the importance of informed consent, I believe I can better teach
 others they have the right to reject treatment. I did not know that patients had the right to deny

treatment, regardless of their diagnosis. I don’t think this is common knowledge, and I think it

lets patients know their rights. If someone does not want to go through a certain treatment or take

a certain medication, they do not have to. We are never trapped when it comes to our healthcare.

Human Research

● Something significant I learned: Something significant I learned is that there are regulations put

in place for clinical trials. Although the trials are not perfect, it is comforting to know that there

is some involvement to stop people from being mistreated when they participate in them.

However, something else I learned is the controversy of performing trials on people in

developing countries. The idea of providing life-saving treatment for people in developing

countries is great, however, once that treatment is developed after the trial, it is difficult to

continue providing it for those who participated. This means that after all the treatments for the

trial, when performing clinical trials in developing countries, we are just using them as a means

to an end. Something needs to change to ensure we can continue helping these people who

sacrifice themselves for science so that other sick patients can benefit from the results of the trial.

● How my opinion has been affected: Regarding human research, I agree with the view of Kantian

Ethics. Placebo groups should not be used if a working alternative exists. That would mean

actively choosing to not treat a sick patient even when a working treatment is available. That is

not permissible. I also agree that informed consent is crucial when it comes to clinical trials or

any type of research on humans. The story of Willowbrook and the Tuskegee Syphilis

experiment opened my eyes to the reality of what can happen when experimenting on humans is

done in the wrong way. For the children of Willowbrook, they were truly treated as a means to

an end. There was no cure for Hepatitis at the time, I acknowledge the need for clinical trials to

be done. However, the horrible conditions the patients were living in and making them drink
 chocolate milk contaminated with feces was completely impermissible. Additionally, with the

Tuskegee Syphilis experiment, they did not give their informed consent for this experiment. The

patients were not fully informed of what was going on, therefore, they could not give full

consent. Even after a cure was found for Syphilis, they were not treated. I believe that clinical

trials are necessary to find answers, but they must be regulated. We cannot repeat the same,

terrible mistakes of the past.

● Description of how my ability to discuss/analyze issues related to this topic has improved: My

ability to discuss and analyze issues related to human research has improved as I have learned of

the terrible human experiments that have occurred throughout history. Specifically, Willowbrook

and the Tuskegee Syphilis experiments. I now recognize and am grateful for how far we have

come as a country to better our clinical trials. For example, it is nice to know that if anyone gives

their consent to participate in a clinical trial, they can choose to stop being a part of it at any

moment. Additionally, things like the Belmont Report that focuses on respect of persons,

beneficence, and justice are great examples of the safeguards and moral principles in place. Now

that I am aware of this, I feel more comfortable participating in a clinical trial later on if it is

necessary for my health.

Euthanasia and Physician-Assisted Suicide

● Something significant I learned: The only thing I was previously aware of regarding euthanasia

was the practice of “pulling the plug” on someone who is on life support and has no chance of

recovery, which I learned is a form of passive euthanasia. I also discovered that euthanasia and

physician-assisted suicide are much more common than I realized. I was unaware that at least 10

states have legalized it.

● How my opinion has been affected: Before this class, I did not have an opinion on this issue

because I honestly did not know that it existed. I now have a firm belief that passive euthanasia,
 in special circumstances, is permissible; however, I believe that both active euthanasia and

physician-assisted suicide are wrong. A vital reason why I am against active euthanasia is

because I believe that a physician must do good for the patient and help them to live, not die. A

main reason why I am against physician-assisted suicide is that many times, people with

disabilities are known for deciding to use it because they feel that they cannot suffer any longer

in that state. By supporting that, we are telling every person within that community that their life

is too hard, and it’s okay if they are done living. If someone without a disability were to say that

to us, we would do everything we could to help them see their life is worth living. This double

standard should not exist. Rather than providing ways for individuals with disabilities to die, we

need to create a more accessible and comforting society.

● Description of how my ability to discuss/analyze issues related to this topic has improved: After

watching various documentaries about individuals who chose euthanasia or physician-assisted

suicide, I have developed a newfound compassion for those who are suffering more than they

believe they can handle. Due to this increased awareness about euthanasia and physician-assisted

suicide, I now feel more prepared to handle any situation that may arise if I have a family

member considering these options. Rather than responding with shock or anger, I can respond

with compassion and assist them in exploring alternative options, such as palliative care.

Race, Racial Bias, and Health Care

● Something significant I learned: The most significant thing I learned about this topic was that

racism does not exist solely because different races exist. We as human beings are the ones who

have created these racialized groups and have claimed one race to be inferior to another.

Additionally, I was surprised to discover that people of the same “race” are not physically and

biologically the same. People within the same race vary so drastically in their genetic makeup

that we cannot medically treat all of them the same way. This brings about an enormous issue
 when physicians practice race-based medicine. This entails treating patients by using race as a

factor in determining appropriate treatment. For black people, physicians are taught that they

have a higher pain tolerance and that they are less likely to carry the breast cancer gene.

Although this may be true among some, this leads to many black people not receiving proper

pain relieving treatment or breast cancer screenings early on. There are many other discrepancies

that people of color receive but those are the ones that stood out to me the most.

● How my opinion has been affected: This new information has greatly affected my opinion of the

healthcare system. I knew our healthcare system was not perfect. Regardless, it frustrates me to

see that the constant racism we have seen throughout history is still unfortunately practiced

today. Especially, in the exact place where we are supposed to do no harm and act in the best

interest of the patient. Medical professionals using racial biases is horrific and should never

happen.

● Description of how my ability to discuss/analyze issues related to this topic has improved: After

studying this topic, I have decided to be an example to others of never allowing someone's race

to decide the kind of treatment or respect they receive from me. I plan to become an X-ray

technician within the next few years and want every one of my patients to know that I will

provide them with the best care I can offer, no matter who they are. Serious change must occur

within our healthcare system and society, in general, to ensure that people of all races receive the

care they deserve. This kind of change must start with a shift in the individual's mindset, which

will open a dialogue for a more accepting society.

 The overall impact this class has had on me (300+ words): This class has opened my eyes to

numerous ideas and topics that I have never before considered or taken the time to understand. For

example, euthanasia and physician-assisted suicide were topics that I didn’t even know existed. I knew

that “pulling the plug” was a term that many use, but I didn’t realize the bioethical issue occurring

within the healthcare field regarding how people want to leave this world with dignity. A better

understanding of important topics like these will help me greatly later in my life when I am called to

face related challenges with my present and future family members and friends.

The world of bioethics intrigues me. There are so many differing moral theories and ideas that

one must take into consideration when dealing with difficult situations like triage or abortion. There

does not seem to be one right answer for any bioethical topic. Individually, we must choose for

ourselves based on our beliefs, experiences, and the continuous information we receive, to know what is

best for our lives and what is the most morally correct. It is interesting to note that throughout history

and into our present day, morality is constantly evolving and will continue to do so.

Before this class, I did not feel comfortable discussing topics that could bring up any sort of

“contention” or differing opinions. For example, I used to completely avoid any conversation

surrounding abortion because I didn’t know why I thought the way I did and how to appropriately

discuss it without getting defensive. Due to this class, I can better share what I believe regarding

controversial, and bioethical topics and listen to what others think, even if I don’t agree. It is important

to have an open mind and be willing to understand why others think the way they do. What I know and

believe to be true may not be correct and that’s okay.