Ethics - Block II
Terms
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- Sydney Callahan
- Catholic psychologist who is against what happened with D.A. Downs baby. "do parents have the right to say if the baby dies?"
- Renee Fox
- Sociologist of D.A. Downs baby. "responsibility to preserve it and to save it, there is no other right answer"
- Bill Freeman
- Pediatrician against what happened with D.A. Downs baby. "society is unwilling to help e/o in such situations"
- William Currin
- Lawyer in D.A. Downs baby case. "physicians should have fought for the baby's life even without parental consent"
- John Fletcher
- Episcopal priest, taught at UVA. "parents in D.A. Downs baby case had to make the very tough choice and their decision should be supported"
- Dr. Bartholomew
- Doctor involved in the D.A. Downs baby case who actually oversaw letting the baby die.
- Dr. Kathy Nelson
- Guest lecturer on Premature Babies and Parents' choice. Worked at Yale during Duff-Campbell era and allowed many premature babies to die.
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Hyaline Membrane Disease
(or respiratory distress syndrome) - Common cause of mortality in the first month of life for premature babies. JFK's baby died from this. No surfactant to keep alveoli open. Now easily treated with continuous positive pressure airflow.
- Mean birth weight and rate of survivors of premature babies in 1976? in 2005?
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1976- ~900g, 17%
2005- ~700g, 70% - Dr. Michael Fleenor
- Guest lecturer about Public Health. Discussed utilitarian versus Kantian ethic in medicine.
- Eye of Horus
- (Rx) Egyptian preist-physician would write this on a sheet of papyrus after invoking the god, Horus, to help cure people.
- Zero sum
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aka Opportunity Cost
Underlies basic tension between utilitarian and Kantian philosophies. - Systems Approach to Public Health
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1.Primary prevention- preventative care
2.Secondary prevention- fight progression of infections
3.Tertiary prevention- manage established disease - How much of the extended quality of life is aattributed to public health and how much of every healthcare dollar is spent on public health?
- 75% and 2-3 cents
- Dr. Delahunty
- Refused to offer an amniocentesis after a suspicous sonogram. Couple sued for wrongful birth after child was born with Downs syndrome. They won $2 million.
- Dr. George Newman
- Dr. in Baby Jane Doe Case that told the parents the child wouldn't ever recognize them, but wrote in the chart that the child could walk with braces.
- Dr. Keuskamp
- Surgeon in Baby Jane Doe case who wanted to drain the hydrocephalus right away.
- Kathleen Kerr
- Reporter who won the Pulitzer Prize for reporting the Baby Jane Doe case. Report was one sided and underinformed.
- Thomas Parham
- Against treating for syphylis because he doesn't want to make it easier for people to sin.
- Abstinence Campaign
- Paired with Muscular Christianity to repress sexual desire through sports.
- Syphilphobia Campaign
- Deliberate distortion of facts about syphilis through movies and posters. Told public that it killed quickly, disfigured bodies, destroyed minds, made you lose your friends, etc.
- Brusgaard and Beck
- discovered that syphilis was not a rapidly progressing disease; led people to question whether heavy metal treatment was best for some people.
- Highest rate of syphilis according to USPHS study?
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Macon County, AL.
approaching 1 in 3 - Jewish Rosenthal Foundation
- Started to study and treat people in severely afflicted areas (including Macon). Wanted to identify everyone in the county with the disease and treat as many as possible.
- Why were participants of the Tuskegee study vulnerable?
- Very poor, black in a racist area, tenant farmers tied to the land, poor access to healthcare. Researchers thought they were inferior, amoral, less intelligent and civilized and inherently syphilitic/tuberculitic.
- Control group of the Tuskegee study
- 200 people who did not have the disease, but were still denied other healthcare.
- Experimental group of the Tuskegee study
- 400 people who had syphilis but were not treated for it or for other medical problems while in the experiment.
- Peter Buxton
- A health student who wrote the only letter of complaint about the Tuskegee study from 1929-1972.
- Problems with the Tuskegee Study
- subject vulnerability, subjects unable to leave area or get any medical treatment for them or their children, subjects couldn't join the military, were not given treatment for syphilis, all had to get spinal taps under false pretenses
- Vertical transmission studies
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Similar to Tuskegee study:
-subjects are vulnerable
-control group being unnecesarily harmed (goes against Declaration of Helsinki- subjects should get gold standard of care) - Greg Friend
- Guest lecturer about medical ethics and schizophrenia. A schizophrenic himself.
- Adverse Selection
- taking a bad point of view of a group of people because of one bad person in that group.
- Rule of Fourths
-
.25 will be okay with meds
.25 will be able to stay at home with meds
.25 will have to live in a supervised home with meds
.25 will have to be institutionalized - the KATIE study
- study that showed a generic drug to be just as effective as another, 12 times as expensive, drug
- Wash-Out periKindling Theoryod
- removing a schizophrenic from all medications for 2-3 weeks to try another treatment option. these periods make the patients very sick and the new treatment often doesn't work and sometimes the old treatment might not work again. Greg Friend tried to kill himself during a wash-out period, and so did Greg Aller (at UCLA).
- Kindling Theory
- each time a schizophrenic has a psychotic episode, they get worse.
- Dr. William Hardin, Jr.
- Guest lecturer burn surgeon.
- allografts
- transplant between non-identical individuals of the same species
- Jennifer
- 6 year old burn victim
- Sydney
- Jennifer's identical twin who donated skin for Jennifer