The first article about was about coercion. Criticism about informed consent is a common topic in research where implications of coercion seem present. Areas where these seem present include ethics consultations, presentations given at bioethics and medical conferences, and in ethics committee meetings. This essay’s main argument was that the arguments for coercion are wrong in these instances. This speaks to authors topic of the essay in stating that the idea of coercion in medical research is not as prevalent as indicated in research ethical dilemmas and topics.
Some arguments come from the fact that potential subjects may be poor, uneducated, naive about research, and lacking alternative, nonresearch-related forms of health care. Commentators claim subjects do not have a choice but to participate and therefore equate lack of good choices with coercion. Another idea presented about medical practices is that doctors should be aware of how vulnerable patients may be to the coercive influence of unrealistic hope, especially those suffering from chronic, life-threatening disorders. It is to be noted, that coercion involves a threat that makes a certain choice irresistible.
It also identifies cases where the choices are so weighted that only one reasonable course of action remains open. Such a person is coerced when his or choices are unfavorably narrowed by someone who is trying to get them to something they would not otherwise do. Coercion in definition contain two elements that should not be intertwined. The first is that the type of choice an agent faces and the second is the actions that are intentional to others that have created that situation. It also requires that some human agency be limiting a person’s options to manipulate them.
But the most important aspect is that not just any action by a person’s choices counts as coercion. Most the ethical problems that arise in research are not true problems of coercion. Researchers standardly make offers to potential subjects, no threats of harm or of unlearned proportion. The next article speaks on the question of clinical equipoise and patient’s best interests. Clinical equipoise stipulates that a randomized control trial is only ethical when there exists a state of true uncertainty in the community of medical experts about the relative therapeutic merits of every part of the trial.
If the trial holds true to this definition, the all treatments of the trial will likely to be beneficial and all are consistent with competent medical care. Charles Fried argues that a physician could ethically enroll her patients in a random control trial if she individually was in the state of equipoise about treatments. She could not have a justified belief that one arm of the study was any better than the others so that it would leave the assignments of the treatments to chance.
Another assertion of the essay was that every part of a study should be consistent in that it offers competent care, which means that the fact that if a patient does not show immediate benefit that it does not mean he or she is being disadvantaged. This should help in alleviating some of the guilt clinical researchers experience because the treatment would be fair. Another assertion is that it is a necessary scientific feature of randomized control trials that some patientsubjects are exposed to what is later discovered to be an inferior treatment.
The concept of clinical equipoise mitigates physician’s responsibility for patients’ outcomes when those patients are assigned to the control group and when they are harmed by experimental agents. The most important concept is that clinical equipoise does more for the physician-investigator and the research enterprise than restrict the domain of acceptable scientific comparison. In the case study, about fetal abnormality in a confrontation between western medical ethics and muslin culture, there were multiple centers of conflict with the actions taken by the care provider.
During the introduction, the reader learns of the patient who is a recent immigrant from Afghanistan that is 22 weeks pregnant. She is admitted to a non-teaching hospital with severe cramping. Upon having an ultrasound, it is found that there exist brain abnormalities with her fetus. The physician discovers that the fetus is afflicted with a relatively severe encephalocele that’s size and location makes survival outside the womb extremely unlikely. The first barrier the physician encounters is that he is not very familiar with the patient and s not have truly accurate information about the history of his patient. Also, the patient speaks very little English. Hey primary language is Dari. However, her husband speaks better English than she does. Her mother is also at the hospital with them as well. Upon coming to inform the woman of her fetus’s dilemmas, the family wishes to speak with the doctor outside before allowing the mother to know. This, in regards to osteopathic practice, is not a very patient-centered practice. The patient should have first rights to information.
Being that the woman was in her thirties and was not incompetent she should have been the one making decisions about her health care. However, dealing with the fact that she was from a different culture the doctor made the right choice in respecting the family’s wishes. The next problem that they encountered was the family had a set time for their religious prayers that they had to perform and wanted the physician to wait until after to talk with them. The physician did not want to wait because he felt that he did not have time for this due to the other patients he needed to see.
As a physician, being efficient and seeing the most number of patients helps him stay on track, however in care he must not be too unconscious of patient culture which plays a significant role in the overall health. Upon finally telling the family the results, the family wishes for the doctor to withhold the information from the mother for multiple reasons of which some are faith based. These reasons, being culture relevant, make it hard on a physician to make in moment decisions.
However, the physician did make the right choice in nforming the mother against the family’s desires about her child’s abnormalities. In any situation, the patient at hand has the right to know about their medical condition or fitness of themselves and or the individuals they carry if they are mentally and cognitively in a state of sanity. These problems come from different practices of medicine in different cultures. It is ultimately the physician’s role to assist the patient with the best options that are right for them. No matter what family ideas or customs are, the patient must come first.
This makes it very hard for doctors to deal with family because the doctor first and foremost must care for the patient at hand and ensure that he or she knows what it is that they may be up against so that they may be educated on what the best medical treatment outcome for them as a patient which it then is their decision to discuss with family. In medicine, families try to do what they want which may not always be what the patient wants. Therefore, with certain types of medicine being more focused on the patient allows for better treatment of the patient.
With differing cultures and religious beliefs, it is easy for physicians to become lost in the proper treatment plan for patients. However, it is part of certain western practices of medicine that the soul, body, and mind are all intertwined. Therefore, keeping a healthy balance between all three is pertinent to the health of the patient. The physician must be able to perform his role at their doctor by treating their biological issues while being cognitive to their patient’s spiritual interests as well. These
