Headlines (Friendship Never Ends)

The Spice Girls were the biggest girl band of the mid-90s, around the time I was a mere preteen going to the early teens. Whoever have not heard this name in one way or another must have come from a whole different universe. Really! They were the biggest group of popstars that everybody adores. Their music was the anthem and their dance moves were imitated in every school program I could remember back then. But after 2 explosive albums and even a movie, they disbanded. Sad but true. I think it was around 1998 that fans went in mourning the world throughout because Geri Halliwell a.k.a Ginger Spice left the group and made out for a solo career. The remaining four, Mel C (Sporty Spice), Emma Bunton (Baby Spice), Mel B (Scary Spice) and Victoria Adams-Beckham (Posh Spice) continued on with the group, although each carried on with their own solo careers later on. Music videos from both camps showed the severance from each other....who could forget Geri's video "Look at me" with a depiction of Ginger's death? And the quartet's "Goodbye" and "Let love lead the way" could only mean sending off Geri with their love.

Fast forward to nine years later, mid 2007, headlines blared that the Spice Girls are reuniting and going on a world wide tour. I could just cry. I guess my blog entry's several months late in keeping with the hot topic but hey, I always didn't have the luxury of time to blog and think of great topics to post. But I few hours ago I saw on TV their first public performance before kicking off their tour, and that was when they performed at the Victoria's Secret fashion show. I almost cried. Call me whatever but it's really like meeting an old friend whom you haven't seen in years. It's good that their back. And I guess their new song tells it all--friendship never really does end!

assignment # 9

Differentiate state paternalism from personal paternalism.

State Paternalism refers to certain actions of the state or government in which they act in a "fatherly" manner towards the citizens even without consent or even to the unwillingness of the citizen. In line with this are paternalistic legistation that are made for the benefit of the people, for their own good and even to protect them against themselves. These include the following: riding a motorcycle without a helmet, gambling, homosexual sodomy, prostitution, polygamy, making and selling pornography, selling and using marijuana, practicing certain professions without a license (law, medicine, education, massage, hair-styling), purchasing blood or organs, suicide, assisting suicide, swimming at a beach without a lifeguard, refusing to participate in a mandatory insurance or pension plan. Paternalism protects people from themselves, as if their safety were more important than their liberty. (ref: http://www.earlham.edu/~peters/writing/paternal.htm)
Soft Paternalism is a political philosophy that believes that the state can “help you make the choices you would make for yourself".

Personal Paternalism refers to your own paternalistic actions over your loved ones, like a father-figure to your younger siblings and making important decisions in behalf of them, especially if they are still underaged.

assignment # 8

What is paternalism? Why is the physician given the authority to practice paternalism? What are the situations wherein paternalism supercedes autonomy?

Paternalism refers usually to an attitude or a policy stemming from the hierarchic pattern of a family based on patriarchy, that is, there is a figurehead (the father, pater in Latin) that makes decisions on behalf of others (the "children") for their own good, even if this is contrary to their wishes. (ref: http://en.wikipedia.org/wiki/Paternalism)

The physician is given the authority to practice paternalism based on the fact that the physician really knows more about the human body and its illnesses (though not all) than the ordinary patient (as opposed to other doctors who might become your own patient). Hence, the physician can make decisions in terms of treatment modalities for the patient, though the patient can actually refuse any intervention if it violates his/her own beliefs and principles. Bottomline, the physician can make the decision for the patient for the patient's own good, especially if to save his/her life. This holds true for certain situations wherein paternalism supercedes autonomy like emergencies or minor patients whose parents or guardian are unavailable to decide, or even those who are mentally incapable of making their own decisions (ex. retarded, comatosed patients with no relatives, ignorant patients). In these cases, the physician is permitted to make decisions for them, like a father who knows better for the good of his children.

assignment # 7

Truth telling and confidentiality

Telling the truth to your patient wholly depends on whether you trust your patient to be able to handle the truth especially if his/her condition lies on the extreme end of the spectrum. While telling the truth is always preferential to lies or even half-truths, we should also take into account the condition of the patient, on whether knowing the truth is beneficial or harmful to his/her overall condition. Sometimes, we overlook the inner strength of the patient by concealing the truth in order to "spare" him/her of unnecessary pain, worry or anxiety. Still, it's all in the delivery of the information. Soften the blow, so to speak, so as not to create more tension and ill-feelings. However, if you think that the mental condition of the patient is very fragile and could hardly handle knowing the truth, as supported by their family, then supplying only half-truths to the patient may be acceptable but still, the whole truth should be given to the family members or preferentially to the elder of the family or the financial supporter.

Confidentiality, on the other hand means disclosing classified information only to those authorized to have access. This would mean that unless a person is the legal guardian of the said patient, he/she cannot access the patient's records unless with a signed consent. This holds true to any members of the family. Other doctors not part of the treatment team or hospital staff are also not permitted to obtain information about a patient record. However, if a patient information is such that it can be harmful to the general public, then in the physician's better judgment it should be disclosed but only to appropriate authorities only. Otherwise, any breech of confidentiality in the part of the physician, or other unauthorized persons should be lawfully dealt with.

ref: http://www.providence.org/everett/Patient_Resources/HIPAA.htm

assignment # 6

You have a patient whose religious belief does not allow blood transfusion. In your medical opinion the patient will die if he or she is not given a blood transfusion. What will you do?

The question is not so much as what will you do but will you do it? Afterall, as the physician, you can actually "have your way" in order to save the patient. But the patient's decision should be placed above my own because it is afterall his life in question. And also, it is stipulated in the patients' bill of rights that they can refuse medical treatment. However, the patient should be duly informed of the consequences of his decision. This is not to say that I am "washing the responsibility off my hands" but I would let the patient sign a waiver stating his refusal of the treatment and the knowledge of possible outcomes of his actions to avoid any legal implications of neglect as most malpractice suits are made of. It pains me to have a patient in my care die but if it is his decision to refuse the only life-saving intervention available, then his life is out of my hands.

assignment # 5

What is a placebo drug? Do you think giving a placebo drug is ethical or not? Explain your answer.

A placebo drug is an inactive substance used in clinical trials as a control, with which comparisons can be made to the real drug. It is used to determine if any effects are real or psychological.

Before anything else, we must acknowledge the fact that most, if not all placebo drugs are used only as control in comparison to experimental drugs, and, as the definition states, to determine psychological effects of drugs. In line with this thought, patients who are given placebo drugs are not usually informed of the nature of this substance, that they are in fact, just placebo. This is the reason why the ethical principle of the matter is questioned. Another thing, most of the patients that undergo these studies are those with terminal conditions, or those conditions with little or no known and effective cure as of yet, hence the experimental studies of the drugs, which make it all the more ethically questionable. For me, using placebo drugs are ethical in the sense that it is essential in the progress of scientific knowledge in pharmacology. In fact, it would be so difficult to determine the effectiveness of experimental drugs if there are no placebo to compare with. I understand that patients with terminal illness are desperate enough to try experimental drugs, even without assurance of cure. However, if they found out that the drug given to them was actually just placebo, this would quite understandably incur their wrath. But I think, if explained to them properly after the research, I'm sure they would see the logic of the study, and the importance of their participation. In the issue that they are in desperate need of the cure but they are not given the drug but only the control, well, I'm sure there's nothing that a very good explanation cannot resolve. That is why obtaining an informed consent at the very beginning of the study is extremely important, that the patients enrolling in the study know that there is in fact a placebo group in the research. So in the end, they cannot really accuse the research group of falsity and immorality for not giving the experimental drug. And afterall, the drug in question is experimental therefore, there really is no assurance that it will work. However, if it does work, then everybody can benefit from the results of the study.

assignment # 4

The twelve basic rights of a patient:

1) A patient has the right to considerate and respectful care.
2) A patient has the right to receive complete information from a physician about a patient's diagnosis, treatment plan, and prognosis.
3. A patient has the right to obtain information about the specific nature of a proposed treatment or procedure, a disclosure of the risks involved, and information about medical alternatives.
4. A patient has the right to refuse treatment and to be informed of the medical consequences.
5. A patient has the right to privacy during discussion of one's medical condition and while undergoing medical care.
6. A patient has the right to expect all records related to medical care will be kept confidential.
7. A patient has the right to expect that reasonable efforts will be made to respond to the patient's request for services, and that the patient will not be transferred to another medical facility without advising the patient of the need to be transferred and without ensuring that the new facility will accept transfer of the patient.
8. A patient has the right to obtain information about the relationships amongst care providers in the hospital and related medical and educational institutions. This is designed to protect patients from conflicting interests that might affect quality of care.
A patient has the right to obtain information about human experimentation and research that might affect treatment or care, and to refuse to take part in such experimentation and research.
9. A patient has the right to expect reasonable continuity of care. This is meant to assure the patient that, for example, diagnoses will be followed up with continued treatment.
10. A patient has the right to examine and receive an explanation of the hospital bill.
11. A patient has the right to be informed of hospital rules and regulations that apply to patient conduct. This statement of rights provides benefit to both patient and hospital.
12. Though the quality of resolution varies widely, most hospitals have grievance committees that will hear complaints and staff representatives that act as patient advocates when a right is called into question.

ref: http://www.faqs.org/health/topics/73/Patient-s-rights.html

assignment # 3

The basic elements of an informed consent are those required information that must be provided to the subject:

1) A statement that the study involves research, an explanation of the purposes of the research and the expected duration of the subject's participation, a description of the procedures to be followed, and identification of any products which are experimental.
2) A description of any reasonably foreseeable risks or discomforts to the subject.
3) A description of any benefits to the subject or to others which may reasonably be expected from the research.
4) A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject.
5) A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained and that notes the possibility that external regulatory agencies, such as the Food and Drug Administration, may inspect the records.
6) For research involving more than minimal risk, an explanation as to whether any compensation and/or medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained.
7) A statement that participation is voluntary, that refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and that the subject may discontinue participation at any time without penalty or loss of benefits to which the subject is otherwise entitled.

Additional elements of the informed consent should also be provided when appropriate:

1) A statement that the particular treatment or procedure may involve risks to the subject (or to the embryo or fetus, if the subject is or may become pregnant) which are currently unforeseeable.
2) Anticipated circumstances under which the subject's participation may be terminated by the investigator without regard to the subject's consent.
3) Any additional costs to the subject that may result from participation in the research.
4) The consequences of a subject's decision to withdraw from the research and procedures for orderly termination of participation by the subject.
5) A statement that significant new findings developed during the course of the research which may relate to the subject's willingness to continue participation will be provided to the subject.
6) The approximate number of subjects involved in the study.

ref: http://www.rgs.uci.edu/ora/rp/hrpp/requiredelements.htm