Session 5: Serving the Common Good in the Context of Clinical Care

 

Click here to download the class powerpoint. 

       This session will explore the concept of the Common Good in clinical care. We begin with a case study, increased mortality and morbidity in pregnant, African American women. We then confront the moral question, “What is the Good?” Our goal is to problematize the adage that there is such a thing as the good, while also confronting the presumption that in clinical cases there is necessarily a good that should be a part of ethical medical decision making. Having identified the inherent tensions arising when thinking about the good in general versus the good of a particular person, the remainder of the session broadens outward to identify and explore additional perspectives from which we can delineate the Good in the context of clinical care. We will consider how thinking about patients’ and providers’ cultural commitments influences our understanding of the good in care, how looking at individual cases from the standpoint of public health affects our assessment of the good in care, and the ways in which “medical futility” impacts conceptualizations of the good. The discussion will especially emphasize the following topics highlighted by ASBH:

                 K05: Common barriers to “patient adherence”K10: Difficult-to-care-for patients and surrogatesK22: Potentially inappropriate                                treatment/futilityK25: Public health issues

                K27: Resources allocation
                K29: Social determinants of health
               K35: Development of health policy
               K48: Community beliefs and perspectives that bear on the health care of marginalized groups
               K56: Perspectives of those who are physically, developmentally, or behaviorally challenged and their surrogates

Recommended Readings (Click on the title below to open PDF):

  1. Martin, N., & Montagne, R. (2017). Nothing protects black women from dying in pregnancy and childbirth.ProPublica, December, 7.

  2. Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330.

  3. White, D. B., & Pope, T. (2016). Medical futility and potentially inappropriate treatment. The Oxford Handbook of Ethics at the End of Life, 65.

  4. Multiple authors (2009). Part VIII: Resource allocation. In Kuhse, H., & Singer, P. (eds.), A Companion to Bioethics, 335-372.

Supplemental Readings (Click on the title below to open PDF):


The Patient as a Person: Socio-Cultural Determinants of Health (re: K05, K29, K48, K56)


5. Villarosa, L. (2018). Why America’s black mothers and babies are in a life-or-death crisis. New York Times, 11.

6. Baylis, F., Rodgers, S., & Young, D. (2008). Ethical dilemmas in the care of pregnant women: rethinking‘‘maternal–fetal conflicts’’. The Cambridge Textbook of Bioethics, 97.

7. Geronimus, A. T. (1996). Black/white differences in the relationship of maternal age to birthweight: a population-based test of the weathering hypothesis. Social Science & Medicine, 42(4), 589-597.

8. Love, C., David, R. J., Rankin, K. M., & Collins Jr, J. W. (2010). Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women. American Journal of Epidemiology, 172(2), 127-134.

9. Bryant, A. S., Worjoloh, A., Caughey, A. B., & Washington, A. E. (2010). Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335-343.

10. Gbadegesin, S. (2009). Culture and bioethics. A Companion to Bioethics, 24-35.

11. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment

recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of

the National Academy of Sciences, 113(16), 4296-4301.

12. Johnson, K. J. and Rhodes, R. L. (2016). Ethnicity as a factor. The Oxford Handbook of Ethics at the End of Life,

65.

13. Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Washington, DC: The National Academies Press. doi: 10.17226/10260. Available at:

https://www.nap.edu/read/10260/chapter/1

“Futility” and Moral Distress (re: K10, K22, K35)

14. Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., Lo, B., Truog, R. D., Rushton, C. H., ... & Au, D. H. (2015). An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine, 191(11), 1318-1330.

15. Huffman, D. M., & Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: a systematic review. Critical Care Nursing Clinics, 24(1), 91-100.

16. Multiple authors (2018). Special Issue on Futility. M Montello (ed.), Perspectives in Biology and Medicine:https://muse.jhu.edu/issue/37924

Just Allocation of Resources and Procedural Fairness (re: K25, K27, K35)

17. Emanuel, E. J. (2000). Justice and managed care: four principles for the just allocation of health care resources. Hastings Center Report, 30(3), 8-16.

18. Kirch, D. G., & Vernon, D. J. (2009). The ethical foundation of American medicine: In search of social justice.JAMA, 301(14), 1482-1484.

19. Kluge, E. H. W. (2007). Resource allocation in healthcare: implications of models of medicine as a profession.Medscape General Medicine, 9(1), 57: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925021/

General Reference:

20. Beauchamp, T. L., & Childress, J. F. (2012). Principles of Biomedical Ethics 7th Ed. Oxford University Press, USA. (Especially Chapters 4-7 on the 4 principles.)

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Tel: 310-258-5417

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