07 Jul Ethics in Health Services Assignment
**Assignment will be submitted to Turnitin**
Question 1 (30 points)
This is a theoreticalcase taken from VHA Intensive Ethics Advisory Committee Training, 1998, aspresented by Arthur R. Derse MD, JD. An 87-year-old woman widowed for sixyears, who is otherwise healthy, was visiting another city and abruptly becameill. She was seen in the emergency department of the local VA and admitted tothe on-call physician. The on-call physician (who has not previously seen her)made the diagnosis of bowel obstruction arid made arrangements for a surgeon toevaluate her. The surgeon recommended surgery and obtained her consent forsurgery. The surgeon expects an uneventful recovery. She is told that she willbe on a ventilator for a short time after surgery. The patient tells thesurgeon that is OK as long as it is for a short time. She tells the surgeonthat she does not want to be dependent upon machines. She was asked uponadmission whether she had an advance directive. She replied that she has aliving will and a power of attorney for health care which names her daughter(who does not live in the area) as her health care agent. The patient undergoessurgery, which is successful in treating the underlying problem and does notshow any malignant causes, but in the recovery room she has a cardiopulmonaryarrest and is resuscitated. She is transferred to the ICU in the care of theon-call physician. The physician attempts to wean her gradually from theventilator, but this is unsuccessful. Three days later, she has regainedconsciousness but is still intubated. Though she cannot speak because of theventilator, she is able to write and asks that the tube be removed. Theattending physician tells her that she is dependent upon the ventilator and thepatient needs to remain on the ventilator until she can breathe on her own. Shewrites that she understands that she may die, but she does not want to be onmachines. Her only children — a daughter and son — – have arrived. Sherepeats her wish to them that she wants the tube removed. She writes to herdaughter that “I don’t want to die, but we all have to die sometime, and Idon’t want to have to live on a machine. I know that whatever the outcome, Godwill take care of me.” Her daughter tells the physician that her mother isadamant that she be off of machines and she respects her mother’s wishes, evenif she cannot breathe on her own. She says this is consistent with herpreviously expressed wishes and her religious beliefs. Her son tells thephysician that he disagrees with his sister — since his mother does not have aterminal condition, he can not see why she should not be forced to put up withthe ventilator until she can be weaned from it. He feels that she is beingshortsighted, and she will be thankful to have been kept on the ventilator whenshe is finally able to be weaned. Describe the criteria for giving”legal” consent. Were all elements met in this case? In other words,did the patient demonstrate decision-making capacity? Explain. (1 Page)
Question 2 (10 points)
Based on case studyabove: Is this patient requesting to be euthanized or for her physician toassist in her suicide (PAS)? In your answer describe how the two terms differ. (Approx.2 Paragrahs)
Question 3 (10 points)
A managed care group maywant to market their organization as being “the best” or “aleader” in providing certain services/ treatment. How can this type ormarketing effect quality of care and utilization of services, hence costs? (Approx.2 Paragrahs)
Question 4 (10 points)
According to Darr, MCOenrollees can be described as either light/moderate users or heavy users. Whatare some of the strategies that management uses to turn “heavy” usersinto light/ moderate users? In your personal opinion, what positives ornegatives may result? (Approx. 2 Paragrahs)
Question 5 (15 points)
Describe theconstraints/challenges that physicians experience as being service providersaffiliated with a Managed Care Organization. (Approx. 2 Paragrahs)
Question 6 (5 points)
Give a very brief”real-life” example/instance where drugs/ medical treatment/serviceswere microallocated. And give a “real-life” example ofmacroallocation. (Do not include the examples provided in the Darr text.). (Approx.1 Paragrahs)
Question 7 (15 points)
Read the case of KarenAnn Quinlan (p. 248-249). Explain why this is a case involving medicalfutility. (Include in your an answer the definition of medical futility). Darr(2011, p. 218) writes, “[the] futility theory has quantitative andqualitative aspects.” What is meant by these terms? Present arguments foreach as it relates to this case. (Approx. 2 Paragrahs)
Reference:
Darr, K. (2011). Ethics in Health Services
Management. (Fifth Edition).
Baltimore, MD: Health
Professions Press, Inc.
