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Univ 4: Problems Related to Systems of Care (Weeks 7, 8 & 9; 11 Mar-31 Mar)

  • "Problems related to systems of care," e.g., ethical issues related to managed care (e.g., the difficulties faced by clinicians who serve as gatekeepers), and gag rules that prohibit clinicians from sharing information with their patients; the ethical tensions created by other systems of care, including ethical issues related to conflict of interest and obligation, referral and consultation, home care and hospice...
Read Sugarman: Part II, pp. 82-128.

Assignment - Use Forum 04 in Nurs 505A or Nurs 505B to post your primary assignment for either Option One or Two. Even though you'll be posting primarily within your discussion group, you're welcome to hop around and see what's going on in the discussions of other groups. You may contribute to another group's discussion if you're so inclined.

Discussion Groups

Nurs 505A:
Forum 04-A
Nurs 505A:
Forum 04-B
Nurs 505A:
Forum 04-C
Antonio
Chan
Dawson
Gelyana
Greco
Miner
Sanchez
Akahori
Kemp
Mealer
Mohun
Person
Rodriguez
Smith
Blaschka
Bosch
Craven
Ebuen
Fox
Peacock
Jacobs

Nurs 505B:
Forum 04-A
Nurs 505B:
Forum 04-B
Nurs 505B:
Forum 04-C
Dingel-Stewart
Halliday
Liebelt
Locke
McManus
Rogers
Wood
Ancelloti-Mendez
Cooper
Krenn
Lewis
Mangunlay
Moreno
Russell
Adams
Bondi
Doolan
Edwards
Hansra
LaCoste
Sork
Steele
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Option One:

By the end of Week 7 (13 March), find at least two articles in the current press or news on ethical "problems related to systems of care." Post an abstract/ summary of each article. If possible, post the URL for the article (many newspaper articles can now be found online; e.g., articles in the SF Chronicle can be found at http://www.sfgate.com). During Weeks 8 and 9 (18-31 March), discuss each other's articles.

  • Use Forum 04 in Nurs 505A or Nurs 505B to summarize both articles, each in a separate entry.
  • What are the ethical issues?
  • Who do they involve?
  • How are the dilemmas or issues resolved?
  • How do you see value, context, principle and perspective related to each other in the situation in each article?
  • Conclude each summary with a question for discussion.

 Google is an excellent search engine for finding newspapers and TV networks: http://www.google.com

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Option Two:

Focus on Hospice as an example of a "system of care," and see if you can identify ethical issues that are unique to it. Begin posting as early as you can in Week 7 so that the discussion can evolve throughout the three weeks of this unit.

  • See if you can find anything in the lay press (within the past year) that reports on ethical issues in Hospice...OR
  • Scope out at least two health plans and see if Hospice services are offered, or covered.
    • Who is health insurance for??? The living or the dying? Is Hospice part of "health" maintenance? What do you think are the ethical implications and consequences of offering or not offering Hospice as a covered benefit?
    • Is Hospice "ethical"? We withhold antibiotics, give morphine without checking vitals first, and maybe even intentionally overdose. In so doing, are Hospice professionals really Kavorkian-ettes? What do you think about this?
  • Talk to a clergy person and see what their perspective is, from the standpoint of the beliefs of their denomination, on these questions about Hospice...OR
  • Talk to a Hospice administrator to see how they think about these questions. Ask them what they see as the preeminent ethical issues in Hospice, and how they come to terms with them.

Finally, get in touch with your own feelings about the ethics of "not" providing care...which is one way of looking at what Hospice is. Do you stick your nose in when it's time? What do you think about the strict criteria Hospice uses to admit? What about patients in which both they and their families could clearly benefit from Hospice but they don't fit the criteria...and so the patient ends up being admitted to acute care repeatedly to get some palliative care and give caregivers a break?

 

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