HSS 261 DBR2

Primary Post for #1 and #2

An ethical dilemma in healthcare is one of the most daunting scenarios, and experienced healthcare professionals and doctors have to confront it almost daily. It is the situation where a healthcare professional needs to choose between morally acceptable standards and unacceptable ones. In this video, the principle of non-maleficence is well portrayed. This is an ethical principle in healthcare whereby some medical personnel has the mandate to ensure that the patient is not injured but safe. This is actualized by providing that the proper diagnosis and prescription are given to the patient to enhance the best healthcare outcomes. To justify this, in the video, the dentist, after her intense analysis and examination of the patient, recommends that the three teeth in the upper jaw of the patient be removed to relieve pain. However, she is faced with an ethical dilemma as the patient is too adamant and likes to postpone teeth removal. The lady dentist in the video, however, stands by the non-maleficence principle in healthcare. The dentist gives the best recommendation to the patient that the best way to relieve pain is to remove the three teeth as they had lost their structure. This advice is to benefit the patient and not the doctor, thus enhancing his well-being. If I were a dentist, I would have advised the patient to go as per my examinations in a kind and polite manner. Before making this decision, I would have understood the socio-economic and cultural background of the patient to make an accurate and credible diagnosis. The patient's oral health would be prioritized (American College of Dentists, 2018).

Reference

American College of Dentists. (2018, May 10). ACD ethical dilemma--patient in pain [Video]. YouTube. https://www.youtube.com/watch?v=_NlBhxLLBRw

1. Sabrina: As the video starts you see a gentleman who you believe is in a lot of pain just trying to get some sort of relief for his pain. He seeks out care from a urgent care center , patient did not get the results he wanted to hear . He was then referred to a dental emergency clinic close by and maybe they could help him a little better. As the dentist comes up with a treatment plan, she discusses it with the patient offering treatment that is best for the patient . Once again patient did not want to take the time to let the doctor take care of him , I am sure the doctor would have had given the patient a work excuse if work was the problem. He continues to make excuses of why he can not come back then proceeds to ask for a prescription narcotic that in the first place was not prescribed to him but to his wife after back surgery.

What ethical principles are involved in this case and what are the steps in the ethical decision-making process that the dentist should use to come to an ethical decision? Ethic principles involved are A). Should the doctor just give the patient what he is asking for then no longer see him? B). Tell the patient she will not prescribe the medication due that is not warranted in this situation with beliefs she may believe he will abuse the medication C). Explain that the narcotic will do nothing to fix this problem and he really needs to use the over the counter medications and come back in the morning for the extraction D). Give the patient what he asking for but only enough to get him through for a day or so until he can come back.

If you were the dentist, what do you think is the best ethical decision and why? If I were that Dentist I would like to think I would have done exactly what she did and not given him the medicine, explaining the narcotic will no help in this situation. Working in the medical field your gut normally can help you out especially when a patient ask for a medication that was not for them but another family member for a major surgery . I would also look up the history of this patient to see how many times he might have requested this medication from other providers instead of getting the problem fixed he is using the pain to get the medication he wants to help his habit. Unfortunately in the medical field people that are drug seekers tend to doctor hop when one doctor catches on to what the patient is really seeking also pharmacy hop as well. Once in awhile you will find that doctor that will just write what you ask for no questions asked.

2. Sandra B.: The ethical decision making in healthcare starts when we have to sort out the ethical principles in each certain circumstance. There will be people that react differently to pain, and in the situation with Parker Ewing he was in a lot of pain. The first Dentist told Mr. Ewing to take an over-the-counter medication so that the inflammation would go down. This was good advice for Mr. Ewing. This is called beneficence (promote good) and can be considered non-maleficence because it was (no harm). The dentist also told Mr. Ewing about Bettis Emergency Dental Clinic.

Mr. Ewing went there to see if he could get some help for his tooth pain. Dr. Topol assess Mr. Ewing’s pain and had some x-ray’s done so Dr. Topol would know more of what the problem was. When consulting with the patient on the matters at hand, the patient became upset with the way the doctor wanted to pursue matters in question (teeth to be pulled). Mr. Ewing did not want to take time off of work to fix his pain. He also insisted that he needed a prescription for his pain. This is where the dentist really needs to pay attention to the patient and his actions. The patient could just be in pain and reacting to that pain, or he could be trying to get some narcotic’s wherever he can. This is what is called a drug seeker. This is where decision making is so important. The dentist has to make the decision on weather or not to proscribe the narcotics, and make sure that it will not harm the patient. This is called (non-maleficence).

I would not give the patient the medication, because I felt he was going from one office to another trying to get narcotics. I do not want to intensify a drug problem, that being said I would check to see if he had any history of problems with drug seeking. I would also try to calm him down and see if he would make an appointment to get the three teeth extracted to make the pain subside and eventually go away.

Primary Post for #3 and #4

From an ethical standpoint, there are concerns over the overpricing of pharmaceutical products by companies aiming to make profits. While the companies need to make money to justify the investments, the overpricing of drugs is unethical, and limits access to care by patients who cannot afford the treatments. Despite claiming that the overprice is due to the financial investment into the research and development of drugs, other drugs such as nitrofurantoin have remained the same; not even cleaning the liquid contents has been done (Frank & Zeckhauser, 2018). Moreover, the policies to limit drug overpricing by pharmaceutical companies have been ineffective. New concerns are also rising regarding precision medicine discoveries such as gene therapy. By highly pricing such drugs, the companies place a monetary value on human life, which is largely unethical. Precision medicines such as Zolgensma are administered to patients with rare diseases (Forbes, 2018) and should not be overpriced as it crosses moral boundaries on the value of human life.

Despite the need to make profits, I would have personal moral conflicts regarding overpricing of drugs. If I learned that a company that I am working for was charging a price much more than it would cover development, I seek moral guidance on what to do. I believe the overall institution of the healthcare industry is to preserve human life and not place humanity in situations where life has a price.

Reference

Forbes. (2018, September). The Immorality Of Prescription Drug Pricing In America. https://www.forbes.com/sites/robertpearl/2018/09/24/nostrum/?sh=6612877b4fb1

Frank, R. G., & Zeckhauser, R. J. (2018). High-priced drugs in medicare part d: Diagnosis and potential prescription (No. w24240). National Bureau of Economic Research.

3. Shane : There are a plethora of ethical concerns that come to mind when reading these articles. On the one hand, one could almost understand the justification of these drug companies in saying that they must recuperate the high costs of research & development for their companies to survive. However, explicitly targeting illnesses to find the most treatable diseases for the least cost is highly unethical. It becomes unfair to the hundreds or even thousands of other patients who could benefit from gene therapy or other medications that have an illness deemed "unprofitable" & puts lives in the hands of these corporate decision-makers. One could argue if these same decisions would be made if the heads of these drug companies had children with untreatable illnesses or if their moral obligation to their children would then override their need for large profit margins. It is also astonishing to learn that the epinephrine within the EpiPen is a dollar & yet with the delivery device, it places the cost at $600 a pair (Mole, 2018). Unfortunately, it seems this stems far beyond the morality of the individual company so far as to say healthcare in the United States has deeply rooted & systemic issues that fosters a capitalist idealism. Here in the states, with the constant pursuit to chase the almighty dollar, capitalism has spilled over to areas of our society that should be considered fundamental human rights. Maybe it is partly because pharmaceutical development companies do not swear oaths to 'do no harm' & to practice maleficence & beneficence. To perhaps think, what is best for the patient & not the pocket. It is unconscionable to think parents may have to choose between medications or meals for their children. Furthermore, to have prices set at higher rates to different countries to maximize profits is utterly wrong. To think one could buy the same medication from another country at significantly reduced prices is heartbreaking (Pearl, 2018). It is easy to agree with Dr. Pearl that until legislation is in place to protect individuals from these drug companies, this will continue to happen. Without action against pharmaceutical companies with law, little is likely to change. With discoveries & advances in healthcare, these companies deserve to turn a profit but perhaps a cap on the percentage of markup from cost to produce, including R&D investments. Personally, it would be extremely difficult to work for a company that relies on the twisted mentality of "you cannot put a price on life," & yet they monetize precisely that for a larger paycheck.

4. Paula: I have been aware of the high cost of medications for quite some time but was still totally shocked reading the first article about Zolgensma. I feel the high pricing on some medications including this gene therapy medication is completely unethical. Of course, pharmaceutical companies should make a profit, and be able to recoup the cost of research and development but some of these companies did not even develop the medications that they have raised the pricing on to astronomical levels. The quote from the CEO of Nostrum Laboratories actually made me feel angry! As a parent, I would pay whatever price necessary of course, but think it's wrong that between pharmaceutical companies and insurance coverage some people go into lifelong debt to et needed medication for their children/family members. What about those families without insurance at all, with no hopes of paying 2.125 million for medication.

I would feel a tremendous moral conflict to work at a pharmaceutical company that I knew was charging a price that was over the costs needed for a reasonable profit. I personally have family members who can not afford insulin (developed around 1921/22) or have to take much lower doses less frequently which endangers their lives. There are not any development costs for insulin, it is the most common treatment for diabetes. I feel like that is the reason pharmaceutical companies raised the price, they know it's widely used and people need it to live, so they charge more. I read that three companies control 90% of the insulin market so they can set prices to whatever they want, and that often they are the only supplier for entire countries. A medication that I know my mother has gone without (due to the high price rise) is Epi-Pens, and she has a severe allergy to bee stings to the point I have been extremely worried about her during the summer months in fear she would be stung and not have a pen. The pen was approved by FDA in 1987, I am sure there have been improvements but still think the high cost is unethical and beyond reasonable profit levels. I honestly would not work at a pharmaceutical company because caring about people not being able to afford needed life-saving medications would be too much to bear.

T1I International. (2019, January 20). 8 reasons why insulin is so outrageously expensive. https://www.t1international.com/blog/2019/01/20/why-insulin-so-expensive/