Chapter 9 Ethics in Health Services Management Questions

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Question Description

This is a theoretical case taken from VHA Intensive Ethics Advisory Committee Training, 1998, as presented by Arthur R. Derse MD, JD. An 87-year-old woman widowed for six years, who is otherwise healthy, was visiting another city and abruptly became ill. She was seen in the emergency department of the local VA and admitted to the 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 to evaluate her. The surgeon recommended surgery and obtained her consent for surgery. The surgeon expects an uneventful recovery. She is told that she will be on a ventilator for a short time after surgery. The patient tells the surgeon that is OK as long as it is for a short time. She tells the surgeon that she does not want to be dependent upon machines. She was asked upon admission whether she had an advance directive. She replied that she has a living 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 undergoes surgery, which is successful in treating the underlying problem and does not show any malignant causes, but in the recovery room she has a cardiopulmonary arrest and is resuscitated. She is transferred to the ICU in the care of the on-call physician. The physician attempts to wean her gradually from the ventilator, but this is unsuccessful. Three days later, she has regained consciousness but is still intubated. Though she cannot speak because of the ventilator, she is able to write and asks that the tube be removed. The attending physician tells her that she is dependent upon the ventilator and the patient needs to remain on the ventilator until she can breathe on her own. She writes that she understands that she may die, but she does not want to be on machines. Her only children -- a daughter and son -- - have arrived. She repeats her wish to them that she wants the tube removed. She writes to her daughter that "I don't want to die, but we all have to die sometime, and I don't want to have to live on a machine. I know that whatever the outcome, God will take care of me." Her daughter tells the physician that her mother is adamant that she be off of machines and she respects her mother's wishes, even if she cannot breathe on her own. She says this is consistent with her previously expressed wishes and her religious beliefs. Her son tells the physician that he disagrees with his sister -- since his mother does not have a terminal condition, he can not see why she should not be forced to put up with the ventilator until she can be weaned from it. He feels that she is being shortsighted, and she will be thankful to have been kept on the ventilator when she is finally able to be weaned.


1. 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. (Minimum of 1 page including in-text citations and references in proper APA format)

Case study above (Chapter 3)


2. Based on case study above: Is this patient requesting to be euthanized or for her physician to assist in her suicide (PAS)? In your answer describe how the two terms differ. (Minimum of 2 paragraphs including in-text citations and references in proper APA format)


3. A managed care group may want to market their organization as being "the best" or "a leader" in providing certain services/ treatment. How can this type or marketing effect quality of care and utilization of services, hence costs? (Minimum of 2 paragraphs including in-text citations and references in proper APA format)

(Chapter 12)


4. According to Darr, MCO enrollees can be described as either light/moderate users or heavy users. What are some of the strategies that management uses to turn "heavy" users into light/ moderate users? In your personal opinion, what positives or negatives may result? (Minimum of 2 paragraphs including in-text citations and references in proper APA format)

(Chapter 12)


5. Describe the constraints/challenges that physicians experience as being service providers affiliated with a Managed Care Organization. (Minimum 2 paragraphs including in-text citations and references in proper APA format)

(Chapter 12)


6. Give a very brief "real-life" example/instance where drugs/ medical treatment/services were microallocated. And give a "real-life" example of macroallocation. (Do not include the examples provided in the text.) (Minimum 1 paragraph including in-text citations and references in proper APA format)

(Chapter 13)


7. Read the case of Karen Ann Quinlan (p. 248-249). Explain why this is a case involving medical futility. (Include in your an answer the definition of medical futility). Darr (2011, p. 218) writes, "[the] futility theory has quantitative and qualitative aspects." What is meant by these terms? Present arguments for each as it relates to this case. (Minimum 2 paragraphs including in-text citations and references in proper APA format)

(Chapter 9)


8. Overall summary. What is Ethics in Health Services Management. What does it involve?



Please cite your references in proper APA format.

No plagiarism allowed!

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Tutor Answer

Kishnewt2017
School: University of Virginia

Attached.

Outline
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Running head: HOMEWORK

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Homework
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HOMEWORK

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Qn.1.
The accepted criteria for giving legal consent alludes that consent should be competent,
informed, and done in a manner that is voluntary. In this case, all the elements were present and
hence legal consent could be given. Firstly, for the patient, she was informed (Darr, 2011). That
is because she knew what the surgery entailed and what would follow after that. For her, she
wanted to have the surgery so that she could stop being dependent on the machine. After the
surgery, she was still on the machine and requested to be taken off. In her case, she knows that
there is a huge chance that she could die but wants to proceed with the decision.
Secondly, she had given her daughter the power of attorney and in this case, the daughter
was present at the hospital. Notably, the daughter did not have a problem in removing the mother
out of the machine. For the part of the son, he views this as a big mistake and alludes that the
mother was going to regret her decisions and hence she should continue being placed on the
machine. Even so, he does not affect the decision of the mother since he does not have the power
of attorney. Given the fact that the lady had left advance directives to the daughter that she be
taken off the machine, it shows that the decision was not coerced but it was voluntary.
Lastly, the lady had already created a living will which meant that the family members
had little to say about the decision. For the will, it was only open to interpretation from the
doctor. Over and above...

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