Medical knowledge systems

• Philip C. Hebert's 5-step procedure for resolving ethical dilemmas:

  1. Recognize that a patient's situation raises an important ethical problem
  2. Identify the problem that needs to be solved
  3. Determine reasonable alternative courses of action
  4. Consider each option in relation to the 3 fundamental ethical principles
  5. Decide on a resolution to the problem
  6. Reflect on your decision
• Three fundamental ethical principles:

  • Respect for persons (autonomy): not treating someone as a means to an end or goal
  • Beneficence and maleficence: trying to promote positive consequences by balancing harms and benefits
  • Fairness (justice): ensuring that resources, risks, and costs are distributed equitably
• Ethical problem-solving involves recognizing the problem or issue, analyzing possible solutions, and considering:

  • What does the patient want? (Autonomy)
  • What can be done for the patient and what are the risks and benefits? (Beneficence and Maleficence)
  • Are the patient's requests fair, reasonable, and satisfied? (Justice)
• Holistic health care trend:

  • Promotes wellness by treating the whole body, mind, and spirit
  • Uses a combination of biomedical and CAM therapies for individual care
• Evidence-based decision making and diagnosis:

  • Involves the conscientious use of current best evidence in patient care
  • Based on a 5-step process: asking focused questions, finding the evidence, critical appraisal, making a decision, and evaluating performance
• Comparison between Western Medicine and Native American Medicine:

  • Western Medicine focuses on pathology and measurable outcomes
  • Native American Medicine takes a holistic view, focusing on the person and community
• Traditional Medicine:

  • Medicinal practices from indigenous groups
  • Based on cultural, spiritual, and societal beliefs
  • Forms the basis for many alternative medical treatments
• Alternative medicine:

  • Healing methods not part of conventional medical training
  • Used instead of conventional methods
  • Based on treating the whole person with a holistic view: body, mind, and spirit
  • Methods may come from or be adapted from traditional medicine
  • Examples: acupuncture, massage therapy, herbal medicine, yoga, reflexology, tai chi, meditation, etc.
  • Mostly less invasive than conventional techniques
• Complementary medicine:

  Alternative medical techniques used alongside conventional methods
• Clinical trials are conducted in four research phased:

  1. Preclinical studies: drugs are tested on non human subjects to find toxicity and efficacy
  2. Phase 1: very small, tested on 10 to 100 healthy people, establishes dosages and safety
  3. Phase 2: tested on 100-300 patients, to determine efficacy
  4. Phase 3: tested on 1000+ patients, assumed drug has an effect, now looking to understand therapeutic effect

  After phase 3, research monitors long term effects
• Types of wellness: physical, emotional, social, mental, spiritual
• Hollistic healthcare uses methods of diagnosis and treatment (CAM therapies) in addition to western (biomedical) practice. CAM therapies refers to the use of complementary alongside conventional and alternative instead of conventional.
• To recognize an ethical question:

  • Ability to detect that there are ethical issues at stake
  • Ability to distinguish an ethical question from other kinds of questions, such as legal, scientific, or personal-preference ones
• A key distinguishing feature of an ethical question is that it typically arises when individuals or groups might be harmed, disrespected, unfairly disadvantaged