Respond for others posts. Health, Medicine, Nursing Essay

LIB 512 E & F: HEALTH CARE ETHICS FALL 2020
Assignment Guide
• The assignments below are in reverse chronological order by week and will be updated as we go throughout the semester, giving you a complete record of the assignments and reading guides for the course.
• Each week’s readings are designed to be read in the order listed.
• Reading Questions:
o For each reading, I’ll give you some questions (the ones listed under each reading) about what the authors actually say—these are to help guide you through the reading, and direct your attention to the particular points we’ll use for class discussions. Read these questions before you start and then follow along with them as you read! They are designed to guide and help you while you read, not to test your understanding afterward.
o You should come to the answers to the Reading Questions more or less in order, so they should also tip you off if you’ve missed something along the way.
o You do not need to write or submit answers to these questions—they are for your guidance only.
• Discussion Board Questions:
o Discussion Board questions are marked in red below. (Note that these are different from the Reading Questions, and have a different purpose—see above.)
o All assignments are due by midnight at the end of the due date, unless otherwise noted. All dates and times are given in Boston time.
o Please post on a single thread for the week, and be sure to read and respond to others’ responses that have already been posted, if any.
o Each person should respond to every question—don’t divvy them up.
o You’re not required to answer each question individually, e.g. in a numbered list—and that will usually not be the best approach. Rather, write a response in paragraph style which addresses all of the Discussion Questions (and others’ responses already posted, if any)—the questions will usually “hang together” in a way that will lend itself to this approach.
o By Friday, everyone except the Responder should post a response to the Discussion Board Questions for the week It’s OK to post your response over the weekend if your Responder for the week agrees—be sure to check! All responses (other than the Responder’s) must be posted by Sunday.
o By Monday, the Responder should, in a single response (i.e., not a separate response for each group member) and also in paragraph style:
 Assess whether the group’s responses, taken together, have responded to all of the Discussion Board questions.• Ask yourself, “Have we as a group fully addressed all of the Discussion questions?”• If not, amplify the answers given so far, or fill in any remaining gaps.• Are there any major perspectives on the Discussion questions not yet represented in the group’s responses? Synthesize your group’s responses in light of our current “Big Questions.”• Ask yourself, “How do our responses to these questions further our thinking on the current Big Questions?”• Identify and highlight major points of agreement within the group.• Identify any disagreements.• Provide your own thoughts on these points of agreement and disagreement. Identify any points on which everyone in the group appears to need further clarification in class.
Week 11
Cara Rosenbloom, “Is This the Secret to Getting Teens to Reject Junk Food?” Washington Post, 1 January 2020.• Watch the video linked and discussed in the article.• How much do food advertisers spend per year to guide our food choices?• How did the study by Christopher J. Bryan, which inspired the video, work? What values often held strongly by teenagers did the study hit, and how?
George Loewenstein, Troyen Brennan, and Kevin G. Volpp, “Asymmetic Paternalism to Improve Health Behaviors,” JAMA 2007;298:2415–8.
Since the concepts and theories we’ll be discussing in part III of the course are still emerging, there are some overlaps and inconsistencies in the terminology used to articulate them. The book Nudge by Thaler and Sunstein—an excerpt from which we read for last time—has been hugely influential. The concepts discussed in this article are similar, but the application is more healthcare-specific. What Thaler and Sunstein call “libertarian paternalism” is the same as what is called “asymmetric paternalism” here. (Since these were written, though, discussions have largely coalesced around T&S’s terms “choice architecture,” “nudging,” and “libertarian paternalism.”) Note also that Loewenstein et al.’s “rational choice perspective” refers to the basic idea we’ve discussed in class—the model of human beings on which the rationalist theories we studied in part II of the course are based.
• Individuals’ modifiable behaviors account for what proportion of deaths in the US?• What factor do the authors cite for higher rates of morbidity and mortality than could be achieved by currently available interventions?• What is the “rational choice perspective,” and what do the authors think is wrong with it?• What is behavioral economics?• How do the three decision biases that tend to produce suboptimal health outcomes—status quo or default bias, present-biased preferences, and intangibility—work?• What is asymmetric paternalism? What makes it paternalistic? What makes it asymmetric?• In what ways do the authors argue asymmetric paternalism could be used to produce better health outcomes?
Michael M. Grynbaum, “Health Panel Approves Restriction on Sale of Large Sugary Drinks,” New York Times, 13 September 2012.• What was the goal of this soda regulation in New York City?• How would it work? How did it intend to achieve its goal?
Robert F. Nease, Sharon Glave Frazee, Larry Zarin, and Steven B. Miller, “Choice Architecture Is a Better Strategy Than Engaging Patients to Spur Behavior Change,” Health Affairs 2013;32: 242–247.• What is patient engagement? How well does it work? (Hint: Note the article’s title!) Why doesn’t it work better?• What general approach do the authors recommend instead? (Should sound familiar.)• What three specific strategies have worked for the authors in changing patients’ pharmacy-related behavior, and how?
Jeffrey S. Gerber, “Improving Outpatient Antibiotic Prescribing: Another Nudge in the Right Direction,” JAMA 2016;315:558–9.
Note: Gerber describes a new study by Meeker et al. A report of an earlier study led by the same researcher (JAMA Intern Med 2014;174:425–31) began this way (I’ve underlined some key concepts and points):“Systems that depend on trusted professionals typically rely on rational models of human decision making. In health care, for example, we assume that the decisions of clinicians are based on scientific knowledge about best practices appropriately applied to each individual patient’s needs; we refer to this as the rational model of clinician decision making. However, clinician decisions often diverge from the rational model of decision making, even when practice guidelines exist and are widely accepted. An alternative model suggests that clinician decisions are influenced by psychosocial factors such as perceived demand from patients, desire to conform to behavior of peers, concern over the opinion or approval of one’s associates, and—importantly—the need to act in ways that are consistent with one’s previous public commitments. Some of these factors may contribute to overuse of medical care; others may be leveraged to reverse this tendency.”
In this earlier study, the researchers tested whether placing a poster on the wall of a clinic could lower rates of antibiotic overuse. The poster explained to patients in simple language the problem of antibiotic overuse, stated that the physician at this clinic is committed to avoiding prescribing antibiotics when they are likely to do more harm than good, and displayed the physician’s own signature at the bottom. Antibiotic prescription rates in the test group fell by 19.7% during the study period.
• How did the interventions in the new study use different “levers” to change clinicians’ actions?• How well did they work?
Excerpts from Rosamond Rhodes, “Genetic Links, Family Ties, and Social Bonds: Rights and Responsibilities in the Face of Genetic Knowledge,” Journal of Medicine and Philosophy 1998;23: sections II–VI, pp. 12–21.• Pre-reading question: Do you believe you have a right not to know genetic information about yourself? Why or why not?• What are your initial reactions to each of the four cases Rhodes presents?• Why is non-directive value-neutrality thought to be especially important in genetic counseling?• How are rights and duties related to each other?o (Remember that etymologically, “deontology” means “study of duty.”)• How is negligence law based on the ethical idea that we sometimes have a duty to know something (and hence no right not to know it)?o (While Rhodes doesn’t discuss it, note that this is obviously an important part of the ethics of healthcare! HCPs often have a duty to know.)• Key points: It’s easy to imagine (a) an autonomy-based argument that Tom, Dick, Harry, and Harriette do have a right not to know (e.g., that each of us has a right to choose what we want to know about our own genetics ourselves, as well as what we want to reveal to others), and (b) a utilitarian argument that they don’t have such a right (e.g., that they ought to participate or be tested even if they don’t want to, because doing so will maximize general wellbeing in some way). Rhodes reverses this: she argues that “respect for autonomy actually leads to the opposite conclusion” (17)—i.e., that Tom, Dick, Harry, and Harriette don’t have a right not to know. She makes two arguments for this conclusion (17–19). The first is about the necessity of having adequate information for truly autonomous decision-making and action. We’ll focus on the second, which builds on Kant’s argument about promise-keeping—but with a twist (“to make the point about genetic ignorance in a different way”).o How does this second argument work? Why does our autonomy not only give us rights but also impose obligations (i.e. duties) on us?o We now normally think of obligations we have to others primarily as limits on our autonomy (i.e., things we have to do even if we don’t want to), but Rhodes argues we have obligations to others because we are autonomous—how so?o Key question: How does Rhodes argue that my concern for my own autonomy—not a concern for my own or others’ wellbeing—implies that I ought “to support the institution of promise keeping” (19)?
On the Discussion Board:
According to my records, Responder assignments for this week (keeping the same order as initially assigned) are as follows—please let me know right away if your group’s has changed: Section E: Rita, Joshua, Riley, Zeba, TianYi Section F: Grace, Vanessa, Alison, Kania
• Consider the articles by Grynbaum, Nease et al., and Gerber. How does each represent a “patternist” (i.e., “nudge,” “choice architecture”) vs a rationalist healthcare intervention? Explain carefully how each differs from a rationalist approach.o Note that the first presents a public health intervention (i.e., one intended to improve the overall health of a population, not any specific individual), the second discusses three interventions in clinical care (i.e., directed to specific individuals), and the third presents the results of interventions designed to change healthcare providers’ own behavior (not the behavior of patients, at least not for its own sake).
Olaedo Patricia Okeibunor Patternist vs. Rationalist approachCOLLAPSEGrynbaum:A patternist philosophy is being implemented in this case. The people are not trusted to make healthy decisions on their own despite whether or not they are able to have rational thought. By limiting the amount of bad choices they are able to make, they nudge consumers towards healthier choices by supplying only the healthier choices. 
Nease et al.:The article successfully proves its point with the results of the study. While the patients are still given a choice (adhering to rationalist philosophy), they are also being influenced to pick a desirable option. The study satisfies both ethical theories.
Gerber:The article talks about nudging healthcare providers towards considering other treatment options. It states "clinicians should be required to justify every antibiotic order by documenting an indication and should be compared with and held to the standard of “top-performing” peers" (Gerber, 2). By requiring clinicians to justify their reasoning for prescription, the clinicians are being nudged towards further consideration of their orders which by extension allows them to explore other options that may be preferable if not more effective. 
Jasmine Khosla Week 11 Discussion BoardCOLLAPSEConsider the articles by Grynbaum, Nease et al., and Gerber. How does each represent a “patternist” (i.e., “nudge,” “choice architecture”) vs a rationalist healthcare intervention? Explain carefully how each differs from a rationalist approach.• Note that the first presents a public health intervention (i.e., one intended to improve the overall health of a population, not any specific individual), the second discusses three interventions in clinical care (i.e., directed to specific individuals), and the third presents the results of interventions designed to change healthcare providers’ own behavior (not the behavior of patients, at least not for its own sake).Regarding Grynbaum's article, a rationalist would suggest to inform people about how bad large and sugar-filled drinks are for your health in order to get people to stop consuming them. Grynbaum discussed how in New York City a public health intervention was a necessity because unfortunately rational thought and people's actions are not always the same. Many people get stuck in bad habits, such as drinking large sugary drinks in this case, which are extremely hard to break. By limiting cup sizes to 16oz or less this removes people's ability to make as poor choices for their health. I believe that choice architecture is being implemented here since people's choices are being limited to cup sizes that are16oz or less. Concerning the excerpts from the study "Choice Architecture Is A Better Strategy Than Engaging Patients to Spur Behavior Change" by Nease et. al rationalists would say that patients can make their own decisions about their health and how they want to manage chronic medication therapy. The results of the study showed that "opt-out" programs consistently had much high levels of patients choosing the desired behaviour. Choice architecture allows the patient to be nudged in the desired direction but ultimately they are still able to use system 2 thinking and actively choose if they would like to opt-out. In terms of Gerber's article, rationalists would say the solution is clear - get clinicians to stop prescribing so many antibiotics to patients! Gerber's argument is that by prescriber's being prompted about antibiotic resistance or being prompted to explain the why antibiotic is needed they are nudged to reconsider what the best course of treatment for the patient is. In my opinion, this also may allow clinicians to feel less pressure from patients or patient's parents to prescribe antibiotics with a warning right in front of them on a screen. Nudging them in this direction is an important first step in reducing the overuse of antibiotics and preventing further antibiotic resistance. Overall, a key point to note is that the "patternist approach" often appeals to our rationalist side. This is because individuals are more inclined to listen to advice for someone who affirms that they are a rational being who can make appropriate decisions.