Week 6: Now is the hour

Ethics-test

So did I achieve my goal to get a global view of ethics? I think I did I can now unequivocally say that there are no right answers anywhere in the world only different perspectives and plastic opinions which meld and change as we extend our knowledge base.

 

I can also unashamedly say I have now blogged all be it a bit to much of a personal style that I can see often confuses others with it’s lack of punctuation and a bit to much stream of consciousness.  I still find it a bit hard to believe that the course is meant to only be 3hrs a week as I still find I may get to engrossed? And was initially spending many hours reading and commenting on others ideas, although I did fine tune it to reading emails when they came in and often skimming for individual blogs that I knew would be well presented/written, entertaining and interesting (something to aspire to).

 

I still enjoy people having different points of view as to me it generates a more interesting discussion and clarifies and crystalline more than one point of view and if backed with evidence all the better.

 

 

But Still Have I Changed?

 

Not entirely I did come into the corse stating I treat each patient like my mother and I find that I still do. I may question some of the policies and politic of the system I work in but still see little I would/can do to change it. Such as when we discussed torture no being an individual exposed to extreme acts of torture I found it hard to say anything on track working on the “Not in My Back Yard” Theory and was interested by how there were some very strong opinions on it, and the consideration that small acts were not considered torture by many. It allowed me to see that perspective is key as physical scars alone to not sum up the word.

 

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There were definitely a few bloggers that were prolific and I followed Chantelle van den Berg had brilliant summaries and did assist in representing ethics in SA, Wendy presented views that I did have to think about, Jakie often covered more topics, and I did love Ellen’s mind Maps. I was just having a quick look through my emails and have 816 in my ethics folder and have read 586 of them quite surprising, I would like to think each has given me new prospective and details on how people see “big questions” internationally

 

I did enjoy this style of course as I obtained prospective I would never otherwise have considered. I do in many social media tend to be more of a voyeur than participator I think this course has required me to challenge myself and participate in a nearly anonyms manor which I think has lead to more information divulged than would be expected if paper assignments were used it also updated us getting us to use multimedia information to realise that essay after essay on the same question may be boring but with modern media can be interesting and diverse.  I would still query some of the qualities of sources (mine included) as we were always told not to use wikipedia etc as so often miss information is presented but I think by read each others boggers we are able to better evaluate ideas with or without evidence.

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I would recommend this course to others to expand their ideas and challenge their norm. I would also like to think that someone in the group may act on their ideas and if not is it an act of futility to have the knowledge the idea but no motivation to act on their convictions? As although the process of understanding others is paramont as individuals I would like to think this would also help to achieve some changes.

 

 

week 5: The big sleep

Euthanasia is still in debate in NZ with a bill for the right under consideration at the moment.

Proponents of Euthanasia seek relief from pain, suffering & depression through death rather than through medical intervention and justify Euthansaia by claiming a right to die and for economic expediency even Sonali Mukherjee’s bases her request on monetary considerations which I find difficult as it is not saying she is in pain etc just that she can’t afford her treatment.

Opponents to legalising Euthanasia generally respect the value of life regardless of circumstances (i.e. age or disability), for either medical, philosphical, religious and/or ethical reasons. They cite historical evidence that legal safeguards simply don’t work in practice and argue for increased support and availability of palliative care 

It is a difficult question as I watched my father die slowly at 62 losing quality of life and I grew up on a farm where animals in pain were down by my dad, so do we differentiate to much, giving animals more dignity than humans? I believe he was ready to go when he passed of a heart attach as the autopsy showed he had had many through his last years which had not been noticed and he had kept going, my mother whom has had 4 bouts of cancer on the other hand is not ready to go and is still surviving, hence my opinion of individual choice. I watched two interesting video’s on the euthanasia issue for cats there was even an uproar this year, Terry Pratchett of whom some of you may have read his books. He as I believe it should be the individuals informed intellectual choice as we can never assume we know what we may do in their place.

Rationally I can comprehend a place for euthanasia in a health system were our guide is quality of life, as in Terry Pratchett’s Documentary the individuals had come to the end of quality with limits to current medicine. But for many they may be looking to future developments and for them euthanasia is not an option and I would hope that it would never be forced on an individual. And again I have issues as currently we do remove babies feeding tubes if they are not thriving so we do not give them a choice it is the choice of the parent.

To me I see both side of the debate and I do agree with both sides to some extent.

So really it comes down to me. I can not say that I would ever want to be put in the position to decide for someone else but I would like to be able to make the decision for myself.

Week 4: Torture why not?

Ok i order to write this I have avoided reading other blogs first as I have seen all the headings coming through and know I will end up agreeing with others but wish to initiate some controversy first.

First I must admit I never watched “Zero Dark Thirty” and with the reviews given don’t really want to. And I do want to state first up that I don’t think torture is good and neuroloscientists in 2009 wrote Torturing the brain showing how at a neurological level torture is often ineffective this was reiterated in 2011 again by O’Mara and Pope. However we are still able and willing to inflict pain on others as shown in the Milgram Experiment in 1961 and repeated unfortunately with similar results in 2009 where even highly educated people are willing to give lethal electric shocks when told to by an authority figure.

The definition of torture as defined by Webster is “something that causes agony or pain”

My personal definition is any pain inflicted on another individual.  Unfortunately as physio’s I would argue on occasion we do torture our patients. Not a popular opinion I know but before everyone berates me for being non PC let me explain. As a training physio one of my first patients said “ow” and I couldn’t treat him and my supervisor had to take over, after the session my supervisor took me aside and told me that patients are in pain we may cause some more in treating them and if I want to be a physio I better get over it. So to me since then in my mind I associated pain eliciting test and some gating techniques (trigger pointing, dry needling) as torture even though we are seeking a positive outcome. And no I would never say what we do could be put on the same level as what was done to Steve Biko. But deep down when testing patients and I elicit an ow as a positive test requires I still internally flinch and remember the  Hippocratic Oath is “work in the best interest of your patient” and not to “do no harm” (which is an argument a lot of the euthanasia rights groups use)

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Now for the weekly questions, if not already answered:

Living in a monetary driving world we have criteria for treatment we are meant to set aside the individuals background and provide treatment to those whom will most benefit. Ideally I would get surgical procedures and the best care for all my patients but  they may not have as good an outcome and when funds are limited it is the individual who will have the best outcome that will get the funding. In someways I like this policy as it is clear cut and I don’t have to say one individual has more value than another, I just have to put them forward for review based on pathology and expected outcome.

I think I may have answered the next two questions already.

Finally do I believe in an “eye for a eye” well if you do look at where it comes from and if you wish me to quote scripture “vengeance is mine sayith the lord” so no I don’t think it is my place to inflict other peoples revenge, my place as a health professional is to work in the “best interest of my patient”. In NZ Capital punishment was completely abolished in 1989 (it had been retained for treason) and I agree with this as personally I believe to have your freedom removed in many ways a higher price though I still look at some of our penalties and think they are light compared to the crimes committed but as a society we will always be judged on how we judge others and personally I go with this is why I went in to health and not law as I want to help and not judge.

Week 3: We are all equal but some are still more equal than others

In NZ this is a difficult Q. as even when you interview for a job you are not allowed to ask about religion, sexual orientation etc but there is always a question on how would you treat a Maori.

In NZ Maori’s have a lower health level and under the treaty of waitangi they are required to have equal health levels so often are treated “better” than other ethnic groups to obtain this.

I have never been comfortable treating one group more than another and practically I find I treat all individuals on an individual basis and allow for ethnic diversity by using the same protocol for all, if one group require me not to wear shoes inside I will do this for all patients, if they require me to ask permission to touch their head I will do this for all not an individual group.

Fortunately I have never treated anyone who’s behavior in my presents has been morally repugnant, though I assume I may refer them to a senior college, as I have once when concerned for my personal safety with a patient whom I believed was not taking his antipsychotics.

I do struggle with very devout behavior only when an individual is non compliant due to belief that prayer rather than treatment will heal them, and internally I do query why the individual attends if they believe medicine isn’t helping, however I will still do my best to assist them.

Do I question my source of morality? I have always considered myself a stroppy female who has a million questions. I like people putting their opinion forward to challenge me and if their argument is sound I will adjust my point of view accordingly, in this way I would believe I may question my morality by comparison to legalities and norms.  As stated before I think many situations are dependent eg if there were a theif they should go to prison but if they steal a loaf of bread because they are starving I may say they are justified. I would say it is wrong to wipe out a living organism but would say it is ok to eradicate a virus. I would say it is wrong to lie to a fried but ok to tell them you like the gift they gave you even if you don’t.

In situations of conflict in a professional situation I find the patient is always right if they can’t be convinced. I had one patient whom believed that stretching caused  injuries, by showing him how to do his stretches correctly and integrating them into his activities at his own pace he was able to come to his own determination that they help.  In more serious situations in points of legality even when it doesn’t sit well with me I will defer to the law. In NZ acc acts as an insurance company paying for injury and there have been cases of fraudulent claims, for me I would rather charge a patient what they can afford (treat for nothing) rather than defraude acc for a claim I know is not legal.  I hate telling parkinsons patients they are not covered for falls but I feel the consequences are not worth it.  Again if it was a different law/legal system I may have a different response, but have learnt well that if I am not in or experienced the situation I do not always know what I will do.

Opening for week 2

Opening for week 2

Are morals and ethics the same thing?

Finally a chance to complete.  Having read quite a few of the posts now (being a week late) I think I may be more succinct with my views.

  1. How has your own sense of morality been informed? What continues to inform it?

As with jackiewong88 and wendywalker I believe that age and background have biased my moral view as when I was young I would be able to say yes there were definitive black and white lines of right and wrong and morals and ethics would be the same. As I have aged I have meet more people, seen more things and have established distinct grey areas where I would say that my morals may not gel with ethics and vice versa.  I have many patients that are strongly christian and have been told by them to advise locations of prayer rooms to other patients as they cured the them, to me I work with the assumption that their beliefs and my beliefs should not be forced on others. I will not advise patients I do not believe pray is curing them but I will not stop them from praying as I do not believe this is my place.

2. What is the relationship between belief and behaviour? How do our morals (what we believe is right) influence our behaviour (what we have to do)? and What is the relationship between your morality and professional practice? Can you think of any situations where your ethical treatment of a patient would be challenged by your belief system?

As Michael said this well in that ethics of your society and professional community may not influence your moral values but will probably influence your actions. As a professional I would hope that I could leave my beliefs at the door and treat each patient equally.  I believe this is not only possible but required, I had been treating a patient for a few years on and off before being advised they had a dubious history which did cause a change in my opinion of them and this concerned me. On my next session with them I was concerned I would not treat them the same however I realized that even with knowledge of their past this person needed to be treated and if I couldn’t treat them as I had as an individual in pain I would need to referrer them to another practitioner as I wouldn’t want my bias’ to effect any individuals out come. This was what we learnt as part of our training – a patient or a practitioner who feels “uncomfortable” has the right and should be referred to someone else in some ways I would say our training reinforces moral courage.

I strongly agree with Chantelle van den Berg  “beliefs and opinions are with regards to my religious, spiritual, cultural or societal upbringing and experiences, has no place in the relationship with my patients”

Am I perfect? of course I am in my own mind. No, perfection is what we strive for but as we evolve our values, morals and ethics change (new ethical codes are printed yearly for PT’s in NZ) if we were perfect there would be no change.