Duty Of Care And Ethical Considerations

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Duty Of Care And Ethical Considerations

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Duty Of Care And Ethical Considerations

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Question:
Discuss about the Duty Of Care And Ethical Considerations.

Answer:

Laboratory examination of patients is encountered by a number of value problems. Earlier on, the function of laboratory testing was focused on identification of diseases. Today, lab testing has raised ethical conflicts. First, conflicts may be caused by diverging views on the benefits and risks of examination and the rights and obligations of all the parties involved including professionals, patients, relatives, health caregivers, and the society. The other occasion is the dilemma in values about inner convictions of life. Patients and the deceased are bounded by ethical issues of values.
Examination of patients is an in-time process where several different professionals participate. The examination process is divided into three phases namely the pre-analytic, the analytic and the post-analytic phases to effectively describe the problematic value situations. The storage of results is also an ethical issue (5).
The following sub-steps raise ethical issues.

The pre-analytic phase

The analytic phase

The post-analytic phase

–          Organizing examination.
–          Making the patient aware.
–          Ordering an examination and preparation of a patient.
–          Collection of the specimen.

–          Preparation of the sample.
–          Storage of sample.
–          Analyzing results.
–          Verification of results.

–          Reporting results.
–          Interpretation.
–          Making the patient or family or both the meaning of the results.
–          Applying results to patient care.

Ethical situations in laboratory testing mostly concern invasive examinations. The most recorded areas of value issue in the pathology lab were HIV, genetic testing, prenatal and autopsy examinations. Autopsies and genetic testing are the most problematic types of examinations. The problems of genetic examination point to confidentiality, autonomy protection, and justice. Confidentiality problem stems from mistakes in predictive values and diagnostic errors while the autonomy rises from counseling. A situation of ethics which is connected to justice entails legal justification of genomic screening. Ethical problems concerning autopsies relate to autonomy in terms of decision-making and informed consent (4).
The organizers and performers of genetic tests have the role of informing the risks and benefits of the test to the individual client, the society, and future generations. Genome projects have aroused ethical challenges, especially in commercial health insurance. Prognosis and calculation of risks pose more problems when dealing with patients who are symptom-free. HIV tests conducted on healthcare professionals and groups of people like prisoners are highly exposed to loss of autonomy and privacy. An ethical problem looms in justifying HIV testing on employees and costs of arranging the program to curb the spread of tuberculosis (2). Prenatal HIV tests are controversial at the legal, ethical, clinical, scientific, theological, economic, cultural and social points of view.
The parties involved have opinions which must be considered. Parties in the autopsy are the coroner, the relatives, the deceased, researchers, legal authorities, medical students and clinicians (3). The ethical factors to be considered in autopsy are the cost of autopsy, need for autopsy, legal requirements, benefit to research, people with brain death, integrity of the deceased, the wishes of the relatives, value of respecting the dead, cultural views, religious views, application of the ethical principles, beneficence and organ transfer. Patients who have recently died have den used to train doctors about emergency skills and this practice is being criticized by ethical, legal and religious organizations. Clear guidelines should state whether medical practitioners should practice minimally invasive trials on recently dead bodies (1).
Genetic testing requires a consent which is completely informed about the risks and benefits. A counselor should be prepared psychologically to handle any emotional distress which may be a consequence of the testing. An example of a patient with Alzheimer’s genetic disease requires counseling to overcome the fear of stigmatization and prejudice. In case of third party’s consent, the patient should be approved as such.
An example of ethical situations that RMIT lab experience is the possession of tissues of sick and even dead people got from public hospitals. The information of the respective dead and sick people is always blocked so that employees and students do not recognize the identity.
In summing up, there is no face-to-face contact for laboratory physicians and the patients. Technicians are required to act in complete interests of the sick person. Knowledge about the patient is not completely available and this will be overcome by collaboration between the patient, the physician and the clinician. Definitive decisions about events which are life-altering are acceptable at the act of faith of the patient.

References

Gilbert AL, Balio C, Bauer NS. Making the Legal and Ethical Case for Universal Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Current Problems in Pediatric and Adolescent Health Care. 2017 Sep 12.
Amirian P, Lang T, van Loggerenberg F, Thomas A, Peeling R. Big Data Analytics for Extracting Disease Surveillance Information: An Untapped Opportunity. In Big Data in Healthcare 2017 (pp. 59-83). Springer, Cham.
Colby LA, Quenee LE, Zitzow LA. Considerations for infectious disease research studies using animals. Comparative Medicine. 2017 Jun 1;67(3):222-31.
Siedner MJ, Bwana MB, Moosa MY, Paul M, Pillay S, McCluskey S, Aturinda I, Ard K, Muyindike W, Moodley P, Brijkumar J. The REVAMP trial to evaluate HIV resistance testing in sub-Saharan Africa: a case study in clinical trial design in resource-limited settings to optimize effectiveness and cost-effectiveness estimates. HIV Clinical Trials. 2017 Jul 11:1-7.
Habibi H, Nekavand M, Akrami SM. Prevention of laboratory errors in the genetic study and related ethical issues: a case report. Iranian Journal of Medical Ethics and History of Medicine. 2017 Jan 15;9(5):63-70.
Hussain S, Moiz B, Aqeel S, Zaidi N. Issues in reproductive health in females having inherited bleeding disorders in Pakistan. Haemophilia. 2017 Jul 1;23(4).

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