Philosophy and Ethics HS20-HC1 Analyze how Western, Indigenous, traditional, complementary and alternative approaches to health care contribute to a holistic.

Philosophy and EthicsHS20-HC1 Analyze how Western, Indigenous, traditional,

complementary and alternative approaches to health care contribute to a holistic perspective (e.g., mental, emotional, physical and spiritual) of

health.

Indicators!

• a. Identify how humanity’s beliefs about health, wellness, illness, disease, and treatment have changed over time. (STSE) • b. Discuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional, complementary,

and alternative approaches to health care within a current global context. (K, A, S, STSE) • c. Assess how health, wellness, illness, disease, and treatment (e.g., Circle of Life disharmony of body energies, being

symptom free, and healthy lifestyle choices) are addressed in Western, Indigenous, traditional, complementary, and alternative approaches to health care. (K, A, STSE)

• d. Investigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques, meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)

• e. Examine the significance of rituals, place based ceremonies, plants, and traditional herbs in Indigenous and traditional approaches to health care. (K, A, STSE)

• f. Describe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in understanding Western approaches to health care. (STSE)

• g. Provide examples of ways in which one or more of the approaches to health care might be implemented together to support the health and wellbeing of an individual. (K, A, STSE)

Western versus Alternative MedicineHow has Western medicine developed over time?

• Western medicine historically just focused on treating the illness of the patient and didn’t look at holistic health.

• Holistic health involves overall well-being of an individual physically, emotionally, mentally, and spiritually.

• Complimentary medicine is using conventional medicine (pills, surgeries, etc.) and alternative medicine (yoga, naturopath, chiropractor).

Alternative medicine has become more common in recent history (last 50 years).

Importance of TerminologyDiscuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional, complementary, and alternative approaches to health care within a current global context. (K, A, S, STSE)

• Western Medicine

• Indigenous Medicine

• Traditional Medicine

• Complementary and Alternative

Differentiating Between Forms of MedicineDiscuss the importance of and difficulties in defining terms such as Western, Indigenous, traditional, complementary, and alternative approaches to health care within a current global context. (K, A, S, STSE)

• Western Medicine - the science and practice of the diagnosis, treatment, and prevention of disease through experimental study and testing. This is typically done through medications and surgery

• Indigenous Medicine/Traditional Medicine - sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.All the ideas and practices of a particular group as it relates to well-being.

• Complementary and Alternative - the combination of the practices and methods of alternative medicine with conventional medicine.

Complimentary and Alternative Medicine (CAM)What is CAMA group of practices and products that are not part of conventional medicine

• Allopathy – conventional medicine or common and usual practice

• Complementary medicine – used with conventional medicine

• Alternative medicine – used instead of conventional medicine

• Complete the Complimentary and Alternative Medicine HandoutCorrect – hand in.

Opening Video – Medicine Men Go Wild – The Hot Zone - Bayaka• Watch the video/documentary - https://www.youtube.com/watch?v=5KVLsiLeTN8

Note: You will see an infected monkey getting cooked and chopped up. And a baby cut with a razor to try to help with an infection.

• Complete the associated question-sheet.

• Key Questions/Takeaways – What is natural selection and how is it at work?

What are the similarities and differences between Western Medicine and other forms of medicine?

Holistic

• Should have heard it in health before… what does it mean?

Holistic

• Overall balance and well-being between all of your different dimensions of health.

Physical Socioemotional Mental Spiritual

• This means… If one suffers, all can suffer

Health StudiesDescribe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in understanding Western approaches to health care. (STSE)

Clinical Based Studies• Randomized – how could you pick them randomly?

Example: Out of a hat.• Blind – the tested on do not know what the outcome should be.

Example: Taste Test (Blindfolded)• Double-Blind – the tested and the tester have no idea what will happen.• Placebo – a fake pill is given to monitor psychological effects.

Come up with a test to perform on your classmates on each of these. Not drug based, but come up with something to test in the class. Small groups – write down your plan for each.

Examples and Definitions• Randomized – completely random sample – everyone take a card from

the deck at random… whoever draws a heart is who I will test.• Blind – “information about the test is kept from the participant until

after the test.” – Here… take this pill *watches and observes what happens*.• Double-Blind – “an experiment or clinical trial in which neither the

subjects nor the researchers know which subjects are receiving the active medication, treatment, etc., and which are not: a technique for eliminating subjective bias from the test results.” –

• Placebo - a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect. Used as a control for testing new drugs. – ‘Here, take this pill to help with your headache’ *expects nothing to happen.

Clinical Based Studies – Problems and LimitationsDescribe the role of clinical based studies (e.g., randomized, blind, double-blind, and placebo) in understanding Western approaches to health care. (STSE)

Problems and possible limitations of Clinical Based Studies (Importance)• Randomized – requires some rules/details in order to pick a specific group to make results more

credible/reliable. If I was testing a hair drug on males, and in my random sample only get men with certain similar characteristics (brown hair), it can impact the reliability of the testing… What if this drug perhaps work better on men with brown hair than dark?

• Blind – still can be subject to personal bias as the tester is aware of what may be occurring in the test.

• Double-Blind – may be more expensive and time-consuming to prepare the testers and tested for the experiment. As well, when they are not informed of the intended results, it can cause concerns regarding allergy or safety regarding the well-being of participants.

• Placebo – simply measures or eliminates the possibility of a drug’s psychological effects… however, when used in combination with other steps can include data on the effectiveness of the pill as well.

Examples of Tests

• Hand in assignment – share one with class… if you are struggling just look up some examples. Collect results from one that you can test the class on.

• Be sure to look at potential problems with each of these methods.

• “Come up with a test to perform on your classmates on each of these. Not drug based, but come up with something to test in the class. Small groups – write down your plan for each.”

Phase of Clinical Research

• Clinical trials involving new drugs are commonly classified into four phases. Each phase of the drug approval process is treated as a separate clinical trial. The drug-development process will normally proceed through all four phases over many years. If the drug successfully passes through Phases I, II, and III, it will usually be approved by the national regulatory authority for use in the general population. Phase IV are 'post-approval' studies.

Phase of Clinical Research

• Pre-Clinical• Phase 0• Phase 1• Phase 2• Phase 3• Phase 4

Vocabulary

Pharmacodynamics

Pharmacokinetics

Phases of Clinical Research

• Pre-Clinical – observe on animal or cells in a test tube.• Phase 0 – humans are given the test but in amounts below what

would actually be given in order to observe results… this may also mitigate the negative effects.• Phase 1 – human-testing – testing safety, pharmacokinetics (what a body

does to a drug), pharmacodynamics (what a drug does to the body), and how food absorption affects this.• Phase 2 – usually when a new drug fails – this is when it is observed if

the drug actually works - how much should be given and how well it works at those doses.

• Phase 3 - the most expensive, time-consuming and difficult trials to design and run – Can involve up to 3000 people and different institutions done randomly. “Pre-marketing phase” – actually given to consumers and data is collected.

• Phase IV (4) – Post-marketing surveillance. Constant monitoring of the drug, if problems appear, drug production will be ceased.

Phases of Clinical Research

How long does it take?

• Approximately 12 to 18 years (but not always), often costing over $1 billion• Some can get fast-tracked – Phase 0 helps with this.

Importance – It is important to understand the extended length of time it takes for a drug that may be very beneficial for individuals to actually make it through testing and into normal/regular consumer use.

Quiz Friday

Matching (match term to definition) -

What are the six phases of clinical testing?

What are the four different ways of clinical based tests?

What does pharmacokinetic and pharmacodynamic mean?

Cultural Beliefs

• Jigsaw – go into groups of 3… there are six different types of ideologies as they pertain to medicine included on the large page I gave you. Each of you select two to read about and teach to others…

• Something I found interesting was…• Something I did/didn’t agree with was…

• Highlight or determine a simply way to categorize their worldview on medicine… save this.

Overall Worldviews of GroupsGroup Belief

Natural Products – Intended UseInvestigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques, meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)

What are the intended results of…• Herbs• Vitamins• Minerals• Probiotics• Essential Oils

Mind and Body Practices – Intended UseInvestigate the intended results of using natural products (e.g., herbs, vitamins, minerals, probiotics, and essential oils) and mind and body practices (e.g., acupuncture, various massage therapies, yoga, spinal manipulation, relaxation techniques, meditation, and movement therapies) and other complementary and/or alternative approaches to health care. (K, A, STSE)What are the intended results of…• Acupuncture• Massage Therapy• Yoga• Spinal Manipulation• Relaxation Techniques • Meditating• Movement Therapies

Philosophy and EthicsHS20-HC2 Examine how personal and societal beliefs impact ethical

decisions regarding health care.

Indicators• a. Pose questions about ethical dilemmas within health care. (K, S, A, STSE) • b. Understand the core ethical questions to be considered when making health care decisions: What can be done for the patient? (intervention technologies) Does the patient understand the options? (informed consent) What does the patient want? (autonomy) What are the benefits? (beneficence) Will it harm the patient? (non-maleficence) Are the patient’s requests fair and able to be satisfied? (justice) Are the costs involved fair to society? (economic consequences) (K) • c. Analyze a health care issue (e.g., case study, interview and current events) with respect to the core ethical questions. (K,A, S, STSE) • d. Contrast how procedures to prevent illness, such as immunizations, vitamin supplements, physical activity, nutrition and prayer, might be viewed

from the perspective of Western, Indigenous, traditional, complementary, and alternative approaches to health care. (K, A) • e. Examine ethical considerations related to various treatments (e.g., chemotherapy, radiation, acupuncture, sweat lodge, blood transfusions, and

hirudotherapy) that might be prescribed in Western, Indigenous, traditional, complementary, and alternative approaches to health care. • f. Examine individual, community and cultural beliefs regarding issues related to life and death such as home birthing, blood transfusions,

contraception, abortions, organ donation, autopsies, euthanasia, cremation and burials. (K, A, STSE)• g. Discuss ethical considerations and perspectives related to issues such as the use of cadavers in professional studies, dissection and raising animals

for the purpose of dissection, and public exhibits of plastinated organs and bodies, all of which could provide increased scientific understanding of human anatomy. (A, STSE)

• h. Understand a patient’s rights in Saskatchewan and in Canada with regards to health care decisions such as developing an advance care directive, refusal of treatment, informed consent, and the role of a proxy or substitute decision-maker. (K)

• i. Discuss ethical considerations (e.g., personal beliefs, informed consent, the roles of institutional review boards and regulatory agencies) of why an individual may choose to participate in a clinical study of a new biomedical intervention (e.g., vaccine, drug, treatment, device, or process). (STSE)

• j. Debate a decision related to ethics in health care from the viewpoint of individuals who hold different belief systems. (K, A, S, STSE)

Core Ethical Questions

• Autonomy – ability to think freely for the patient• Beneficience - what is best for the patient• Non-maleficense – do not harm.

• Justice – are measures taken within reason?

Making Health Care Decisions

• a. What can be done for the patient? (intervention technologies) • b. Does the patient understand the options? (informed consent) • c. What does the patient want? (autonomy) • d. What are the benefits? (beneficence) • e. Will it harm the patient? (non-maleficence) • f. Are the patient’s requests fair and able to be satisfied? (justice) • g. Are the costs involved fair to society? (economic consequences)

Rights of an SK IndividualUnderstand a patient’s rights in Saskatchewan and in Canada with regards to health care decisions such as developing an advance care directive, refusal of treatment, informed consent, and the role of a proxy or substitute decision-maker.

• Advance Care Directive - is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.

• Refusal of Treatment – individuals have the right to refuse treatment when they are able to make a decision to do so.

• Role of a proxy or substitute decision-maker• Informed Consent - a process for getting permission before conducting a

healthcare intervention on a person. Ex. Massage Therapy, sign here.

• There is an associated activity for each of the following

Role of Substitute Decision-Maker (SDM)

• http://www.hss.gov.yk.ca/pdf/substitute_dm_brochure.pdf • How is it chosen?

Guardian Proxy (Advance Directive) Spouse Child Parent Grandparent Brother or Sister Other relative close friend last resort – care providers

• Who can be one?

Over 19 years of age… unless they are spouse or parent.Contact in last 12 months and;No court orders or conflicts preventing this.

Things to be aware of in this role…• The person’s current wishes;• Whether the person’s condition or well-being is likely to improve, worsen or stay the same if the person receives the care;• Whether the person’s condition or well-being is likely to improve, worsen or stay the same if the person does not receive the care;• Whether the benefits of the care will outweigh the risks or negative consequences;

• Whether a less restrictive or less intrusive form of available care would have greater benefits or less negative consequences;

SDM - Duties and Decisions to Make

Duties• Consult with the person to the extent reasonable, given their condition;

• Consult with any friend or relative who asks to assist if the substitute decision-maker does not know the person’s values or wishes;

• Follow the wishes expressed by the person when they were still capable and after they turned 16 years of age unless: • It is impossible to follow the wish; OR • The substitute decision-maker believes that because of changes in knowledge, technology or practice, the person would no longer act on the wish;

• Use the person’s wish as guidance where it does not clearly anticipate the specific circumstances that exist;

• Make a decision based on the person’s values and beliefs if the substitute decisionmaker does not know the person’s wishes;

• Make a decision based on what is in the person’s best interests if the substitute decision-maker does not know the person’s values and beliefs or wishes;

Decisions to make…• Health care (e.g. medical treatment, dental care, diagnostic procedures)• Admission to a care facility (e.g. nursing home, group home for adults with cognitive disabilities)• Personal assistance services (e.g. home care, personal care in a care facility)

SDM - Importance and Takeaways

• Select someone to represent you who really knows you and your wants OR select someone whose opinion you trust even if you sometimes don’t agree with it.

• Ultimately they are making decisions for you when you are incapable to do so… this includes “pulling the plug”.

SDM – Who would you actually pick?

• I would pick my father. He is the most similar to me in terms of life-outlook (science-focused) and has similar beliefs about death.

• Donate organs… anything to science. Plant tree from remains.• If there’s legitimate hope (>1%) for even just my brain to recover, give it a short amount of time

(<month) until it becomes a financial burden on others – if I have kids, ensure their needs are met first and foremost and financial needs for my health do not jeopardize their futures.

• Reinact Weekend at Bernies.

• No funeral needed. Have a party or something! I think once I’m dead I’m dead so regardless of what you do it don’t matter… if chosen to cremate, spread my ashes somewhere near the Base on the prairies or on the hockey arena.

• Avoid religion if memorial-based, but offer services to those who are.

Role Play

• Pick someone in our class to be your SDM. Talk with them for 2 minutes about each of your health desires should anything bad happen to you.• You will read the story on the next slide, they will decide your future

and write it down including their rationale.• They will then share it with you and we will see if they did what you

would have wished.

Story

• They were in a car accident. Severe damage to the body. Permanent paralysis from the waist down, waste-above will work. Possible sight-loss but no apparent damage to vocal cords and no apparent brain damage. However, they have been in a coma for the past month. Life support has helped. Doctors say that IF they come out of a coma naturally in the next 2 months they would retain brain function… or they could induce you try to come out of a coma immediately with a 50% success/mortality rate. Decision?

Keep in mind what you think the wishes of this person are.

Informed Consent

• Be sure to grab the hand out!

Informed Consent to Treatment• Throughout Canada, before health care professionals may treat a client,

he or she requires the informed consent of the client. The health care professional must determine whether the person is capable of giving consent to treatment.

• The individual’s capacity to give consent can change. One day they may be capable, the next, incapable. If a person becomes incapable (unable to understand the nature of an intervention), the issue of consent must be readdressed.

• Consent MUST be both Informed and Voluntary.

Informed Consent• Informed Consent is based on the patient understanding:• 1) the treatment or procedure• 2) the nature and purpose of the proposed treatment• 3) risks, side effects, benefits and expected outcomes• 4) implications of refusing recommended treatment• 5) be made of alternatives (if any) to the proposed treatment so they

understand their choices• *Health care professionals have an obligation to use language that is at an

appropriate level and to discuss the information when the client is not stressed or unhappy (may require second explanations of the intervention when the client is in a calm frame of mind)

Voluntary Consent:

• Clients must NOT feel compelled to make a decision for fear of criticism, nor must they feel pressured toward any particular decision by the information provider or anyone else.

*At times only a fine line exists between coercing (i.e., bullying) and making a recommendation especially when the health care professional feels strongly that the client should consent to a treatment, and the client is leaning toward refusing it.

• *According to the Supreme Court of Canada, it is the basic right of every capable person to decide which medical interventions he or she will accept or refuse. It shows respect for the client and the person’s right to autonomy; it also improves client compliance with treatment regimes.

• *Every province has its own legislation regarding informed consent. Health care providers are encouraged to obtain written consent for all medical services even minor medical services like immunizations.

Types of Consent:• Written Consent:• Major medical interventions require signed, written consent as confirmation that the

appropriate process for obtaining consent was followed and that the client has agreed to the intervention.

• Client must understand the intervention along with the risks and benefits• Most forms must be signed by the client, dated and witnessed (the definition of a witness

varies in different areas)• For minor or major surgeries, physicians or a registered nurse will usually witness the consent• The witness must be sure the client understands what they are signing. If there is doubt, there

must be further explanation and clarification.• Most hospitals have a list of volunteer interpreters should the need arise, but interpreters who

can deliver health-related information clearly and accurately are not always available. Often family members translate and what is presumed to be “informed consent” may not be.

Types of Consent:

• Oral Consent:

• Given by spoken word over the phone or in person and is as equally binding as written consent• At times, someone other than the client offers consent to surgery• Two people must validate that consent has been given• Written consent is still preferred for complex treatments

Types of Consent:• Implied Consent:• Consent assumed by the client’s actions, such as seeking out the care of a health

care professional or failure to resist or protest. • More and more health care professionals are requesting written consent even for

treatments within a health clinic (e.g., receiving immunizations at the clinic).

• By allowing themselves to be admitted into a hospital, clients imply their consent to certain interventions (e.g., allowing the nurse to give them a bath or take vital signs). However, where possible oral consent should be obtained. “Is it okay if I change your dressing in a little while?” *Refusal to treatment are recorded on health records with reasons for refusal provided by the client*

Who Can Give Consent• The person receiving medical care most often gives consent for treatment

• If the person is incapable of providing consent (e.g., is unconscious or not mentally competent), the person’s legal representative or next of kin assumes the responsibility.

• The person who has power of attorney (A legal document naming a specific person or persons to act on behalf of another in matters concerning personal care, personal estate or both) may take on this duty.

• If no power of attorney is present, most provinces and territories will allow a spouse (legal or common law) or another family member to legally provide consent. In some locations, there is a designated order depending on the availability of particular relatives – typically, a spouse will have control before a mother and father who have control before a sibling, then aunts and uncles and so on.

• In most regions, there is no specific age defining a minor (a person under the age of majority in a particular province or territory) when it comes to providing independent consent to treatment or to requesting treatment without a parent’s knowledge.

• As long as the minor fully understands the treatment (along with risks and benefits), he or she can make an informed decision about accepting or rejecting treatment, and health care professionals MUST respect his or her wishes.

• When a minor’s consent is accepted, the minor is referred to as a mature minor. Frequently, a minor’s consent to treatment is made along with the parents.

• Emancipated minors – those married, living on their own, or showing independence from parents in some way – may also consent to medical care.

• When required, either parent with legal custody of the minor (or legally appointed guardian) can provide consent to treatment.

• **In the view of the courts, if the children are too young to hold and express beliefs or understand the consequences of receiving or not receiving treatment, courts will uphold requests made to intervene on the child’s behalf.

Case Study/Current Events – how does it relate?Analyze a health care issue (e.g., case study, interview and current events) with respect to the core ethical questions. (K,A, S, STSE)

• Case Study Assignments

Ethical DilemmasPose questions about ethical dilemmas within health care. (K, S, A, STSE)

Your thoughts on these treatments…immunizations, vitamin supplements, physical activity, nutrition and prayer

• What does the evidence support? Western?

• How might these contrast with other beliefs and perspectives?

Ethical Considerations for…chemotherapy, radiation, acupuncture, sweat lodge, blood transfusions, and hirudotherapy