User:Juliastein8/sandbox

CONTENT.
The second sentence about animals could be a section in itself. It sounds confusing where it is now. The main topic is abortifacents and that could be divided between abortifacents humans have used and use today and abortifacents used on other animals. The testing of abortifacents (possibly on animals) can also be divided into its short paragraph if enough information is found.

The history section could use an additional paragraph about abortifacents that we use or have been used more recently in different cultures/countries around the world. The history section can also be expanded on by dividing it into subsection based on different cultures and civilizations that have a record of having made use of multiple kinds of abortifacents.

Side effects from and dangerous aspects section can be expanded on (it is one short sentence).So far there is only a mention of herbal abortifacent dangers. No mention (in that section) about dangers of taking synthetic drugs is there. I suspect more information could be found on that specific subject.

TONE AND NEUTRALITY
As far as the article's neutrality, I think this article has a straightforward, factual tone, and it does not seem to be making an argument against or for the use of abortifacents in the past or the present. I think it is missing information on other countries/cultures aside from the ones mentioned and I suspect more information could be found on the countries and cultures already mentioned.

TALK SECTION
This article is rated a Start-Class. The majority of the discussions have to do with the wording of specific sentences and the assumptions some writers may have made about certain sources which led to a bit of a Wiki "fight" amongst two wikipedians. Nothing of importance is discussed besides the oldest post which claims there is a good source that has not been accepted multiple times.

Articles that have potential information:

 * Encyclopedia of birth control by Vern L. Bullough

Content
I would add to the first paragraph that although we have an established set of principles (autonomy, non-maleficence, beneficence, and justice), and 1) no principle negates or dismisses another and 2) they can be used to reach a moral decision without "any" conflict, there are instances where one principle does have more weight and conflicts with another. That is where controversial and difficult decisions in health care take place and it is often the reality healthcare providers and family are faced with. I know that these principles are what the author of our class' textbook (Practical Decision Making in Health Care Ethics: Cases, Concepts, and the Virtue of Prudence, Fourth Ed. page 133) calls "normative," which suggest that they are basic rules health care providers should follow in order to provide the best care. I would include that these principles are based on societal ideals of "respect for persons" (PCSBI report; Devettere).

In the values section they mention paternalism and mention soft paternalism. Some sources such as Devettere's book would point out that in some cultures people, especially older people, may expect a paternalistic approach during treatment and not want to know everything about their diagnosis, and possible treatment plans. That information may be valuable to add.

"The definition of autonomy is the ability of an individual to make a rational, un-influenced decision"... has not bee cited. Furthermore, at the end of autonomy I would add medical proxy as an important term and relate it to loss of capacity in medical decision.

Under respect for human rights there is a quote in the middle of that section that seems oddly placed. I would not necessarily get rid of it but maybe i would introduce it or place it somewhere that makes sense of it. In that paragraph there is also a long citation that could be substituted by summarizing an explanation of the declaration they are talking about (UNESCO).

In terms of organization of the whole paper, the subtopics are well thought out and the overall table of contents is good. However, I think conflicts could be expanded on because there are only two conflicts that are discussed.

Neutrality
This article has a little opinionated verbiage and does not appear to support any specific opinion. Some of its sections are very detailed but written in an unbiased factual manner.

Citing
There is a LOT of work to be done here. Far too many paragraphs have little to no citations.

The history section needs a lot of citations that are not there to support the information. I think I could find at least a couple on the subjects talked about.

Beneficence and non-maleficence paragraphs have little to no citing. Informed consent and ethics committee section also needs some citing.

Source Reliability
Many sources have been checked and replaced and their content reflects the article's claim. However, many claims have yet to be sourced.

Talk Page
multiple people have commented on the Talk page and said that citations are needed in many sections of this article. Furthermore, it was also recently mentioned that this article is very detailed oriented and that expanding on the section of family members would be good. Also, there could be some brief explanation of how this ties into abortion, human genetic engineering and embryo research as well as cadaver treatment and organ transplantation. This could all go under conflicts.. there is an extensive amount of conflicts and since there are so many maybe a list with links to other wikipedia articles would be necessary.

Citation Practice
The Presidential Commission for the Study of Bioethical Issues has organized and come up with a set of guidelines in order to make difficult healthcare decisions in a timely manner.

Intro: end of first para:
Conflicts as well as conflicts of interest and cross-cultural health care sections can be introduced here: this is where ethical dilemma is introduced and where the use of medical ethics is most needed in order to avoid maleficence and in some instances choose the best of all bad outcomes. EX: ethical dilemmas in African humanitarian practice, different cultures and the balance between respecting religion and culture while also upholding medical standards. BIG DILEMMA SOMETIMES

Humanitarian practices in areas lacking optimum care pause interesting and difficult ethical dilemmas in terms of beneficence and non-maleficence. Humanitarian practices are based upon providing better medical equipment and care for communities who's country does not provide adequate healthcare. The issues with providing healthcare to communities in need may sometimes be religious or cultural backgrounds keeping people from performing certain procedures or taking certain drugs. On the other hand, wanting certain procedures done in a specific manner due to religious or cultural belief systems may also occur. The ethical dilemma stems from differences in culture between communities helping those with medical disparities and the societies receiving aid. Women's rights, informed consent and education about health become controversial, as some treatments needed are against societal law, while some cultural traditions involve procedures against humanitarian efforts. Examples of this are female circumcision, aiding in reinfibulation, providing sterile equipment in order to perform procedures such as female genital mutilation, as well as informing patients of their HIV positive testing. The latter is controversial because certain communities have in the past outcast or killed HIV positive individuals.

Intro: in addition to second paragraph:
More recently, new techniques for gene editing aiming at treating, preventing and curing diseases have made ground breaking advances and, although not yet perfected, are prospective future techniques in order to precisely remove or replace small portions of genetic material in living cells using host defenses against viral infection, originally found in bacteria's adaptive immune system. Commonly known as CRISPR/Cas9, applications and benefits of this technique are being developed and improved. In terms of bioethics and medical ethics, this advancement is relevant in that certain applications, such as somatic cell gene editing and germline gene editing, raise important questions about how far society should interfere in natural human development in order to rid itself of genetic illnesses and different kinds of cancer. https://www-sciencedirect-com.proxylib.csueastbay.edu/science/article/pii/S0140673617303896

http://clinchem.aaccjnls.org/content/64/3/489

Under Values:
justice is not explained and is described briefly in the beginning - could use source on PG and source on humanitarian medical treatments

autonomy : definition of autonomy from Greek is "autos" (self) and "nomos" (rule). This encompasses both the idea of freedom from another individual's control as well as having the knowledge necessary to make an informed and reasonable decision. This leads to the concept of informed consent as a right which every patient morally deserves. In contrast to this, the term 'therapeutic privilege,' which is carefully placed in situations where a patient would not benefit from full disclosure of a procedure or medical event. However, this idea, if unchecked could lead right back to the beneficence model of medicine in which paternalism overrules personal freedoms in medical care. (Source number 8)

Acceptance of Ambiguity in Medicine

The concept of normality, that there is a human physiological standard contrasting with conditions of illness, abnormality and pain, leads to assumptions and bias that negatively affects health care practice. It is important to realize that normality is ambiguous and that ambiguity in healthcare and the acceptance of such ambiguity is necessary in order to practice humbler medicine and understand complex, sometimes unusual usual medical cases. Thus, society’s views on central concepts in philosophy and clinical beneficence must be questioned and revisited, adopting ambiguity as a central player in medical practice.

Solidarity

The more individualistic standards of autonomy and personal human rights as they relate to social justice seen in the Anglo-Saxon community, clash and can sometimes also go supplement the concept of solidarity, which stands closer to a European perspective focused on communal perspective in which common cause, universal welfare and the unselfish wish to provide healthcare equally for all is emphasized. In the United States individualistic and self-interested healthcare norms are upheld, whereas in other countries, including European countries, instill a sense of respect for the community and personal support to all citizens. (paper from class)

Under control and resolution :
Leading causes of death in the United States and around the world are highly related to behavioral consequences over genetic or environmental factors. This leads some to believe true healthcare reform begins with cultural reform, habit and overall lifestyle. Lifestyle, then, becomes the cause of many illnesses and the illnesses themselves are the result or side-effect of a larger problem. Some people believe this to be true and think that cultural change is needed in order for developing societies to cope and dodge the negative effects of drugs, food and conventional modes of transportation available to them. In 1990, tobacco use, diet, and exercise alone accounted for close to 80 percent of all premature deaths and continue to lead in this way though the 21st century. Heart disease, stoke, dementia, and diabetes are some of the diseases that may be affected by habit forming patters throughout our life. Some believe that medical lifestyle counseling and building healthy habits around our daily lives is one way to tackle health care reform.

Under Conflicts section:
Organ donations can sometimes pause interesting scenarios, in which a patient is classified as a non-heart beating donors (NHBD), where life support fails to restore the hard beat and is now considered futile but brain death has not occurred. Classifying a patient as a NHBD can qualify someone to be subject to non-therapeutic intensive care, in which treatment in only given to preserve the organs that will be donated and not to preserve the life of the donor. This can bring up ethical issues as some may see respect for the donors wishes to donate their healthy organs as respect for autonomy, while others may view the sustaining of futile treatment during vegetative state maleficence for the patient and the patient's family.

Under Cultural Concerns:
Language and Culture

sources 6 and 11

As more people from different cultural and religious backgrounds move to other countries, among these, the United States, it is becoming increasingly important to be culturally sensitive to all communities in order to provide the best health care for all people. Lack of cultural knowledge can lead to misunderstandings and even inadequate care, which can lead to ethical problems. A common complaint patients have is feeling like they are not being heard, or perhaps, understood. Preventing escalating conflict can be accomplished by seeking interpreters, noticing body language and tone of both yourself and the patient as well as attempting to understand the patient's perspective in order to reach an acceptable option.

Some believe most medical practitioners in the future will have to be or greatly benefit from being bilingual. In addition to knowing the language, truly understanding culture is best for optimal care. Recently, a practice called 'narrative medicine' has gained some interest as it has a potential for improving patient-physician communication and understanding of patient's perspective. Interpreting a patient's stories or day to day activities as opposed to standardizing and collecting patient data may help in acquiring a better sense of what each patient needs, individually, with respect to their illness. Without this background information, many physicians are unable to properly understand the cultural differences that may set two different patients apart, and thus, may diagnose or recommend treatments that are culturally insensitive or inappropriate. In short, patient narrative has the potential for uncovering patient information and preferences that may otherwise be overlooked.

Humanitarian efforts:

In order to address the undeserved, uneducated communities in need of nutrition, housing, and healthcare disparities seen in much of the world today, some argue that we must fall back on ethical values in order to create a foundation to move towards a reasonable understanding, which encourages commitment and motivation to improve factors causing premature death as a goal in a global community. Such factors -such as poverty, environment and education- are said to be out of national or individual control and so this commitment is by default a social and communal responsibility placed on global communities that are able to aid others in need. This is based on the framework of 'provincial globalism,' which seeks a world in which all people have the capability to be healthy.

As different cultures continue to intermingle and more cultures live alongside each other, the healthcare system, which tends to deal with important life events such as birth, death and suffering, increasingly experiences difficult dilemmas that can sometimes lead to cultural clashes and conflict. Efforts to respond in a culturally sensitive manner go hand in hand with a need to distinguish limits to cultural tolerance.

Chinese medical ethics:
In traditional Chinese philosophy, human life is believed to be connected to nature, which is thought of as the foundation and encompassing force sustaining all of life's phases. Passing and coming of the seasons, life, birth and death are perceived as a cyclic and perpetual occurrences that are believed to be regulated by the principles of yin and yang. When one dies, the life-giving material force referred to as ch'i, encompassing both body and spirit, rejoins the material force of the universe and cycles on with respect to the rhythms set forth by yin and yang.

Because many Chinese people believe that circulation of both physical and 'psychic energy' is important to stay health, procedures which require surgery as well as donations and trans-plantations of organs are seen as a loss of ch'i, resulting in the loss of someone's vital energy supporting their consciousness and purpose in their lives. Furthermore, a person is never seen as a single unit but rather as a source of relationship, interconnected in a social web. Thus, it is believed that what makes a human one of us is relatedness and communication and family is seen as the basic unit of a community. This can greatly affect the way medical decisions are made among family members, as diagnoses are not always expected to be announced to the dying or sick, the elderly are expected to be cared for and represented by their children and physicians are expected to act in a paternalistic way. In short, informed consent as well as patient privacy can be difficult to enforce when dealing with Confucian families. Furthermore, some Chinese people may be inclined to continue futile treatment in order to extend life and allow for fulfillment of all acts involving benevolence and humanity. In contrast, patients with strong Daoist beliefs may see death as an obstacle and dying a reunion with nature that should be accepted, and therefore are less likely to ask for treatment of an irreversible condition.

Islamic culture and medicine
Some believe Islamic medical ethics and framework remain poorly understood by many working in healthcare. It is important to recognize that for people of Islamic faith, Islam envelops and affects all aspects of life, not just medicine. Because many believe it is faith and a supreme deity that hold the cure to illness, it is common that the physician is viewed merely as help or intermediary player during the process of healing or medical care.

In addition to Chinese culture's emphasis on family as the basic unit of a community intertwined and forming a greater social construct, Islamic traditional medicine also places importance on the values of family and the well-being of a community. Many Islamic communities uphold paternalism as an acceptable part of medical care. However, autonomy and self-rule is also valued and protected and, in Islamic medicine, it is particularly upheld in terms of providing and expecting privacy in the healthcare setting. An example of this is requesting same gender providers in order to retain modesty. Overall, Beauchamp's principles of beneficence, non-maleficence and justice are promoted and upheld in the medical sphere with as much importance as in Western culture. In contrast, autonomy is important but more nuanced. Furthermore, Islam also brings forth the principles of jurisprudence, Islamic law and legal maxims, which also allow for Islam to adapt to an ever-changing medical ethics framework.

Buddhist medicine
Buddhist medicine is one based on its religious teaching of compassion and understanding of suffering and cause and effect and the idea that there is no beginning or end to life, but that instead there are only rebirths in an endless cycle. In this way, death is merely a phase in an indefinitely lengthy process of life, not an end. However, Buddhist teachings support living ones life to the fullest so that through all the suffering which encompasses a large part of what is life, there are no regrets. Buddhism accepts suffering as an inescapable experience, but values happiness and thus values life. Because of this suicide is prohibited. However, attempts to rid oneself of any physical or mental pain and suffering are seen as good acts. On the other hand sedatives and drugs are thought to impair consciousness and awareness in the dying process, which is believed to be of great importance, as it is thought that one's dying consciousness remains and affects new life. Because of this, analgesics must not be part of the dying process, in order for the dying person to be present entirely and pass on their consciousness wholesomely. This can pose significant conflicts during end of life care in Western medical practice. As

Truth-telling
The WMA International Code of Medical Ethics explicitly states, "A physician shall...report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception." There is also the conflict with physicians who are tempted to report made up incidents or make an incident worse than what it was for their own personal motives. In vice versa, a physician might be hesitant to report an incident because of personal friendship he or she may have with his or her colleague.



"Medical Ethics" Peer Edit by Arleah
Hi Julia! This is Arleah. Feel free to clarify any confusion with my edits by asking me questions via your sandbox's "Talk" page. I'd be glad to answer your questions.

Overall Peer Edit Comments + Questions

Comments :


 * I'm sure you'll do this for your actual article, but it might help to start adding citations now rather than later so you don't have to recall where you got your information from
 * Again, I'm sure you'll do this for your actual article, but linking key phrases and words that already have wikipedia articles would be useful for other users who want to further read/understand what you're trying to say. It helps so you don't have to fully explain it in your article and lose track of your main point. For example, in your "intro: end of first para" edit you use the word "maleficence" and you could link that word to the "maleficence" wikipedia article if readers want to further understand what that word means. Your article has very general as it's "medical ethics" so linking other wikipedia articles related to terminology and other ethics articles will be very useful for your readers
 * Let me know if you need help with linking articles :)

Intro: end of first para:

Comments :


 * I think the examples and points you bring up are valuable and were good choices to add in the "lead section"
 * Bringing up the humanitarian aspect of your topic was an interesting point to add in the "lead section"
 * The flow of the overall paragraph feels little choppy since I was a little confused on how the first portion about conflicts related to the humanitarian section of your paragraph, but it could be because you're not completely done with this section yet since there are all capitalized phrases that seem more like your thoughts than what you plan to input into the article. If these aren't supposed to be related maybe making them into 2 different paragraphs would make your edits flow better.

Questions :


 * 1) Is this part of the "lead section"? I wasn't sure if that's what you meant by "intro".
 * 2) What did you mean by your very first word "conflicts" (i.e. type of conflicts are you referring to or was the end of your paragraph the examples you wanted to add)?
 * 3) I'm assuming this paragraph isn't complete yet since you left the last sentence as "example of this are" - what are these examples of (i.e. are they going to be more humanitarian examples)?

Intro: in addition to second paragraph:

Comments :


 * Gene editing is definitely an important aspect of medicine that is changing the field for medical ethics as well, I think it's a good point that you bring up
 * If this is the 2nd paragraph of your "lead section" maybe consider generalizing the statement and just stating that "technological advancements" are interfering with natural human development because it's not necessarily just CRISPR/Cas9 that has affected medical ethics. Focusing just on CRISPR/Cas9 only seems too specific
 * Since this is an article on medical ethics, I don't think it's necessary to expand too much into detail on CRISPR/Cas9 especially because there's a wikipedia that talks about CRISPR editing that you could just link when you use the phrase "CRISPR/Cas9" instead of explaining it in your paragraph.

Under Values:

Questions :


 * 1) Your first sentence starts with "justice is not explained..." do you plan to further explain that in your edits or are you just going to bring it up in your article's "talk" page?

Under Conflicts section:

Comments :


 * Woo! Feel free to link my article on "Maternal-Fetal Conflict" once I create the whole article
 * Adding other conflicts and linking the articles would be useful so you don't have to expand too much on it in your own article

Under Cultural Concerns:

Comments :


 * The example of buddhist medicine was interesting and well written, since "buddhist medicine" doesn't exist as a wikipedia article, I think the information you expanded on is good and valuable
 * It'd be nice to hear other types of cultural concerns even if you just make a list of them and then link their articles or write a sentence summary that others can expand on