Philosophy and Ethics

1. Philosophy and Ethics HS20-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.

2. 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)

3. Opening Video – Medicine Men Go Wild – The Hot Zone – BayakaIndicator: compare Western medicine to other cultures’ medicine. • Watch the video/documentary - https://www.youtube.com/watch?v=5KVLsiLeTN8Note: 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?

4. Western versus Alternative Medicine (Types of Medicine)How has Western medicine developed over time? • Western (conventional) medicine historically • Holistic health – • Complimentary medicine – • Alternative medicine –

5. Western versus Alternative Medicine (Types of Medicine)How has Western medicine developed over time? • Western (conventional) medicine historicallyDoctors (Health Care Providers) use drugs, surgery, or radiation to treat symptoms, injury, disease and illness. • Holistic health – health includes not just illnesses of the body, but of the mind and soul (well-being physically, mentally, emotionally, and spiritually). • Complimentary medicine – a combination of conventionaland alternative medicine! • Alternative medicine – a medical treatment that may not be scientifically tested or proven.

6. 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).

7. Traditional (alternative) Medicine - Meditation • What cultures meditate? • What are the benefits?

8. Traditional (alternative) Medicine - Meditation • What cultures meditate?East Indian Religions (Hinduism, Buddhist, Judaism and Christianity) – meditation is now a global practice – not culture-specific • What are the benefits?Decreases tension, boosts immune system, lowers blood pressure, reduce anxiety attacks.

9. Traditional Medicine - Meditation • What cultures meditate?Pre-historic but mostly attributed to Hindu and Eastern Asia! • What are the benefits? lower blood pressure, improved blood circulation, lower heart rate, less perspiration, slower respiratory rate, less anxiety, lower blood cortisol levels, more feelings of well-being, less stress, deeper relaxation

10. Traditional Medicine - Meditation • How to:- Sit or lie comfortably.- Close your eyes.- Make no effort to control the breath; simply breathe naturally.- Focus your attention on the breath and on how the body moves with each inhalation and exhalation. Notice the movement of your body as you breathe. Observe your chest, shoulders, rib cage and belly. Make no effort to control your breath; simply focus your attention. If your mind wanders, simply return your focus back to your breath. Maintain this meditation practice for 2–3 minutes to start, and then try it for longer periods. • Let’s try! There are others online! http://marc.ucla.edu/body.cfm?id=22

11. 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

12. 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. What we consider conventional medicine. • 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.

13. Complimentary and Alternative Medicine (CAM) What is CAM • Allopathy – • Complementary medicine – • Alternative medicine – • Complete the Complimentary and Alternative Medicine HandoutCorrect – hand in.

14. Complimentary and Alternative Medicine (CAM) What is CAMA group of practices and products that are not a strict part of conventional medicine • Allopathy – conventional medicine or common and usual practice of medicine • Complementary medicine – alternative medicine used with conventional medicine • Alternative medicine – used instead of conventional medicine • Complete the Complimentary and Alternative Medicine HandoutCorrect – hand in.

15. Holistic • Should have heard it in health before… what does it mean? • Overall ___________ and _____________ between all of your different ___________ of health. _______ Socioemotional _______ Spiritual • This means… __ ____ _______, ____ ____ ________. • Important to remember that this involves the most complete form of health and needs to be considered beyond simply treating a condition with a pill… this is what CAM keeps in mind.

16. 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 • Important to remember that this involves the most complete form of health and needs to be considered beyond simply treating a condition with a pill… this is what CAM keeps in mind.

17. Clinical-Based Studies • Randomized –Problem/Limitations • Blind –Problem/Limitations

18. Clinical-Based Studies • Double-Blind –Problem/Limitations • Placebo –Problem/Limitations

19. 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. BUT there may be some rules to the randomness. • 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.* If something does, it may not be the pill.

20. 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 – if you warn of allergies, could that influence bias? • 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.

21. 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 StudiesWhat are you testing for and why? What is your prediction and why? • Randomized – • Blind – • Double-Blind – • Placebo – Come up with a test to perform on your classmates for one of these. Not drug-based, but come up with something to test in the class. Small groups (3 or less). • Importance: Conventional medicine needs clinical based studies to become widely used and distributed to meet the health needs of people.

22. Scientific Method Reminder • Hypothesis/Prediction – • Independent variable – • Dependent variable – • Control group – • Data Collection – • Model data (making a graph) – • Analyze results/draw conclusion –

23. Scientific Method Reminder • Hypothesis/Prediction – if we do ______, then _____ should happen because of ___________. • Independent variable – what you change. • Dependent variable – what happens as a result of the change. • Control group – group that isn’t given the drug (but may have the same environment and conditions as the other group). • Data Collection – collect your data • Model data (making a graph) – Put data into a visual. • Analyze results/draw conclusion – what does the data say? Did it work? Why or why not?

24. 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.”

25. 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.

26. Phase of Clinical Research • Pre-Clinical • Phase 0 • Phase 1 • Phase 2 • Phase 3 • Phase 4 VocabularyPharmacodynamicsPharmacokinetics

27. Phases of Clinical Research • Pre-Clinical – observe (drug) on animal or human 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 reduce 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 the drug. “Helps determine safety and dosage” • 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. “Evaluate effectiveness, look for side effects”

28. Pre-Clinical

29. Chart of Phases and Timelines

30. Phase 1!

31. Phases of Clinical Research • Phase 3 - the most expensive, time-consuming and difficult trials to design and run – Can involve up to 3000 people and different institutions (hospitals for example) done randomly. “Pre-marketing phase” – actually given to consumers and data is collected. (Can take a minimum of 3 years)IF GOOD IT’S DISTRIBUTED! YAAAAAY! • Phase IV (4) – Post-marketing surveillance. Constant monitoring of the drug, if problems appear, drug production will be ceased. This can last over 10 years!

32. 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.

33. Phases of Clinical Research • Importance:It can take up to twenty years for a drug to be tested and proven safe. And close to 10 years for it simply to be put on the market. So when you hear about new drugs to cure diseases (like Cancer or HIV), it may not come into mainstream usage for awhile to ensure it’s safety.

34. 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?

35. Cultural Beliefs Read over the cultural beliefs! Then record the following on looseleaf! • Something I found interesting about __________ (culture) was… __________________ because __________________. • Something I did/didn’t agree with about __________ (culture) was… __________________ because _________________. • Summarize a simple way to describe one particular culture’s worldview on medicine.

36. Overall Worldviews of Groups Different parts of the world practice different means of medicine. Using parts from all of them may provide the most complete health care service to everyone.

37. 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 (pick one and look it up)… • Herbs – any plant with leaves, seeds or flowers used for medicine, flavour or food. Example Aloe and Chamomile • Vitamins – essential for normal growth and nutrition. Organic compounds. In pill form – does it work? • Minerals – solid, inorganic substance that the body needs to function. • Probiotics – microorganism introduced into the body for beneficial qualities, typically aiding with digestion. • Essential Oils – oils obtained from plants by distillation. They can help with sickness, moods, and other health concerns. Do they work? For some maybe.

38. Your thoughts on these treatments…immunizations, chemotherapy, radiation, vitamin supplements, physical activity, nutrition and prayer • Pick one of the above and answer briefly what they involve as it pertains to health. • Does the evidence support this practice (does it work)? Are there guaranteed benefits? Are there side effects? Is it a western practice? • Think of another belief we covered, would they accept this given their beliefs and perspectives?

39. Your thoughts on these treatments…immunizations, chemotherapy, radiation, vitamin supplements, physical activity, nutrition and prayer • Pick one of the above and answer briefly what they involve as it pertains to health. Immunizations – injections of a weak form of a virus to get the body to learn how to fight it. • Does the evidence support this practice (does it work)? Are there guaranteed benefits? Are there side effects? Is it a western practice?Assuming no allergies – evidence supports it! Tiredness and fatigue (fighting off infection). In Western countries typically vaccine rates are high and disease rates are low. • Think of another belief we covered, would they accept this given their beliefs and perspectives?Hispanic – may not agree because their methods are pain free and alternative forms of medicine.

40. Your thoughts on these treatments…immunizations, chemotherapy, radiation, vitamin supplements, physical activity, nutrition and prayer • Pick one of the above and answer briefly what they involve as it pertains to health. Chemotherapy – two forms: directly into blood or vein. Chemical that kills cancer cells – can prevent or reduce spreading of cancer. • Does the evidence support this practice (does it work)? Are there guaranteed benefits? Are there side effects? Is it a western practice?Proven to work, will kill cancer cells. Poisons your body (every system) – lose weight, get sick. Yes to Western practice. • Think of another belief we covered, would they accept this given their beliefs and perspectives?Jewish – no blood donation. “Obligation to preserve life takes precedence over a person’s decision with their body” – may not agree.European – would accept this, it is a medication to help treat the illness.Hispanic – against beliefs, but some may still use it.

41. Your thoughts on these treatments…immunizations, chemotherapy, radiation, vitamin supplements, physical activity, nutrition and prayer • Pick one of the above and answer briefly what they involve as it pertains to health. Physical activity – bodily movement produced by skeletal muscles requiring energy. • Does the evidence support this practice (does it work)? Are there guaranteed benefits? Are there side effects? Is it a western practice?It helps, evidence supports it! Reduces blood pressure amongst other things! Side effect – possible injury. It is a western practice! • Think of another belief we covered, would they accept this given their beliefs and perspectives?All beliefs would practice this.

42. Your thoughts on these treatments…immunizations, chemotherapy, radiation, vitamin supplements, physical activity, nutrition and prayer • Pick one of the above and answer briefly what they involve as it pertains to health. • Does the evidence support this practice (does it work)? Are there guaranteed benefits? Are there side effects? Is it a western practice? • Think of another belief we covered, would they accept this given their beliefs and perspectives?

43. 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

44. Philosophy and Ethics HS20-HC2 Examine how personal and societal beliefs impact ethical decisions regarding health care.

45. 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)

46. Making a Health Care Decision • Several core ethical questions (CEQ) guide health care providers in making decisions. • In addition to these questions, there are 7 additional steps to resolving ethical dilemmasthat relate to health decision making. • Why? Health care providers will be faced with tough life/death decisions and it helps to have a set of guidelines to follow in making a decision of that magnitude and being confident in it.

47. Making Health Care DecisionsCORE ETHICAL QUESTIONS • a. (intervention technologies) • b. (informed consent) • c. (autonomy) • d. (beneficence) • e. (non-maleficence) • f. (justice) • g. (economic consequences)

48. Making Health Care DecisionsCORE ETHICAL QUESTIONS • 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)

49. Making Health Care Decisions7-Steps to Resolving Ethical Dilemmas • Recognize that a case raises an important ethical problem. • Identify the problem that needs to be solved. • Determine reasonable alternative courses of action. • Consider each option in relation to the fundamental ethical principles.

50. Making Health Care Decisions7-Steps to Resolving Ethical Dilemmas • Recognize that a case raises an important ethical problem. Ethical problems arise when there is a conflict of values and when there are different ways of proceeding. It is important to be as knowledgeable as possible about the case. • Identify the problem that needs to be solved. Once the problem is precisely identified, you will be better able to decide what resources you need to handle the problem. • Determine reasonable alternative courses of action. These options don’t need to include everything, but they should be clearly distinct. • Consider each option in relation to the fundamental ethical principles. None of these principles is always paramount, but in certain situations, one may trump another(benefits may outweigh the harm).