For this section you will choose a topic triggered for you, as a result of talking to your patient.<\/p>\n
The essay you decide to write should relate to either a psychological issue around illness and<\/p>\n
health behaviour, or social factors affecting the patient\u2019s development and experience of<\/p>\n
illness. Alternatively, it could be a particular ethical issue of interest to you that is relevant to<\/p>\n
the patient in question or could be significant in their future care.<\/p>\n
Think about the patient\u2019s health overall \u2013 not just the presenting condition. Patients may have<\/p>\n
co-morbidities, and the recent episode may be just one incident in a long-term condition.<\/p>\n
If you decide to write an essay on ethics, consider what the legal as well as moral arguments<\/p>\n
are and how they relate to the care and decisions around management in your patient\u2019s case.<\/p>\n
Apply these principles to the investigations, treatment and management that might be<\/p>\n
appropriate for the patient\u2019s health problems. Discuss ethical issues which you believe are<\/p>\n
(or will be) raised in the treatment and care of your patient. ESSAY<\/strong><\/p>\n The following is a guide to marking.<\/strong><\/p>\n Assessors should consider the following areas & score up to a max of 25 marks:<\/p>\n Introduction<\/p>\n Literature review and knowledge<\/p>\n Integration of information<\/p>\n Relevance to the patient<\/p>\n Discussion\/Summary\/Conclusion<\/p>\n References<\/p>\n These descriptors should act as a guide to marking only <\/em>Mark<\/strong><\/p>\n Excellent. <\/strong>Complete command of the relevant concepts and<\/p>\n facts; well researched with an excellent understanding of the<\/p>\n literature with evidence of substantial reading in and around the<\/p>\n subject; a high level of critical and\/or analytical thinking; evidence<\/p>\n of using a wide range of sources including the original research<\/p>\n literature. Thoughtful consideration of potential implications for<\/p>\n the patient. Good evidence that all the relevant information has<\/p>\n been integrated into single coherent body of work. Excellent<\/p>\n standard of presentation.<\/p>\n 23-25 marks<\/strong><\/p>\n Good. <\/strong>Clear exposition of the subject. Fairly comprehensive<\/p>\n grasp of the relevant concepts and facts; gives a mainly accurate<\/p>\n account of the relevant literature; shows some evidence of<\/p>\n reading around the subject and shows some critical\/analytical<\/p>\n thinking. Considers potential implications for the patient. Well<\/p>\n presented with minimal errors.<\/p>\n 18-22<\/strong><\/p>\n Clear Pass <\/strong>Essay that shows a reasonable grasp of the basic<\/p>\n concepts and facts; gives a mainly accurate account of the<\/p>\n relevant literature. Some reference to the patient. Acceptable<\/p>\n standard of presentation.<\/p>\n 14-17<\/strong><\/p>\n Essay Plan: <\/strong><\/p>\n What is the ethical problem surrounding long-term drug treatment?<\/p>\n Why is it relevant now (e.g., ageing populations, polypharmacy, multimorbidity)?<\/p>\n What specific patient case will this essay reference?<\/p>\n What is your main argument\/thesis?<\/p>\n Point: Long-term pharmacotherapy raises complex ethical tensions between autonomy, beneficence, non-maleficence, and justice.<\/p>\n Evidence: Refer to Beauchamp and Childress\u2019s Four Principles of Biomedical Ethics.<\/p>\n Explanation: Each principle may conflict in cases of chronic medication\u2014e.g., beneficence (suppressing symptoms) vs. non-maleficence (causing long-term harm).<\/p>\n Analysis: Critically explore how these tensions appear in a real patient\u2019s case (e.g., Mr A on antipsychotics or Mrs B on long-term corticosteroids).<\/p>\n Link: Understanding this tension is essential in ethically sound, patient-centred chronic care.<\/p>\n Question: How does informed consent function in long-term drug treatment, and is patient autonomy truly respected over time?<\/p>\n Question: Is it ethical to continue long-term treatment that causes harm when alternative options are limited?<\/p>\n Question: What are the core ethical principles at play in long-term drug treatment, and how do they guide or conflict in practice?<\/p>\n Question: Do long-term drug regimens reinforce health inequality or unjust burden on certain populations?<\/p>\n Question: How can shared decision-making improve ethical care in long-term pharmacotherapy?<\/p>\n Questions to address:<\/p>\n Reinforce your thesis: Long-term treatment must be regularly re-evaluated through ethical and patient-centred lenses. Shared decision-making, transparency, and attention to harm are essential to protect both health and dignity.<\/p>\n Written so far: <\/strong><\/p>\n A Chronic disease is defined \u201cas an ongoing\/recurring illness,not caused by infection or spread through contact, that does not resolve spontaneously. And are rarely cured by medication or other medical procedure.\u201d(1) Management of chronic diseases is heavily reliant on key principles such as continuity of care, patient centeredness and shared decision making. (2) These principles are essential to help navigate the complexities of long term pharmacotherapy used for symptomatic treatment rather than curative care. These Long term pharmacotherapies used can result in long term Adverse effects. For instance long term oral corticosteroid (OCS) used in Asthma and COPD can result in Cushing’s disease,increased cardiovascular disease risk & Osteoporosis. Atypical antipsychotics used in schizophrenia and Bipolar disorder can cause serious metabolic conditions- weight gain,Type 2 diabetes and insulin resistance- if used long term. While these treatments help control these conditions and improve patient quality of life, they come at an increased risk of Adverse effects with long term use.This raises an interesting Ethical dilemma of whether these adverse effects risk is outweighed by the benefits. Is it justifiable to continue treatments in the long term if they may cause significant harm? Especially if no other treatment alternatives exist? As patients are living longer with chronic diseases, the accumulating risk of adverse effects, especially ones that cause systemic problems like corticosteroids or antipsychotics, becomes ethically and clinically problematic. This essay explores the ethical tensions inherent in long-term drug treatment ,legal standards, and a real-life clinical scenario.<\/p>\n Long term Pharmacotherapy remains a principle strategy in chronic disease management, yet the sustained use of many medications has considerable and well documented risk. For instance a meta analysis of over 15,000 patients found that prolonged use of second generation antipsychotics was found to be linked to weight gain, dyslipidemia, and insulin resistance: all components of metabolic syndrome that substantially elevate cardiovascular risk. (3.)While oral corticosteroids(OCS) used in treatment of respiratory conditions such as Asthma and Chronic obstructive pulmonary disease (COPD) have been proven to cause Osteoporosis, increasing fracture risk, Cushing’s disease, Insulin resistance & steroid induced diabetes. (4) A population study done in the UK found that the incidence Osteoporosis was increased by 1.56\u20133.38.(4)The american journal of cardiology also published a paper that found that patients with COPD on OCS had increased risk of cardiovascular disease. (5)Despite these risks, these medications are often crucial for disease control, forcing physicians to weigh the therapeutic benefits against the cumulative harm. The ethical dilemma then lies in the tension of the Adverse effects that arise from long term use vs the clinical necessity. Especially in patients unable to grasp the eventual harmful outcomes and make a fully informed decision.<\/p>\n Beauchamp and Childress\u2019s Four Principles of Biomedical Ethics: autonomy, beneficence, non-maleficence, and justice (6) States that Autonomy allows patients to make decisions about their care while beneficence requires clinicians to promote patient welfare and non-maleficence demands they avoid causing harm and justice ensures fair distribution of healthcare resources. These principles are found to be conflicting in the justifying continued use of Long term pharmacotherapy despite adverse effects. For instance in the case of OCS used for respiratory exacerbations may provide a benefit to the patient, Beneficence. However, the long term adverse effect of cushing syndrome can be considered to be doing harm which goes against non-maleficence. Additionally the limited availability of new drug therapies such as Biologics, can be considered a direct contradiction to justice. As some patients will not be able to afford experimental and expensive drug therapies. <\/p>\n Patient History: <\/p>\n Patient: <\/em><\/strong>Mrs. X<\/p>\n Age: <\/em><\/strong>49 years<\/p>\n Source of History<\/em><\/strong>: Patient interview, Patient Medical notes.<\/p>\n Presenting Complaint:<\/p>\n History of Presenting Complaint (HPC) Characteristics of symptoms:<\/p>\n Response to symptoms: <\/strong>Patient now works from home due to multiple exacerbation affecting her availability.<\/em><\/p>\n Patient\u2019s ideas, concerns and expectations (ICE):<\/p>\n Ideas: <\/em><\/p>\n Concerns: <\/em><\/p>\n Expectations:<\/em><\/p>\n Past Medical History (PMH):<\/strong><\/p>\n Medication History:<\/em><\/p>\n MDT: <\/em><\/p>\n Family History (FH): <\/em><\/strong><\/p>\n Social History (SH) <\/em><\/p>\n Review of Systems (ROS):<\/em><\/p>\nItroduction (Approx. 150\u2013200 words)<\/h3>\n
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Literature Review & Knowledge (Approx. 400\u2013500 words)<\/h3>\n
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Integration & Application to Patient Case (Approx. 400\u2013500 words)<\/h3>\n
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Discussion & Critical Analysis (Approx. 300\u2013350 words)<\/h3>\n
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Conclusion (Approx. 100\u2013150 words)<\/h3>\n
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Part A: The medical History.<\/em><\/h3>\n
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