Issues in Health Test 2
Adult stem cells
Taken from adults No harm to individual extracted from Can't produce different organs May not be pluripotent
Diseases on the Forefront of Stem cell research
Type 1 diabetes Parkinson's disease Cardiovascular disease
Diabetes
Type II: adult onset, largely controllable oral medication, diet, exercise Type I: juvenile onset, glucose monitoring, daily subcutaneous insulin injections
Place of death, over time
Under 65 years: dying hospital inpatient Over 65: more and more people are dying at nursing homes, but the trend is still in the hospital
Cell Replacement Therapy
"degenerative" diseases Damaged cells in particular organs Diabetes, Parkinson's disease, CVD
Cardiovascular Disease
#1 cause of death in the United States For many, the only option is a heart transplant: lack of organ donors, lack of adequate donors
Strategic Goals
Increase the number of transplants Provide equity in access to transplants Improve waitlisted patient, living donor, and transplant recipient outcomes Promote living donor and transplant recipient safety Promote the efficient management of the OPTN
Infertility/ sterility
Infertility - a disease of the reproductive system that impairs the conception of children diagnosis: a couple unable to achieve pregnancy after 1 year of unprotected intercourse Sterility - failing to produce or incapable of producing offspring
Infertility Statistics
Infertility affects about 6.1 million women and their partners in the U.S. -- about ten percent of the reproductive-age population (Source: National Survey of Family Growth, CDC 1995). Most infertility cases -- 85% to 90% -- are treated with conventional medical therapies such as medication or surgery. While vital for some patients, in vitro fertilization and similar treatments account for less than 3% of infertility services, and about (or approximately) seven hundredths of one percent (0.07%) of U.S. health care costs
Preferred Status - recommendation
Seems intrinsically fair but problems like those associated with payment still exist Implementation may also be difficult
Six in 10 Women Having Abortions Are Already Mothers
Six in 10 women having abortions are mothers. If a sexually active woman were to use abortion as her means of birth control and wanted two children, she would have about 30 abortions by the time she reached age 45. Previous abortion: 13% Previous abortion and previous birth: 37% Previous birth: 24% Neither: 26%
UNOS
a non-profit, scientific and educational organization* that administers the nation's only Organ Procurement and Transplantation Network (OPTN), established by the U.S. Congress in 1984. collect and manage data about every transplant event occurring in the United States facilitate the organ matching and placement process using UNOS-developed data technology and the UNOS Organ Center bring together medical professionals, transplant recipients and donor families to develop organ transplantation policy
Non-traditional sources of Organs
animals artificial organs stem cells aborted fetuses
Financial Incentives
any material gain or valuable consideration obtained by those directly consenting to the process of organ procurement, whether it be the organ donor himself (in advance of his demise), the donor's estate, or the donor's family "Donor insurance" - prior agreement to be a donor and if it ever happens your family will be compensated. Problems: who pays, how much, when?
Vegetative State
arousal is present, but the ability to interact with the environment is not. Eye opening can be spontaneous or in response to stimulation General responses to pain exist, such as increased heart rate, increased respiration, posturing, or sweating Sleep-wakes cycles, respiratory functions, and digestive functions return There is no test to specifically diagnose Vegetative State; the diagnosis is made only by repetitive neurobehavioral assessments.
Animals - Xenotransplantation
cost high risk of rejection zoonotic diseases
Human cloning - the stakes
identity and individuality the meaning of having children the difference between procreation and manufacture the relationship between the generations the manipulation of some human beings for the benefit of others the freedom and value of biomedical inquiry our obligation to heal the sick (and its limits) the respect and protection owed to nascent human life.
Preferred Status
involves the rewarding of organ donors by providing them with a modest but definite recognition, in kind, for their willingness to participate in the system
Living and Deceased donors all organs
living +38% deceased +39%
Human cloning - legislative issues
relationship between science and society can or should society exercise ethical and prudential control over biomedical technology and the conduct of biomedical research.
Committee recommendation
required response: addresses most concerns, can be individualized, DMV, tax returns, health insurance
Brain death
very severe injury to the brain. When brain death occurs, the brain shows no sign of functioning. The physician performs a specific formal brain death examination
Cloned Human embryo
(a) A human embryo resulting from the nuclear transfer process (as contrasted with a human embryo arising from the union of egg and sperm). (b) The immediate (and developing) product of the initial act of cloning, accomplished by successful SCNT, whether used subsequently in attempts to produce children or in biomedical research.
But most pay out of pocket for abortion
12% - private health insurance 13% - financial assistance 20% - medicaid 2% - other 57% - out of pocket
Additional Timeline Information
1st trimester = weeks 1-12 2nd trimester = weeks 13-27 3rd trimester = weeks 28-40 (birth usually 37-42) Embryo: 1 day? 3 weeks? to 8 weeks? Fetus: 9 weeks to birth
Types of Stem Cells
3 types: Totipotent Stem Cells: contain all the genetic material necessary to develop into any cell in the body and placenta, very hard to isolate because they only exist during the first few cell divisions of a fertilized egg (not often used in stem cell research) Pluripotent stem cells: Highly useful stem cell because it can develop into any cell in the body except the placenta, best type of stem cells for research or therapy because of their great potential for development Multipotent Stem Cells: They can become different types of cells but are most limited Example: Hematopoietic cells, can develop into several types of blood cells but not brain or lung cells
Most Abortion Patients Have Health Coverage...
33% - no health 5% - other 30% - private health insurance 31% - medicaid
Statistics
79,003 Tests 4,548 Disorders 5,386 Genes 680 Lab 1,067 clinics
Cloning
A form of reproduction in which offspring result not from the chance union of egg and sperm (sexual reproduction) but from the deliberate replication of the genetic makeup of another single individual (asexual reproduction)
Facilities Providing Only Medication Abortion had a significant impact
A minimum of 193 nonhospital providers, or 17%, offered only early medication abortion in 2011; most were nonspecialized clinics or physicians' offices with small abortion caseloads. The provision of medication abortion, particularly by providers who do not offer surgical abortion, is likely responsible for the stabilization in the number of abortion providers that has occurred since 2000.
International Perspective on abortion
A very small proportion of abortions worldwide take place in the United States. Most unsafe abortions occur in countries where abortion is illegal.
Outcomes of Unintended Pregnancies (3.4 million)
A woman who has an unintended pregnancy is more likely to carry it to term than to have an abortion. Four in 10 unintended pregnancies end in abortion. Of the approximately 6.6 million pregnancies in the United States in 2008, 3.4 million were unintended. Approximately 1.7 million unintended pregnancies resulted in births, 1.2 million in abortions and 549,000 in miscarriages. 40% abortions, 60% births
21.6 Million Unsafe Abortions Occur Each Year
Abortion happens at about the same rate in regions of the world where it is highly restricted and where it is broadly legal. Overall abortion levels are strikingly similar among women living in developed and developing regions (39 per 1,000 and 34 per 1,000, respectively). The key difference is safety. Women in developing countries with restrictive abortion laws often go to untrained providers.
Safety of Abortion
Abortion is one of the safest common surgical procedures for women in the United States. Abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses. Laws criminalizing abortion make abortions unsafe, but do not eliminate them.
Abortion is safer the earlier in the pregnancy it is performed
Abortion is one of the safest surgical procedures for women. The risk of death associated with abortion is low—approximately 0.6 deaths per 100,000 abortions—and the risk of major complications is less than 1%. The risk of death when a pregnancy is continued to birth is about 12 times as great as the risk of death associated with induced abortion. (Note: The calculation of mortality associated with childbirth omits deaths related to miscarriage and ectopic pregnancy.) On average, eight women each year die from complications of induced abortion, compared with about 280 who die from complications of pregnancy and childbirth, excluding miscarriage and ectopic pregnancy. Abortion is safer the earlier in pregnancy it is performed.
Two General Types
Adult Stem cells Embryonic Stem cells
The Global Decline in the Abortion Rate Has Stalled
After declining substantially between 1995 and 2003, the global abortion rate stalled between 2003 and 2008. Between 1995 and 2003 , the abortion rate for the world overall dropped from 35 to 29. It remained virtually unchanged at 28 in 2008. This plateau coincides with a slowdown in contraceptive uptake, which has been especially marked in developing countries. In Africa, the annual increase in modern contraceptive use fell from 0.8 percentage points in 1990-1999 to 0.2 percentage points in 2000-2009.
Other Causes
Age - Age is the strongest predictor of female fertility. After about age 32, a woman's fertility potential gradually declines. A woman does not renew her oocytes (eggs). Infertility in older women may be due to a higher risk of chromosomal abnormalities that occur in the eggs as they age. Older women are also more likely to have health problems that may interfere with fertility. The risk of miscarriage also increases with a woman's age. A gradual decline in fertility is possible in men older than 35. Tobacco smoking - Women who smoke tobacco may reduce their chances of becoming pregnant and the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Alcohol - There's no certain level of safe alcohol use during conception or pregnancy. Body mass - Extremes in body mass — either too high (body mass index, or BMI, of greater than 25.0) or too low (BMI of lower than 20.0) — may affect ovulation and increase the risk of infertility. Being overweight - Among American women, infertility often is due to a sedentary lifestyle and being overweight. Being underweight - Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women following a very low-calorie or restrictive diet. Strict vegetarians also may experience infertility problems due to a lack of important nutrients such as vitamin B-12, zinc, iron and folic acid. Marathon runners, dancers and others who exercise very intensely are more prone to menstrual irregularities and infertility. Sexually Transmitted Infections
"Morning after pill"
Aka "Plan B" High dose of estrogen and progestin: 75% effective Or, progestin only: 89% effective Take immediately or up to 5-days after unprotected sex Side effects: 50% experience nausea, 25% vomiting may inhibit or delay ovulation, inhibit tubal transport of the egg or sperm, interfere with fertilization, or alter the endometrium (the lining of the uterus), thereby inhibiting implantation of a fertilized egg
Allocation from non-directed living donors
Also called: good samaritan donation, altruistic stranger, living anonymous donor Current recommendation: donation should be treated the same as those from cadavers; organ part of the public domain/ pool of organs, transplant team does not have ownership
Obstacles to Obtaining Abortion Services
Although most women obtain abortions early in pregnancy, some women face substantial obstacles to access. Nearly four in 10 women of reproductive age receive coverage under Medicaid, yet 32 states allow Medicaid funding for abortion only in cases of rape, incest or life endangerment. Lacking insurance coverage, poor women often require time to find the money to pay for an abortion, if they are able to at all. More than 200 state abortion restrictions were enacted between 2011 and 2013, making it more difficult for women to obtain timely services.
Additional Applications
Alzheimer's Disease Rheumatoid Arthritis Osteoarthritis Skin grafts for burn victims Macular Degeneration Paralysis Possibility for stronger chemotherapy for cancer patients
Advance direction
An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions
DNR
Another type of advanced directive in which there is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states
Health care proxy/medical durable power of attorney (MDPOA or DPA)
Another type of advanced directive that states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. But a DPA may not be a good choice if you don't have another person you trust to make these decisions for you
Direct Donation
Any hospital, physician, medical organization, medical/dental school, etc can be recipients of anatomical gifts An individual can be designated as a recipient for transplant or therapy Cannot discriminate
Type I diabetes
Autoimmune response which attacks insulin-producing Beta cells Recent research in CRT
Terminally differentiated cells
Become too specialized to be manipulated even though scientists are now beginning to experiment with this idea
An Increasing Proportion of Abortions Are Unsafe
Between 1995 and 2008, the proportion of all abortions that were unsafe increased from 44% to 49%.
Deaths Associated with Abortion Declined Dramatically After Legalization
By the end of 1970, four states had repealed their antiabortion laws, and 11 states had reformed them
Hospice
Care for person with any life threatening or terminal illness Typically for individuals with a prognosis of less than 6 months to live Family member serves a primary care giver and helps patient make decisions Team of hospice workers make regular visits and are available 24-7
Parkinson's Disease
Cells do not produce enough dopamine Dopamine is necessary for vital message transmittance: to nerves, other parts of the brain, muscles, spinal cord
Publications on cloning problems
Cloned cattle (Wells et al The health of somatic cell cloned cattle and their offspring Cloning Stem Cells. 6(2):101-10, 2004) Between weaning and 4 years of age: Mortality rate 8%, Musculoskeletal abnormalities, severely contracted flexor tendons, chronic lameness Older than 3 years: "blood profiles and other indicators of general physiological function such as growth rate, reproduction, rearing of offspring, and milk production are all within the normal phenotypic ranges"
Consequences of Unsafe Abortion
Complications from unsafe abortion procedures account for 13% of all maternal deaths, or 47,000 per year. 8.5 million women experience complications that require medical attention each year; 3 million do not receive care. Virtually all of these deaths and injuries occur in the developing world. Abortion-related mortality rates are hundreds of times higher in developing countries, where abortion is often illegal or highly restricted, than in developed countries. According to World Health Organization (WHO) estimates, unsafe abortions account for 13% of all maternal deaths worldwide. Abortions occur where abortion is illegal. WHO estimates that 47,000 pregnancy-related deaths that occur each year result from unsafe abortions. Unsafe abortion has significant negative consequences beyond its immediate effects on women's health. Other costs include: loss of women's productivity; economic burden of health care costs on poor families; considerable costs health care systems, which are already unable to meet demand for health care and in extreme cases, maternal deaths that leave children motherless.
Most Important Reasons Given for Terminating an Unwanted Pregnancy
Concern for/responsibility to other individuals: 74% Cannot afford a baby now: 73% A baby would interfere with school/ employment/ability to care for dependents: 69% Would be a single parent/ having relationship problems: 48% Has completed childbearing: 38% Most women who decide to have an abortion understand the responsibilities of parenthood; a majority already have children. In a national survey of 1,209 women having abortions in 2004, some of the most common reasons women gave for terminating an unwanted pregnancy were inability to care for or afford a child and concern for the kind of life they could provide for a child (or another child). Eighty-nine percent of women gave more than one reason. The average number of reasons given was four. Each year, about 10,000-15,000 abortions occur among women whose pregnancies resulted from rape or incest.
Genetic Problems
Deletions, translocations, and inversions Sex chromosomes: XY normal, single X or Y, XXY or XXXY Mutations Oncogenes
Gold Standard for brain death
Demonstration of coma Evidence for the cause of coma Absence of confounding factors, including hypothermia, drugs, electrolyte, and endocrine disturbances Absence of brainstem reflexes Absent motor responses Apnea A repeat evaluation in 6 hours is advised, but the time period is considered arbitrary Confirmatory laboratory tests are only required when specific components of the clinical testing cannot be reliably evaluated
Reasons for Abortions After 16 Weeks Since Last Menstrual Period
Did not recognize the pregnancy: 71% Had difficulty making arrangements for abortion: 48% Was afraid to tell parents or partner: 33% Needed time to make decision: 24% Hoped relationship would change: 8% Was pressured not to have abortion: 8% Something changed during pregnancy: 6% Did not know timing was important: 6% Did not know abortion was an option: 5% Fetal abnormality was diagnosed late: 2% Other: 11%
Other alternatives to current organ donor recruitment
Direct market - payment to donor or donors families Indirect market - tax credit, payment or funeral expenses Encouragement - donors get preferential status as recipients Altered professional practice - required request legislation, applied at the primary care level Increase efficiency - idea that presumed consent will increase efficiency Empower donor preferences - families can make decisions
Who Has Abortions, Why and When in Pregnancy
Disadvantaged women bear a disproportionate burden of unintended pregnancies and abortions. The most frequent reasons women give are that having a child or another child would limit their ability to meet current responsibilities and that they cannot afford a child at this point in their lives. Almost 90% of abortions occur in the first trimester.
Dilation and curettage (D&C)
Done within 12-15 weeks of pregnancy Currette: long, looped shaped knife that scrapes the lining, placenta and fetus away from the uterus May be followed by suction/vacuum Takes about 10 min with patient released in about 5 h Complications: possible uterine perforation 100% effective
Incidence of Early Medication Abortion
Early medication abortion accounted for 23% (239,400) of all nonhospital abortions, an increase from 17% in 2008. An estimated 36% of eligible abortions (those performed up to nine weeks) were early medication abortions. Fifty-nine percent of all known providers offer this service, compared with 33% in early 2001 Recently developed technologies—including RU-486, or mifepristone, for early medication abortion—have made it possible for women to have an abortion earlier in pregnancy than ever before. Abortions can now occur within days of a missed period
Arguments for Presumed Consent
Efficiency is Good: Increasing the supply of organs -- that is, supply-side efficiency -- is a worthwhile goal. It is sufficiently important to collect more organs that other goals and values, within limits, may be compromised; Asking for Consent can be Cruel: Presumed consent would obviate the need to ask the donor's family for consent at a time of family's painful grieving. Individual Conscience Can be Respected: Presumed consent respects the principle of individual choice by giving objectors to organ donation an opportunity to empower their anti-donation preference; Individuals Owe Society the Effort to Register their Objection: Individuals who object to organ donation should be burdened with the task of registering their preference to the public authorities because organ donation is, presumptively, socially desirable. The burden of communicating objection should be placed on objectors to organ donation.
Many U.S. Counties Lack an Abortion Provider; About 1/3 of Women Live in Those Counties
Eighty-seven percent of U.S. counties had no abortion provider in 2011. As a result, many women must travel substantial distances to access the service. In 2008, American women traveled an average of 30 miles to access abortion services. Sixty-seven percent of abortion patients traveled less than 25 miles, 16% traveled 25-49 miles, 11% traveled 50-100 miles and 6% traveled more than 100 miles, a significant distance and a documented barrier to timely care The proportion of women in counties without a facility that provides even one abortion a year has increased, reaching 34% in 2011. The proportion of women in unserved counties would be higher if not for the efforts of nonprofit organizations to establish and maintain clinics in areas without other providers.
Split vs. Whole Liver Transplantation
Ethical Issues: increased risk, coercion, ownership Types of split liver transplants: right trisegmental and left graft(adult/pediatric) (most successful nearing whole liver success under good conditions), true split (adult/adult)
Stem Cells
Ethical issues regarding source Time Cost Current status: cell replacement, tissue engineering
Split vs. Whole Liver Transplantation: guidelines/ considerations
Ethically obligated to maximize use of organ Recipient should have right of refusal Medical team responsibility to adequately inform/education recipient Recipient should have right to decide Informed consent obtained early Recipient should be offered split even if previously stated they did not want it No claim of ownership by the transplant team/center
Ethical Issues
Ethics of Presumed Consent Convicted Criminals: Transplant Evaluation and Organ Donation Financial Incentives for Organ Donation Assessment for Candidacy Preferred Status for Organ Donors Split versus Whole Liver Transplantation Objectives for Equitable Organ Allocation Allocation from Non-Directed Living Donors Directed Donation
Artificial Organs
Examples: valves, dialysis, joint replacement, pacemakers Problems: tethered to/ dependent upon power source, cumbersome, testing
Convicted Criminals and Transplant Evaluation
Exclusion from medical treatment unethical Status as prisoner should not be a factor. There may be issues specific to being a prisoner that would influence one's candidacy: Infectious disease - increasing likelihood of failed transplant, Psychosocial issues, Logistics Decisions left to Transplant Team
Long-term Safety of Abortion
First-trimester abortions pose virtually no risk of: Infertility, ectopic pregnancy, miscarriage, birth defect, preterm delivery or low birth weight abortion is not associated with breast cancer. Abortion does not pose a hazard to women's mental health. The preponderance of evidence from well-designed and well-executed studies indicates that first-trimester abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses. Vacuum aspiration, the modern method most commonly used during first-trimester abortions, poses virtually no long-term risks of fertility-related problems. Exhaustive reviews by panels convened by the U.S. and British governments have consistently found no association between abortion and breast cancer. The available evidence also indicates that abortion is not a risk factor for other types of cancer and may even protect against certain kinds of cancers. The decision to terminate a pregnancy is often complex and sometimes difficult. However, well-designed studies continue to find that, among women who have an unplanned pregnancy, those who have a single abortion are at no greater risk of mental health problems than if they have a baby.
Types of ART cycles - US
Fresh nondonor - 68.5% Frozen nondonor - 19.3% Fresh donor - 7.4% Frozen donor - 4.9% New treatment procedure - <0.1%
Gene
Functional and physical unit of heredity Pieces/segments of DNA Contain information for making a specific protein Allele - a variant of a specific gene that specifies a particular trait humans have approximately 25,000 genes
Commercial Cloning
Genetic, Savings & Clone (2004-2006) Provided services for saving tissue/genetic material from pets, Produced cloned pets (3 cats) and made advances in dog cloning, Not commercially viable BioArts International Commercial cloning of livestock under FDA review
Lessons from the PCB
Human Cloning and Human Dignity: An Ethical Inquiry The President's Council on Bioethics Washington, D.C., July 2002
The Overwhelming Majority of Abortions are preformed in clinics
In 2011, abortion clinics—defined as facilities where half or more of patient visits are for abortion services—provided 63% of all abortions. Other clinics, many of which focus on family planning services, provided most of the rest (31%). Hospitals performed 4% and physicians' offices 1%. The proportion of abortions performed in hospitals has declined markedly, from 22% in 1980 to only 4% in 2011. At least 300 doctors are known to provide abortions in their offices, but most perform 100 or fewer procedures per year and many perform fewer than one abortion per week. Together, they account for only 1% of all abortions. Nevertheless, these providers are important to their patients in that they make abortion services available.
Incidence of Abortion
In 2011, some 1.06 million pregnancies were terminated by abortion in the United States. The abortion rate in 2011 was 16.9 abortions per 1,000 women aged 15-44. Put differently, 1.7% of all women aged 15-44 had an abortion in 2011.
The number of abortion providers has declined substantially, mainly due to fewer hospitals providing abortion
In 2011, the United States had 1,720 abortion providers. The number of abortion clinics has declined slightly in recent years, but the number of other clinics (typically family planning facilities) has increased.
Genetic Testing
Information on various traits and characteristics Screen for future/potential health risks Predict how you'll respond to medication (pharmacogenetics) Information on ancestry Forensics
Cell Therapy
Involves replacing diseased or dysfunctional cells with healthy young ones: Similar to organ transplant, scientists are replacing individual cells instead of an entire organ, goal of the therapy is to have the new cells become part of the organ or tissue and function just as the previous cells did, bone marrow transplants are an example of this type of therapy using multipotent stem cells Challenges: Identifying and integrating stem cells, risk of cancer from uncontrolled division, and the risk of tissue rejection
Aborted Fetuses
Major ethical issues: late term abortion, organ farming reasons to consider: organs grow quickly, better than wasting the organs
Policy Recommendations
Majority recommendation: ban on cloning-to-produce-children four-year moratorium on cloning-for-biomedical-research federal review of current and projected practices of human embryo research, pre-implantation genetic diagnosis, genetic modification of human embryos and gametes, and related matters, with a view to recommending and shaping ethically sound policies for the entire field. Minority Recommendation: a ban on cloning-to-produce-children regulation of the use of cloned embryos for biomedical research
Hospice Services
Manages the patient's pain and symptoms; Assists the patient with the emotional and psychosocial and spiritual aspects of dying; Provides needed medications, medical supplies, and equipment; Coaches the family on how to care for the patient; Delivers special services like speech and physical therapy when needed; Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and Provides bereavement care and counseling to surviving family and friends.
UNOS Rationale for Objective of Equitable Organ Allocation
Maximize the availability of transplantable organs Maximize patient and graft survival. Minimize disparities in consistently measured waiting times until an offer of an organ for transplantation is made among patients with similar or comparable medical/demographic characteristics. Minimize deaths while waiting for a transplant. Maximize opportunity for patients with biological or medical disadvantages to receive a transplant. Minimize effects related to geography. Allow convenient access to transplantation. Minimize overall transplantation-related costs. Provide for flexibility in policy making. Provide for accountability and public trust
Adult Stem cells - Plasticity and Transdifferentiation
May be pluripotent Hematopoietic stem cells: Most blood cells, skeletal muscle cells, cardiac muscle cells, liver cells. Bone marrow stromal cells: cardiac muscle cells, skeletal muscle cells. Brain stem cells: three major types of brain cells (neurons, oligodendrocytes, and astrocytes), blood cells, skeletal muscle cells.
Organ Donation from Condemned Prisoners
May be used in other countries Exchange for commuted sentence Raises numerous additional issues
Infertility Treatments - Women
Medical therapy: correcting ovulation dysfunction, no underlying causes of ovulation problems, clomid, femara, or glucophage (induces normal ovulatory function, increased incidence of twins), gonadotropin: effective when oral medication doesn't work, daily injections for 1 week, stimulates release of egg
Infertility Treatments - men
Medical: hormone replacement, antibiotics, anti-inflammatory medication, dopamine agonists to decrease prolactin, antioxidants, correcting current medications, drugs targeting erectile dysfunction Surgical: variocose vein repair, mircosurgical vasocasotomy, transurethral resection of the ejaculatory duct, vasoepididymostomy
Surgical Abortion
Menstrual Aspiration or manual vacuum aspiration Done within the first 10 weeks of pregnancy or 1-3 weeks after a missed menstrual period syringe used to remove pregnancy from uterine lining performed in doctor's office or clinic takes 5-15 min and patient usually released within 2 h Tool for providing emergency care for incomplete induced abortions or spontaneous abortions Very few side effects or complications 99.5% effective
More Abortion Restrictions Were Enacted in 2011-2013 Than in the Entire Previous
More abortion restrictions were enacted between 2011 and 2013 than in the entire previous decade (2001-2010).
Pregnancies in the US (6.6 million)
More than half of all U.S. pregnancies are unintended. The two-thirds of U.S. women at risk of unintended pregnancy who use contraceptives consistently and correctly throughout the course of any given year account for only 5% of all unintended pregnancies. The 19% of women at risk who use contraceptives but do so inconsistently account for 44% of unintended pregnancies, while the 16% of women at risk who do not use contraceptives at all account for 52%. Unintended pregnancy rates are highest among poor and low-income women, women aged 18-24, cohabiting women and minority women.
Provision of and Access to Abortion Services
Most abortions occur in abortion clinics. Many women have to travel significant distances to find a provider, which can pose problems for those with limited resources, or work or family responsibilities.
Causes of Infertility
Most common male infertility factors: azoospermia - no sperm cells are produced, oligospermia - few sperm cells are produced Most common female infertility factors ovulation disorder, blocked fallopian tubes
Where are stem cells found?
Multipotent Stem cells: Every adult on earth is constantly producing multipotent stem cells Ex/ blood, neurons, muscle etc. Umbilical cords: Uses umbilical cord from after birth that is normally disposed of. Donated by the parents, Blood in cord has many multipotent blood stem cells
Assessment for Candidacy
Non-medical criteria for transplant candidacy: Life expectancy, organ failure caused by behavior, compliance/adherence, repeat transplantation, alternative therapies Potential Problems: Borders on evaluating the value of an individual's life.
Gestational age: Abortions overwhelmingly occur early in pregnancy
One-third of abortions occur at six weeks or earlier; 89% occur in first trimester of pregnancy (the first 12 weeks after the first day of the woman's last menstrual period). Sixty-three percent of abortions occur at or before eight weeks' gestation—up from just 20% in 1970. Just 1% of abortions are performed after 20 weeks.
Review - Reproduction
Ovulation: release of an egg, survival time 24hrs Intercourse: delivery system, sperm survival 12-24 hr Fertilization: fusion of a sperm and ovum, typically occurs in the fallopian tube Zygote: takes 4 days to reach uterus, may contain about 48 cells Morula: continued development in the uterus until about 100 cells Implantation: blastocyte attaches to the wall of the uterus, 6-8 days after fertilization, release of HCG
Chromosomes
Package of genes/ DNA Humans have 46 (23 pairs)
Oregon's "Death with Dignity Act" (patients)
Patients must: be at least 18 years old, be an Oregon resident, have a terminal illness with less than 6 months to live, make 3 requests for a prescription (one written and 2 verbal) with at least 15 days between requests
Dilation and Evacuation (D&E)
Performed 15-21 weeks after pregnancy Dilation by synthetics and insertion of cone shaped rods Tissue removed by currette, forceps and suctioning Takes ~30 min and typically done in hospital due to higher risks Fetal remains examined to ensure removal and complete abortion Additional complications: damage to uterine lining or cervix, perforation of the uterus, infection, blood clots
Dilation and Extraction (D&X, Intrauterine Cranial Decompression and Partial Birth Abortion)
Performed later than 21 weeks Dilation induced and water breaks (over 2-3 day period) Fetus legs, arms and shoulders pulled through birth canal by forceps Incision made at base of skull and suction catheter removes cerebral material until skull collapses, and fetus is completely removed Complications: Same as D&E, increased psychological/ emotional problems
Percentage of Providers of 400 or More Abortions per Year Who reported harassment in 2008
Picketing: 88% Picketing with physical contact with patients: 37% Vandalism: 19% Picketing home of staff members: 7% Bomb threats: 5% Patient picture posted on the internet: 5% Many abortion patients experience emotional upset and postabortion depression if they encounter aggressive antiabortion protesters Small providers are much less likely than large ones to experience harassment. In 2008, 89% of nonhospital providers of 400 or more abortions reported experiencing picketing or other harassment, compared with only 35% of those that performed 30-399 abortions More than 6,100 acts of violence have been reported
Where are stem cells found?
Pluripotent stem cells: Only can be found as embryonic stem cells, not adult Fetal Germ cells: Usually from terminated pregnancies Frozen Embryos: Fertilized egg allowed to thaw and divide to a certain point before pluripotent cells are harvested destroying the embryo, usually found in fertility clinics when couples do not need their frozen embryos anymore Therapeutic Cloning - making a clone not for the purpose of making a child, for the purpose of curing diseases
Preferred Status - benefits and harms
Potential benefits: Potential tie-breaker (best), fairness, encourage more to be donors Potential harms: May override other considerations which might be used in a "tie-breaker", might allow other criteria to become part of the assessment process, discrimination (educational, access, etc), induced giving, forcing a response may be detrimental
Oregon's "Death with Dignity Act" (doctor)
Prescribing doctor and consulting physician must: Confirm terminal diagnosis and prognosis, determine the patient is capable and acting voluntarily Refer the patient for counseling if either the patient's judgment is impaired by a psychiatric or psychological disorder Prescribing doctor must: Inform the patient of feasible alternatives such as hospice care
Cloning to produce children
Production of a cloned human embryo, formed for the (proximate) purpose of initiating a pregnancy, with the (ultimate) goal of producing a child who will be genetically virtually identical to a currently existing or previously existing individual.
cloning for biomedical research
Production of a cloned human embryo, formed for the (proximate) purpose of using it in research or for extracting its stem cells, with the (ultimate) goals of gaining scientific knowledge of normal and abnormal development and of developing cures for human diseases.
Policy Options
Professional self-regulation but no federal legislative action ("self-regulation") A ban on cloning-to-produce-children, with neither endorsement nor restriction of cloning-for-biomedical-research ("ban plus silence") A ban on cloning-to-produce-children, with regulation of the use of cloned embryos for biomedical research ("ban plus regulation") Governmental regulation, with no legislative prohibitions ("regulation of both") A ban on all human cloning, whether to produce children or for biomedical research ("ban on both") A ban on cloning-to-produce-children, with a moratorium or temporary ban on cloning-for-biomedical-research ("ban plus moratorium") A moratorium or temporary ban on all human cloning, whether to produce children or for biomedical research ("moratorium on both").
Presumed Consent
Public policy based on presumed consent would offer every adult the opportunity to express and have recorded by publicly accountable authorities his or her refusal to be a donor of solid organs and tissues. A clinically and legally indicated candidate for cadaveric organ and tissue recovery is presumed to have consented to organ and tissue recovery if he or she had not registered a refusal.
Telomere
Region of highly repetitive DNA at the end of a chromosome Telomere shortening - during each replication part of the DNA is lost/ shortened (Hayflick limit 52 replications) Telomere reverse transcriptase (TERT)
Cloning-to-produce-children
Reject: moral status of the cloned embryo, the exploitation of human life, moral harm to society, what we owe the suffering
Infertility Treatments
Reproductive surgery: endoscopic, used to remove scar tissue, treat endometriosis, remove cysts on the ovaries Intrauterine insemination: inject sperm into uterus, for men with slightly abnormal sperm, possibly donor sperm Assisted Reproductive Technology (ART): In vitro fertilization (IVF), Intracytoplasmic sperm injection (ICSI), Pre-implantation genetic testing (PGD)
General Misconceptions
Stem Cell Therapy and Cloning is the same thing. All stem cells are the same.
Cloning-for-biomedical-research
Suffering of humanity versus human embryos Favor with moral concerns: Intermediate moral status, deliberate creation for use, going too far, other moral hazards Favor with no major concerns
SRTR
Supports the ongoing evaluation of the scientific and clinical status of solid organ transplantation including kidney, heart, liver, lung, pancreas, and intestine transplants Data on all solid organ transplants and donations in the US Oversight and funding from the HRSA, a division of the US department of health and human services Coordinated by Arbor Research Collaborative for health in collaboration with UMich
Embryonic Stem Cells
Taken from embryo in blastula stage Are pluripotent Are differentiable Embryo is destroyed after harvesting
Scientific and technological status
Technique of cloning Animal cloning Attempts at human cloning Stem cell research The transplant rejection problem Stem cells from cloned embryos The fate of embryos used in research
Gender Selection
Techniques: sperm separation, PGD (preimplanation), PGD (prenatal) Primary reason: sex-linked genetic diseases Controversies: gender discrimination, appropriateness of expanding control over nonessential characteristics of offspring, importance of sex selection considering limits of medical and financial resources Recommendation: ethically acceptable to prevent genetic disorders, non-medical gender selection should be discouraged
Black women account for a disproportionate share of unintended pregnancies
The 14% of women at risk of unintended pregnancy who are black account for 24% of unintended pregnancies.
Poor women account for a disproportionate share of unintended pregnancies
The 17% of women at risk of unintended pregnancy who are poor account for 40% of unintended pregnancies.
Hispanic Women Also Account for a Disproportionate Share of Unintended Pregnancies
The 19% of women at risk of unintended pregnancy who are Hispanic account for 26% of unintended pregnancies.
HD
The HD gene is located on the short (p) arm of chromosome 4 at position 16.3. More precisely, the HD gene is located from base pair 3,046,205 to base pair 3,215,484 on chromosome 4.
In 2011, U.S. Abortion Rates Reached Their Lowest Level Since 1973
The abortion rate has declined almost every year since 1980—most rapidly from 1990 to 1996—leveled off between 2005 and 2008, and continued to decline between 2008 and 2011. Declines in teen abortion rates account for much of the decline in overall U.S. abortion rates, as they have declined at a higher rate than those of adult women. The declining pregnancy rate among teenagers is the result primarily of better contraceptive use, especially use of injectables and implants, and secondarily of lower rates of sexual activity, leading to declining rates of abortion among this group.
Highly Restrictive Abortion Laws Are Not Associated with Lower Abortion Rates
The abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 in Latin America, regions where abortion is illegal under most circumstances. The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds. Levels of abortion are much less directly tied to the legal status of abortion than to the incidence of unintended pregnancy. Some of the world's lowest abortion rates are in countries with the most liberal abortion laws. In the Netherlands, abortion is legal, free and widely available; however, the abortion rate is less than half of the U.S. rate. Dutch women, like American women, want small families, marry late and experience high rates of premarital sexual activity. However, in contrast to the United States, the Netherlands has a low incidence of unintended pregnancy, because of comprehensive sex education programs, easy access to contraceptives (including through a national health insurance program), effective contraceptive use and the high value society places on contraceptive use. At the other end of the spectrum, abortion rates are often highest in many of the countries where the procedure is most severely restricted.
Suicide
The act or an instance of intentionally killing oneself
Human Cloning
The asexual production of a new human organism that is, at all stages of development, genetically virtually identical to a currently existing or previously existing human being. It would be accomplished by introducing the nuclear material of a human somatic cell (donor) into an oocyte (egg) whose own nucleus has been removed or inactivated, yielding a product that has a human genetic constitution virtually identical to the donor of the somatic cell. (This procedure is known as "somatic cell nuclear transfer," or SCNT). We have declined to use the terms "reproductive cloning" and "therapeutic cloning."
And Both Groups Are Overrepresented Among Abortion Patients
The largest group having abortions (accounting for 36% of procedures) are non-Hispanic white women. Black and Hispanic women together make up more than half (55%) of women having abortions. This proportion is greater than their proportion in the population because they have a higher rate of unintended pregnancy; additionally, black women are more likely than other groups of women to resolve an unintended pregnancy through abortion. About 9% of women having abortions are Asian, Pacific Islander or Native American.
Women in Their 20s Make Up the Majority of Abortion Patients
The majority (58%) of women having abortions are in their 20s. Fewer than 1% are younger than 15, while 17% are aged 15-19. More than four-fifths of pregnancies among teenagers are unintended, and teenagers account for more than one in five unintended pregnancies nationwide. Abortion numbers and rates decline with age because fecundity declines, use of contraceptive sterilization increases and women's likelihood of being married grows. Marriage makes it easier to use contraceptives effectively and to continue an unintended pregnancy if it occurs. For teens, abortion rates and numbers decline because of an increasing number of teens delaying first sex, improvements in teens' contraceptive use and a relatively high likelihood of teens continuing unwanted pregnancies.
Causes of Abortion-related deaths
The most common causes of abortion-related death are infection and hemorrhage. Infection: 27% Hemorrhage: 24% Embolism: 17% Anesthesia: 16% Other: 15%
Poor Women are also overrepresented among abortion patients
The need for abortion spans the economic spectrum; however, low-income women are overrepresented among abortion patients. Some 69% of women having abortions in 2008 were poor or low-income (living at less than twice the poverty level, or less than $35,200 for a family of three), compared with 35% of women in the general population. Nearly one-fifth of abortion patients were above 300% of the federal poverty level. Low-income women are less likely than high-income women to end an unintended pregnancy by abortion; however, because low-income women have high rates of unintended pregnancy, they have higher abortion rates than high-income women.
Abortion Statistics
The numbers are on slow decline on the terms of abortion 20-24 is the highest % Under 15 - high likelihood that they'll get an abortion
Unintended pregnancy rates have risen among poor women even as they have fallen among higher income women
The rate of unintended pregnancy among poor women (those with incomes at or below the federal poverty level) in 2008 was 137 per 1,000 women aged 15-44, more than five times the rate among women at the highest income level (26 per 1,000). Poor women's high rate of unintended pregnancy results in their also having high rates of both abortions (52 per 1,000) and unplanned births (70 per 1,000). In 2008, poor women had an unintended birth rate nearly six times as high as that of higher-income women (at or above 200% of poverty.) Poverty line is $12,000 or less as an individual
Incidence of Unintended Pregnancy and Abortion
The typical American couple wants to have two children. To achieve this goal, a woman will spend roughly five years trying to become pregnant, pregnant or postpartum—and 30 years trying to avoid pregnancy. Women, then, are highly motivated to use contraceptives, and virtually all women do. Ninety-nine percent of women who have ever had sex have used some method of contraception. But 30 years is a long time to use contraceptives flawlessly. Contraceptives can fail, and mistakes can happen.
Arguments against presumed consent
There will be false positives, that is, persons who were 'presumed" to consent but who, in fact, objected to donation. Problems in Registering and Transmitting Objection Status in a timely fashion. Individual Autonomy Speaks to a Core Value. To Decide Whether to Consent is Not a Dichotomous Choice.
Genetic Problems - Chromosomal
Trisomy - 3 copies of chromosome Down's syndrome (trisomy 21) Trisomy 13 (Patau) Monosomy - 1 copy (missing one)
Nearly Half of Abortions Are Obtained by Never-Married Women
Two-thirds of abortions are obtained by never-married women. Married women account for a low proportion of abortions (15%), in part because they have a low rate of unintended pregnancy; those who experience an unintended pregnancy are more likely than unmarried women to continue the pregnancy. 29% of abortions occur among women living with a male partner to whom they are not married. This is a group at very high risk of unintended pregnancy and abortion. The proportion of unintended pregnancies terminated by abortion ranges from 67% among formerly married women and 57% among never-married women to 27% among currently married women
Incidence of Pregnancy and Abortion in the United States
Unintended pregnancy and abortion are common among all groups of women. Certain groups of women are at greater risk of unintended pregnancy than are others. Half of all pregnancies are unintended. Four in 10 unintended pregnancies end in abortion
Persistent Vegetative State
Vegetative State that has lasted for more than a month. The criteria is the same as for Vegetative State The use of this term is considered controversial because it implies a prognosis.
Problems with cloning technologies
Very low success rates: Dolly - 276 attempts, Animals to date - 0.3-1% success rate Expensive Ethical issues: Use of embryos, use of surrogate mother, genetic manipulations Environmental/developmental issues: 30% of clones born alive are affected with "large offspring syndrome" or other debilitating disorders, many die prematurely from infections or other complications, unknown issues regarding mental development Premature aging: Programming errors Somatic cell nuclear transfer involves use of genetic material (DNA) from aged cell, Reprogramming cell/DNA to produce express genes important for development, May use multiple transfers to overcome these problems, New cell must be acceptable to surrogate mother Imprinting: A process whereby DNA obtains biochemical marks that instruct a cell how and when to express certain genes. Imprinting often results in gene expression from only one copy of a gene - either the maternal or paternal copy. Telomere Shortening
Virtually All Abortions in Africa and Latin America Are Unsafe
Virtually all unsafe abortions in Europe occur in Eastern Europe, where the abortion rate that is nearly four times that of Western Europe. This discrepancy corresponds with Eastern Europe's relatively low levels of modern contraceptive use and low prevalence of highly effective methods such as the pill and the IUD. After a striking decline in the abortion rate between 1995 and 2003, from 90 to 44 per 1,000 women, Eastern Europe experienced virtually no change in the rate between 2003
Waitlist and Transplant Activity for Liver
Wait list - 12,000 and increasing and is stable around 16,000 total transplants - slightly increasing deaths - staying the same
Wait list and Transplant Activity for lung
Wait list - decreasing total transplants - slightly increasing deaths - staying the same
Wait list and transplant activity for heart
Wait list - decreasing total transplants - stable deaths - slightly decreasing
Wait list and transplant activity for kidneys
Wait list - increasing total transplants - slightly increasing deaths - staying the same
Fetal Development - 1st trimester
Week 1 - since conception occurs prior to the diagnosis of pregancy, the gestational period is usually calculated as 40 weeks from the start of the last period. This takes into account that ovulation typically occurs 2 weeks after the start of a menstrual cycle Week 2 - Fertilization Week 3 - Implantation Week 4 - Embryonic period (1/25 inch) Week 5 - Heart beat (1/17 inch) Week 6 - Neural tube closes (1/8 inch) Week 7 - Umbilical Cord appears (1/3 inch) Week 8 - Fingers and toes form (1/2 inch) Week 9 - Movement Begins (1 inch) Week 10 - Neurons Multiply Week 11 - Sex May be apparent Week 12 - Fingernails and toenails appear (3 inches)
Fetal Development - 2nd Trimester
Week 13 - Baby flexes and kicks Week 14 - Hormones gear up Week 15 - Skin begins to form Week 16 - Facial Expressions possible (4-5 inches) Week 17 - Fat accumulates Week 18 - Baby begins to hear and swallow Week 19 - Lanugo covers baby's skin Week 20 - Halfway (6 inches) Week 21 - Nourishment evolves Week 22 - Taste buds develop (approx 1 lbs) Week 23 - Lungs prepare for outside Week 24 - Sense of balance (1.5 lbs, 50% survival) Week 25 - Exploration continues Week 26 - Eyes remain closed Week 27 - End second trimester (85% survival)
Fetal Development - 3rd Trimester
Week 28 - Baby's eyes open (15 inches) Week 29 - Movement more forceful Week 30 - Packing on pounds (1/2 lb/wk) Week 31 - Reproductive development continues Week 32 - Downy hair falls off (15-17 inches) Week 33 - Baby detects light Week 34 - Protective coating thickens Week 35 - Rapid growth continues Week 36 - Baby can suck (16-19 inches, ~6 lbs) Week 37 - Full term Week 38 - Improved organ function Week 39 - Antibodies/immunity Week 40 - Due date (19-21 inches, 7-8 lbs)
Most Women Obtaining Abortions Report a Religious Affiliation
When U.S. women having abortions are asked their religion, 37% say they are Protestant. By contrast, 50% of women aged 18-44 in the U.S. population identify themselves as Protestant. The difference suggests that Protestant women's abortion rate is lower than that of all women. The proportion of abortion patients who are Catholic is virtually identical to the proportion of all women who are Catholic. Thus, the abortion rate per 1,000 Catholic women aged 18-44 is comparable with that of all women. One in five abortion patients say they are "born-again" or "evangelical" Christians. 28% of abortion patients claim no religious identification, compared with only 16% of the population. 28% are roman catholic
What is a stem cell?
a primitive type of cell, which only exists for a short amount of time Also called progenitor cells They are cells that haven't had time to specialize/differentiate into their specific cell type: They do however have the genetic material necessary to become any type of cell Differentiation—The process whereby an unspecialized early embryonic cell acquires the features of a specialized cell such as a heart, liver, or muscle cell.
Abortion
a procedure, either surgical or medical, to end a pregnancy by removing the fetus and placenta from the uterus
Medical Abortion
abortion caused by medicine or pharmacologic abortion MTX: Methotrexate & Misoprostol Methotrexate attacks rapidly dividing cells misoprostol (brand name: Cytotec): Causes uterus to contract and empty Taken within the first 7 weeks of pregnancy
Purposes of cloning to produce children
allow infertile couples or others to have genetically-related children permit couples at risk of conceiving a child with a genetic disease to avoid having an afflicted child allow the bearing of a child who could become an ideal transplant donor for a particular patient in need enable a parent to keep a living connection with a dead or dying child or spouse enable individuals or society to try to "replicate" individuals of great talent or beauty
Therapeutic cloning
also called nuclear transplantation: Involves transferring the nucleus and hence the genetic makeup of a somatic cell into an egg cell whose nucleus has been removed. egg is allowed to divide eventually forming a blastocyst of cells with an inner and outer layer of cells Inner cluster= the inner cell mass; contains pluripotent stem cells addresses the risk of rejection by the body because the person wanting the transplant uses their own DNA to fuse with the egg cell. Controversial because hypothetically if allowed to divide, the blastocyst would develop into a human being: Different than cloning whole animals (eg. Dolly)
Genetic Testing: Types/timing of testing
carrier screening, which involves identifying unaffected individuals who carry one copy of a gene for a disease that requires two copies for the disease to be expressed preimplantation genetic diagnosis prenatal diagnostic testing newborn screening Pre symptomatic testing for predicting adult-onset disorders such as huntington's disease conformational diagnosis of a asymptomatic individual forensic/ identity testing/ parental Pharmacogenetics
Induction abortion
for later term abortions labor may be induced with drugs salt water, urea, or potassium chloride to terminate the viability of the pregnancy rarely used used when there is a medical problem
Medical Abortion (cont.)
mifepristone (brand name: Mifeprex (aka RU 486): blocks progesterone, causes uterine lining to thin typically results in heavy menstrual flow Side effects: excessive bleeding, fever, severe pain 97% effective Must be taken within first 7-9 weeks of pregnancy or within 49 days since the start of the last menstrual cycle
Advanced Directives: Living Wills
one type of advance directive. It only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will doesn't let you select someone to make decisions for you
Minimally conscious state (MCS)
presence of partial consciousness
Coma
state of unconsciousness from which the individual cannot be awakened, in which the individual responds minimally or not at all to stimuli, and initiates no voluntary activities Persons in a coma appear to be asleep, but cannot be awakened no meaningful response to stimulation Persons who sustain a severe brain injury can make significant improvements, but are often left with permanent physical, cognitive, or behavioral impairments
Euthanasia (assisted suicide)
the act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection or the suspension of extraordinary medical treatment etymology (good death)
Hospice Team
the patients personal physician; hospice physician; nurses; home health aides; social workers; clergy or other counselors; trained volunteers; and speech, physical and occupational therapists
