Health Science Ethics - GMS 6871-005 - Chapter 9 - Controversial Issues in Health Care

If a patient is considering organ donation, what advice can you give him or her?

- increase awareness of the need for donated organs and educate patients on the advanced directives available to them

Ethical Concerns for Genetic Testing

-Burlington Northern Santa Fe Railroad -testing is new and not entirely reliable -testing merely reveals a predisposition for developing a cancer, not a certainty -if only possibility, then should health insurance companies be required to pay for preventative measures? -screening of children for certain traits in utero or after birth -misuse of genetic information can lead to problems (eugenics)

United Network for Organ Sharing

-Organ Procurement and Transplantation Network is operated by this organization -awarded the contract in 1986 -focuses on sharing organs from deceased donors in an efficient and equitable manner -maintains list of potential organ recipients and works on educational efforts to increase organ donation nationwide

what countries pay donors or have altered their systems for organs?

-Singapore (36k) -Iran -Israel (bottom of list if you aren't willing to donate) -Great Britain operates under presumed consent (at time of autopsy)

Three common sources of stem cells are _______________ _______________, _______________ _______________ _______________, and _______________ _______________ _______________ _______________ _______________ _______________.

-bone marrow -umbilical cord blood -embryos created by in vitro fertilization

what ethical issue has arisen with Pres. Obama's Affordable Health Care Act

-catholic church refuses to pay for contraceptives as part of its benefits package -can an employer force its moral standards on an employee? -should an employee be able to opt out of job requirements simply because of moral differences?

Burlington Northern Santa Fe Railroad

-company was taking blood samples from employees and using them to screen for predisposition to carpal tunnel syndrome -employees told blood test was mandatory but did not give an explanation to the employee (super secret)

Scientists involved in stem cell research hope to find _______________ for diseases and other therapeutic treatments to _______________ the lives of patients with debilitating injuries and birth defects.

-cures -improve

Henrietta Lacks

-developed cervical cancer at 30 years old -tissue samples of her cancer were taken by a scientist at Johns Hopkins and given to a scientist trying to grow lines of human cells to be used for research purposes -first human cells to grow successfully in an artificial environment - used to develop cure for certain diseases like polio and for gene mapping -HeLa cells used by many who benefited financially and in their research, while Lacks and her family never benefited financially from any of this research

Catherina Cenzon-DeCarlo

-devout catholic who was asked to help with an abortion procedure -had expressed religious objections when interviewed for the job -patient had pre-eclampsia -Catherina led to believe that this was a medical emergency, though after the fact it was found to not be -additionally, threatened with charges of patient abandonment and insubordination if didn't assist

Eugenics

-effort to improve the genetic makeup of a population -the science of improving a human population by controlled breeding to increase the occurrence of desirable heritable characteristics -practiced by Nazi Germany

If a patient is considering using stem cells, what advice can you give him or her?

-if patient asks questions or raise concerns, it is always best to refer them to their primary physician. Anything else would be outside the scope of practice of most allied health professionals.

Human Genome Project

-in 2003 succeeded in mapping the human DNA sequence

Genetic Testing

-in healthcare, can be used to determine if someone has a genetic disorder, will develop one, or is a carrier -used by legal system to match samples from crime scenes to criminal suspects -used by courts to establish paternity and thereby ensure financial support is provided to mothers and their children

As the conscience clause is written now, can pharmacists refuse to fill prescriptions used to prevent or terminate pregnancies?

-in some states yes, in some states no

ethical issues surrounding paying for organ donation

-may prey on lower-income families who might consider selling a kidney to pay off a credit card debt -quality regulation -long term consequences of decisions -donating to someone you don't even know

advantages and disadvantages to using umbilical cord blood stem cells or bone marrow stem cells

-more compatible with all body types and appear to grow more rapidly -but cord blood doesn't generate a high number of usable stem cells -as the stem cells are duplicated they begin to lose their effectiveness -and both adult and umbilical cord stem cells have a greater risk of rejection by patients

Dickey-Wicker Amendment

-originally signed in 1995 by President Bill Clinton, renewed every year since -an amendment to a federal bill providing funding to the NIH -prohibits the use of federal funding of research that creates, destroys, or harms embryos -2001: Pres. George W. Bush allowed federal funds to be used on stem cell lines already created but no new lines allowed to be created -2009: Pres Obama reversed Pres. Bush's mandate -does not prohibit the use of federal funds on stem cells that were created by institutions funded with non-federal money

The Uniform Anatomical Gift Act

-passed in 1968 -allows anyone 18 years of age or older to donate body parts for the purpose of transplantation after his or her death -also allows next of kin to give permission regarding the donation of body parts -also addresses the donation of bodies for medical research or study -as a part of an advance directive, any living person can volunteer to donate organs

National Organ Transplantation Act

-passed in 1984 -simplifies and organizes the donation of organs by creating a network for registering and matching organ donor recipients -Organ Procurement and Transplantation Network (OPTN) = private, nonprofit organization that contracts with the federal government

Sterilization

-process to reduce the risk of continuing a genetic line -occurred in the US where states passed laws mandating the sterilization of "mentally ill" patients to prevent continuation of their genetic line -laws eventually overturned, but not before thousands of patients were sterilized

If a patient is considering participating in a research study, what advice can you give him or her?

-provide all options (including the clinical study and palliative care) to the patient and let the patient choose what he or she thinks is best

ethical issues of matching organs

-race - more caucasian organs donated, so caucasians get matched more quickly -if patient has been waiting a long time, their health may decline, which then puts them lower down on the list -geographic location - organs can only survive for a limited time once they are harvested. patients with financial ability to travel on short notice might make arrangements to be on more than one waiting list

DNA

-small code contained in all human cells that determines our characteristics -having a map of our personal DNA allows scientists to complete genetic testing

Blastocyst

-source of embryonic stem cells -develops shortly after a sperm and an egg are joined together to create a fertilized embryo -if stem cells are taken, will destroy the embryo

According to the _______________ _______________ _____ _______________, patients have the right to decide whether or not to participate in _______________ _______________.

-the Patient Bill of Rights -research studies

Cloning

-the copying of cells to create copies with similar genetic content -considered appropriate for research purposes only (HeLa cells) -concept of cloning life forms is too controversial at this time

Stem Cells

-undifferentiated cells found in embryos that have the ability to self-replicate either as copies of themselves or as copies of other types of cells -3 main sources: bone marrow, umbilical cord blood, and embryos created by in vitro fertilization

The United Network for Organ Sharing maintains a _______________ _______________ and matches donated _______________ to potential transplant recipients

-waiting list -organs

ethical issues with conscience clause

-whether healthcare professionals should be allowed to decline normal job duties that they find offensive -healthcare professionals have an ethical obligation to research their job duties carefully before accepting a job -should they even have taken the job in the first place?

Who said, "Controversial proposals, once accepted, soon become hallowed."?

Dean Acheson

True or False: All religions disagree with embryonic stem cell research.

False -Embryonic research bad: Catholicism, Fundamentalist Christianity, some Protestant sects -Embryonic research ok: Islam, Judaism -Embronic research unclear: Buddhism and Hinduism

True or False: All funding for stem cell research comes from federal sources.

False -both federal and state laws restrict the funding of stem cell research that involves stem cells obtained from embryos -Dickey-Wicker Amendment prohibits the use of federal funding for research that creates, destroys, or harms embryos

True or False: Organs are given out on a first come first-served basis

False; variety of factors determine a match, including compatibility, location, and the age/size of both the donor and the recipient, along with the health condition of both the donor and the recipient

True or False: The conscience clause can be used at any time in a healthcare professional's career

False; -legally a healthcare professional must tell an employer that he/she wishes to utilize the conscience clause at the time of hire

In 2003, the _______________ ________________ ______________ succeeded in mapping out the human DNA sequence.

Human Genome Project

True or False: Nazi Germany used the philosophy of eugenics to justify medical experiments and extermination of citizens

True; non-white and Jewish citizens

Which sources of stem cells are considered less controversial?

adult stem cells (bone marrow) and umbilical cord blood