AMA 103 Ethical
Concepts
Human Genome Project
• Completed in 2003
• Numbers of encoded genes unknown
• International Human Genome Sequencing
Consortium established in 2004
– Led by United States and Dept of Energy
– Working on encoding genes
– Successful or not?
Genetic Procedures
• Genetic screening and testing
– Voluntary
– Mandatory
– Used to treat diseases
– Screening for pregnant women
Genetic Counseling
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Voluntary
Provides information
Does not dictate decisions
Becomes part of medical record
Sterilization
• World’s most popular form of birth control
• Carriers for serious disease may consider
sterilization
• Ethical considerations
• Legal considerations
Assisted Reproduction
• Artificial insemination
– AIH
– AID
– Legal implications
– Ethical implications
In vitro Fertilization
• “Fertilization in glass”
• Woman has donor’s eggs fertilized by
husband’s sperm; implanted into her
uterus
• Woman carries embryo of donor’s ova and
donor’s sperm
• Woman receives donated embroys from
completed in vitro fertilization (embryo
adoption)
Surrogacy
• Substitute
• Potential options
– Sperm injected into surrogate to fertilize her
egg
– Retrieve egg, inseminated by partner,
transferred to surrogate
– Donor sperm, donor egg creates embryo,
transferred to surrogate
Legal and Ethical Issues
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Informed consent
Agreements in writing
Confidentiality
Cost of assisted reproduction
Legal parentage
Infant rights
Fetal Tissue Research
• Holds promise for medical research and
treatment of diseases
• Has politically rocky road
• Federal funding first restricted; then
released; restricted again
• Controversy of cells coming from induced
abortion
• Ethical and legal considerations
Considerations for Employees
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Keep knowledge up-to-date, current
Demonstrate professional attitude
Protect confidentiality
Assist in informed consent process
Explore personal views prior to
employment
Fetal Development/When Does Life
Begin?
• Spermatozoon +
ovum
• Zygote
• Mitosis
• Blastocyst
• Embryo
• Fetus
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Conception
Brain function
Quickening
Viability
Birth
Ethics and Abortion
• Are there any reasons to justify abortion?
• Are current laws regarding abortion
consistent, fair, and just?
• Are abortions appropriate methods of birth
control?
Professional Protocol
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Understand personal feelings, beliefs
Participate within the law
Provide accurate medical knowledge
Obtain written, informed consent
Provide counseling
Professional Protocol
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Refer if needed
Keep records confidential
Seek legal counsel when indicated
Be understanding, compassionate
Legal Issues
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Living Will
Advance Directive
The Patient Self-Determination Act
Durable Power of Attorney for Health Care
Choices in Dying
• Personal decisions?
• Controlled by technology and advanced medicine?
Uniform Determination of Death
• Act established by three organizations; identified
criterion for death
– Irreversible cessation of all circulatory and respiratory
functions
– Irreversible cessation of all functions of entire brain,
brain stem
Legal Implications
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Who decides?
Prolong life or postpone death?
Karen Ann Quinlan
Theresa (Terri) Schiavo
Ethical Considerations
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Who decides?
Role of politics?
Economics?
Role of providers, family, insurance?
Philosophy on life?
Good life versus good death?
Professional Protocol
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Follow the law
Recognize religious and cultural practices
Protect clients’ rights
Respect clients and their families
Refer for legal counsel as needed
Living With Dying
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Dying is personal
No two people die alike
Most want an “easy death”
Pain, suffering, dependence are feared
most
Suffering in Dying
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Old age and debility
Life-threatening illness
Pain and agony
Loss of control
Fear of leaving loved ones
Medical experimentation/technology
Psychological Aspects
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Anger
Depression
Inability to make decisions
Change in relationships
Loss of self-image
Change in goals
Communication difficulties
Physiological Aspects
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Use of pain medication
Loss of communication skills
Loss of bodily functions
Changes in sexual identity and
involvement
Kübler Ross’ Stages of Grief
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Denial
Anger
Bargaining
Depression
Acceptance
Death Considerations
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Hospice
Death with Dignity Act
Uniform Anatomical Gift Act
Autopsy
Professional Protocol
• Determine personal attitudes toward pain,
suffering, dying
• Converse without fear, anxiety
• Listen
• Pay attention to family needs
• Refer as indicated
• Recognize grieving