Bioethical Issues In
Healthcare
DEFINITION
BIOETHICS is defined as
discipline dealing with the ethical
implications
of
biological
research
and
applications
especially in medicine.
Bioethical Issues in Health care
1.
Bioethical issues related to Beginning of Life
– Family planning, Abortion, prenatal testing,
sterilization,
Artificial
insemination,
Assisted
reproductive technology
2. Bioethical issues concerning Death – Advance
Directives, Living wills, Euthanasia, Withdrawing
and with holding treatment, Assisted suicide
3. Bioethical
concerns related to sustaining
Quality of Life – Organ and tissue Transplantation,
Genetic engineering, human cloning
1. Bioethical
a.
b.
c.
d.
e.
f.
g.
issues
related
Beginning of Life:
Family planning,
Abortion,
Prenatal testing,
Sterilization,
Surrogate mother
Artificial insemination,
Assisted reproductive technology
to
FAMILY PLANNING
Refers to the various methods used to
control the size of one’s family or to
space birth.
The religious, beliefs and personal values
of individuals usually influence the
methods and approaches used
FAMILY PLANNING
Natural Family Planning
 It is based on fertility
awareness, which revolves
around
tracking
a
woman's
reproductive
cycle to determine the
days of the month that she
is most likely to conceive
and avoiding sex during
these times.
 Does not have the health
side effects associated
with artificial forms of
birth control.
Artificial Family Planning
 involves the use of birth
control pills, devices, and
sterilization surgeries.
 Sterilization, while
permanent, has the highest
rate of effectiveness in
pregnancy prevention and
can sometimes be reversed.
 Birth control methods such as
condoms and spermicide can
be purchased over the
counter, and have high rates
of effectiveness when used
properly.
PROBLEMS OF CONSENT AND FAMILY
PLANNING
In legal term the age of consent is the age at which
one is capable of giving deliberate and voluntary
agreement.
 The age of consent is established state by state and
varies from 14 to age 18 and may different for
males &females
Emancipated minor : is an individual legally under
the age of majority ,who are financially independed
,married or in the military ,may give consent for
medical treatment
Mature minor :is generally applied to individual
In their mid to late teens who are considered mature
enough to understand the treatment being
recommended and provide informed consent
ABORTION
Is the termination of pregnancy before
the viability of the fetus that is, any time
before the end of the sixth month of
gestation.
Fetal Rights
 Fetal Rights are the legal or ethical rights of fetuses.
The term is used most often in the context of the
abortion debate, as the basis for an argument in
support of the pro-life stance. Legislative measures
sometimes seek to establish the right to life of the
fetus from the moment of fertilization. Such laws
regard the fetus as a person whose legal status is on
par with that of any other member of the species
homo sapiens
Abortion: Its Bio-ethical Issues
 The two most obvious ways the issue has been framed is as a




debate between those who are pro-life and those who are prochoice.
Pro-life: They stance the frame of the issue as a refusal to
“justify the deliberate killing of an innocent human being”.
Pro –choice: They insist that those who would force a woman
to bear her child are in no way acting morally.
Instead, pro-lifers are perpetuating abusive patriarchal
structures in which women are denied a right to be their own
decision-makers about what they want to do with their body.
Both of these positions often center the debate on the status of
the fetus: is it a full-fledged person with all the rights and
dignity we accord to other fully grown persons.
PRENATAL TESTING
 Sonography, Amniocentesis and CVS: to detect
genetic abnormalities.
 Ethical concern:
 Govt. may make amniocentesis n abortion of all
defective fetuses mandatory.
 Couples may be stressed as carrying defective gene.
ASSISTED REPRODUCTIVE TECHNOLOGY (ART)
 The IVF technology is a boon to childless couples.
 A procedure in which a fine catheter (tube) is inserted
through the cervix (the natural opening of the uterus)
into the uterus (the womb) to deposit a sperm sample
from the husband or from a donor.
 The purpose of this procedure is to achieve fertilization
and pregnancy.
 Initially this technique was pioneered by Prof. Robert
Winston during 1970s which was later applied by P.
Steptoe and R. Edwards for the production of first test
tube baby.
 The first IVF baby - Louse Joy Brown, who was born on
July 25, 1978.
Artificial Insemination
AIH (artificial
insemination by husband)
AID (artificial
insemination by donor)
 AIH is also known as
 AID is also called
homologous insemination.
 A procedure in which a fine
catheter (tube) is inserted
through the cervix (the
natural opening of the
uterus) into the uterus (the
womb) to deposit a sperm
sample from the woman's
mate directly into the
uterus.
heterologous insemination.
 A procedure in which a fine
catheter (tube) is inserted
through the cervix (the
natural opening of the
uterus) into the uterus (the
womb) to deposit a sperm
sample from a donor other
than the woman's mate
directly into the uterus.
Ethical concerns
 Woman may have multiple births as several fertilized
ova are returned to uterus to ensure that at least one
will survive.
 At times this lead to abortion leading to financial and
emotional costs.
 What to be done with fertilized ova that are not
returned to the uterus?
 Donate, freeze (how long) or thrown away
(abortion)?
SURROGATE MOTHERS
 She is the one who agrees to bear a child conceived
through artificial insemination / IVF and relinquish
the baby at birth to others for rearing.
 A formal, contractual relationship is usually
established between the surrogate & the contracting
family.
ETHICAL CONCERNS
 What happens if the child is born with an anomaly
and family refuses to take the child?
 What if the surrogate becomes attached to the child
& refuses to give up custody?
 What happens if the parents divorce before the child
is born & wish to nullify the contract? What will
happen to the child?
2. Bioethical issues concerning Death –
a. Futile treatments
b. Advance Directives,
c. Living wills,
d. Euthanasia,
e. Withdrawing and with holding
treatment,
f. Assisted suicide
PLANNING FOR END OF LIFE ISSUES
 FUTILE TREATMENTS (medications, devices /
therapy): are those that are evaluated by the
healthcare team, family or both as being nonbeneficial or harmful to the patient in as much as
they cannot cure or reverse the underlying disease.
For e.g. terminally ill cancer patient.
ADVANCE DIRECTIVES & LIVING WILL
 ADVANCE DIRECTIVES are legal documents that
indicate the wishes of an individual with regard to
end of life issues & LIVING WILL allows individuals
to identify what measures to include in care if they
become terminally ill.
 Ethical concern: they are not clear, specific,
misunderstood, signing for power of attorney for
healthcare.
 EUTHANASIA: the act or method of causing death
painlessly so as to end suffering.
CLASSIFICATION
POSITIVE / ACTIVE EUTHANASIA:
•It occurs in a situation in which the
physician prescribes, supplies or
administers an agent that results in death.
•Medications given for the comfort of the
dying patient may be ethically justifiable
even if they hasten death to some extent.
NEGATIVE / PASSIVE EUTHANASIA:
•It refers to a situation in which no
extraordinary measures are undertaken to
sustain life.
•This concept has resulted in (no codes”
also called as do not resuscitate order
(DNR) in hospital.;
 WITHDRAWING AND WITHHOLDING
TREATMENT: This has been described mainly in
situations related to technical interventions
(ventilator, hemo-dialysis).
 Can also be applied by extension to chemotherapy,
artificial hydration to prolong life beyond
expectation, to delay death.
 ASSISTED SUICIDE: involves helping another end
his or her life.
 Role of the nurse should be directed toward
reversing the despair and pain experienced in the
last stages of life, and in fulfilling the obligation to
provide competent, comprehensive & compassionate
end of life care (ANA, 1994).
3. Bioethical concerns related to sustaining
Quality of Life –
a. Organ and tissue Transplantation,
b. Genetic engineering,
c. Human cloning
Organ and tissue Transplantation
 Organ transplantation is the process by which an
entire organ is removed & replaced by a
corresponding part.
 Donor can be living or recently deceased.
Genetic Engineering
 Genetic Engineering, also called genetic modification, is
the human manipulation of
an organism's genetic material in a way that does not
occur under natural conditions.
 Genetic engineering works because there is one language
of life: genes
 Genetic engineering examples: Genetic engineering has
created a goat with spider genes that creates "silk" in its
milk. Insertion of human genes into sheep so that they
secrete alpha-1 antitrypsin in their milk - a useful
substance in treating some cases of lung disease.
Human Cloning
 Human Cloning is a type of genetic engineering, but
is not the same as true genetic manipulation.
 In human cloning, the aim is to duplicate the genes
of an existing person so that an identical set is inside
a human egg. The result is intended to be a cloned
twin, perhaps of a dead child.
 Genetic engineering in its fullest form would result
in the child produced having unique genes - as a
result of laboratory interference, and therefore the
child will not be an identikit twin
Cloning Ethical Debate
 Argument against Human Cloning: Human Cloning
Constitutes Unethical Experimentation That human
cloning threatens identity and individuality.
 That human cloning turns procreation into manufacture.
That human cloning means dictatorship over children
and the perversion of parenthood.
 Scientific Debate: Human Cloning could save many lives
The Quality of Humans could be improved To develop
new organs for transplantation in humans. This could
decrease the time a patient waits for a transplant