AMA 103 Ethical AMA 103 Ethical ConceptsConcepts

Human Genome ProjectHuman 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 ProceduresGenetic Procedures

• Genetic screening and testing– Voluntary – Mandatory– Used to treat diseases– Screening for pregnant women

Genetic CounselingGenetic Counseling

• Voluntary

• Provides information

• Does not dictate decisions

• Becomes part of medical record

SterilizationSterilization

• World’s most popular form of birth control

• Carriers for serious disease may consider sterilization

• Ethical considerations

• Legal considerations

Assisted ReproductionAssisted Reproduction

• Artificial insemination– AIH – AID– Legal implications– Ethical implications

In vitro FertilizationIn 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)

SurrogacySurrogacy

• 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 IssuesLegal and Ethical Issues

• Informed consent

• Agreements in writing

• Confidentiality

• Cost of assisted reproduction

• Legal parentage

• Infant rights

Fetal Tissue ResearchFetal 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 EmployeesConsiderations for Employees

• 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 Fetal Development/When Does Life Begin?Begin?

• Spermatozoon + ovum

• Zygote• Mitosis• Blastocyst• Embryo• Fetus

• Conception• Brain function• Quickening• Viability• Birth

Ethics and AbortionEthics 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 ProtocolProfessional Protocol

• Understand personal feelings, beliefs

• Participate within the law

• Provide accurate medical knowledge

• Obtain written, informed consent

• Provide counseling

Professional ProtocolProfessional Protocol

• Refer if needed

• Keep records confidential

• Seek legal counsel when indicated

• Be understanding, compassionate

Legal IssuesLegal Issues

• Living Will

• Advance Directive

• The Patient Self-Determination Act

• Durable Power of Attorney for Health Care

Choices in DyingChoices 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 ImplicationsLegal Implications

• Who decides?

• Prolong life or postpone death?

• Karen Ann Quinlan

• Theresa (Terri) Schiavo

Ethical ConsiderationsEthical Considerations

• Who decides?

• Role of politics?

• Economics?

• Role of providers, family, insurance?

• Philosophy on life?

• Good life versus good death?

Professional ProtocolProfessional Protocol

• Follow the law

• Recognize religious and cultural practices

• Protect clients’ rights

• Respect clients and their families

• Refer for legal counsel as needed

Living With DyingLiving With Dying

• Dying is personal

• No two people die alike

• Most want an “easy death”

• Pain, suffering, dependence are feared most

Suffering in DyingSuffering in Dying

• Old age and debility

• Life-threatening illness

• Pain and agony

• Loss of control

• Fear of leaving loved ones

• Medical experimentation/technology

Psychological AspectsPsychological Aspects

• Anger

• Depression

• Inability to make decisions

• Change in relationships

• Loss of self-image

• Change in goals

• Communication difficulties

Physiological AspectsPhysiological Aspects

• Use of pain medication

• Loss of communication skills

• Loss of bodily functions

• Changes in sexual identity and involvement

KKüübler Ross’ Stages of Griefbler Ross’ Stages of Grief

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Death ConsiderationsDeath Considerations

• Hospice

• Death with Dignity Act

• Uniform Anatomical Gift Act

• Autopsy

Professional ProtocolProfessional Protocol

• Determine personal attitudes toward pain, suffering, dying

• Converse without fear, anxiety

• Listen

• Pay attention to family needs

• Refer as indicated

• Recognize grieving