Chapter 7 Bioethical Issues Joseph T Catalano Copyright

Code of Ethics § The earliest codes of ethics made obedience to the physician the nurse’s primary responsibility. § The present code of ethics recognizes that the primary responsibility of the nurse is the client’s well-being. § This reflects nursing’s increased self-awareness, independence, and growing accountability for its actions. Copyright © 2015. F. A. Davis Company

Abortion § Polarizing issue § Has religious, ethical, social, and legal implications § Elective abortion: voluntary termination of a pregnancy before 24 weeks’ gestation § Self-selected, or elective, abortions are those performed solely on the mother’s own decision. Copyright © 2015. F. A. Davis Company

Abortion (cont’d) § Roe v. Wade in 1973, the Supreme Court changed the legal status of elective abortion in the United States. § Ethical basis and moral status of this decision remain controversial. § No decision was made about the ethics or morality of elective abortion. § Based on the belief that people have a right to determine what they can do with their bodies (i. e. , the right to selfdetermination) and that such a right includes termination of a pregnancy. Copyright © 2015. F. A. Davis Company

Abortion (cont’d) § Fundamental issues at the heart of the abortion debate center on the question of when life begins and the right of freedom of choice. § As a client advocate, should a nurse be for or against abortion? § How can a nurse avoid influencing the woman’s decision about abortion? § Can a nurse ethically and legally refuse to assist at abortions? Copyright © 2015. F. A. Davis Company

Abortion (cont’d) § Abortion has become a hot political issue again. § Many states with conservative legislatures have passed laws that basically prevent abortions. § Restrictive state laws have closed many abortion clinics. § This may violate the national law and be ruled unconstitutional. Copyright © 2015. F. A. Davis Company

Genetics and Genetic Research § Genetically altered plants and animals are in common use in the United States. § As with most scientific research and techniques, the techniques of genetic engineering are ethically neutral. § The potential for misuse of genetic procedures is great. Copyright © 2015. F. A. Davis Company

Genetics and Genetic Research (cont’d) • Mandatory genetic screening would most likely be unethical; although the concept is not unrealistic. • Because it requires just one blood sample from a person at some point during that person’s life, it is possible that this type of screening could even be done without the individual’s knowledge or consent. Copyright © 2015. F. A. Davis Company

Genetics and Genetic Research (cont’d) § Ethical issues involved in genetic research § §

Fetal Tissue Research § Traditional fetal tissue research has been generally limited to taking living cells from an aborted fetus. § Scientists are now growing their own fetal tissue in the laboratory through artificial insemination and in vitro fertilization procedures. § Legislation to control this practice has been passed. Copyright © 2015. F. A. Davis Company

Fetal Tissue Research (cont’d) § Stem cells are the very early cells present in the developing fetus that have not yet begun to differentiate. § All the cells are identical and contain all the genetic material needed to reproduce an identical individual. § They can be separated and then placed in an environment where they will form more stem cells. § The genetic material from the stem cell can be removed and replaced, or the genetic material can be removed, manipulated, and then replaced. Copyright © 2015. F. A. Davis Company

Cord Blood Banking § Cord blood banking uses the stem cells present in umbilical cord blood to treat disease. § Embryonic (pluripotent) stem cells come from fetal tissue. § Cord blood supplies hematopoietic stem cells responsible for the development of red blood cells, white blood cells, and platelets. § Cord blood can be a viable treatment option for blood and immune system diseases, cancers, and congenital defects in adults and children. Copyright © 2015. F. A. Davis Company

Cord Blood Banking (cont’d) § Public cord blood banks take in donations that can be used for anyone in need. § Cord blood banking is mostly accepted by the general medical community. § Banks must follow the stringent guidelines set in place to allow the donated cord blood to be added to a public registry. Copyright © 2015. F. A. Davis Company

Cord Blood Banking (cont’d) § The National Marrow Donor Program keeps a list of public regional cord blood banks on their website. § Most public banks do not charge processing or storage. § Once cord blood is donated to a public bank, the family has no way to access the unit should it be needed by them in the future. http: //www. nurturingheartsbirthservices. com/blog/wp-content/uploads/2011/10/cord 1. jpg Copyright © 2015. F. A. Davis Company

Cord Blood Banking (cont’d) § Private banks charge processing and storage fees, as well as “biological insurance” premiums. § These fees can be rather high. § They may use coercive marketing designed to play on the fears of expectant parents. § Regulated by the Food and Drug Administration’s Code of Federal Regulations. Copyright © 2015. F. A. Davis Company

Cord Blood Banking (cont’d) § General consensus: Public cord blood banking, because of its altruistic nature and low cost to the donors, is more widely accepted than private cord blood banking. § The American Academy of Pediatrics advises against private cord blood storage, unless there is a family history of specific genetic diseases. Copyright © 2015. F. A. Davis Company

Organ Transplantation § Whenever a human organ is transplanted, many people are involved. § § Donor’s family Medical and nursing personnel Recipient and his or her family § All have rights and obligations. Copyright © 2015. F. A. Davis Company

Organ Transplantation (cont’d) § Three primary sources for organ and tissue donations § Living

Organ Transplantation (cont’d) § Neurological death = death § Ethical questions still linger about what constitutes death. § Because organs such as the heart, lungs, and liver need to come from a donor whose heart is still beating, some clinicians fear that there will be a tendency for physicians to declare that a person is dead before death actually occurs. Copyright © 2015. F. A. Davis Company

Organ Transplantation (cont’d) § The Uniform Anatomical Gift Act was passed to increase the supply of donor organs and reduce some of the confusion over organ donation. § The national organ recipient list attempts to list and rank, in a nondiscriminatory manner, all people who need organs. § Criteria for ranking § Need, length of time on the list, potential for survival, prior organ transplantation, value to the community, and tissue compatibility Copyright © 2015. F. A. Davis Company

Use of Scarce Resources in Prolonging Life § An issue of distributive justice. § Most public money allocated for health care is spent during the last year of life for many elderly clients. § The traditional belief has been that life should be preserved at all cost and by any means available. § The hospice care movement and a growing number of physicians and other health-care professionals support palliative care for the terminally ill that provides pain relief and comfort measures but does not try to prolong the person’s life. Copyright © 2015. F. A. Davis Company

Use of Scarce Resources in Prolonging Life (cont’d) § The ethics of tube feeding § Tube feeding is a relatively simple procedure. § It is a way of maintaining nutrition and hydration, two of the most basic needs of life. § When do tube feedings stop being beneficial to clients? § Is there a right to death with dignity? § What ethical rationales could be used for removal of the feeding tube in this case? Copyright © 2015. F. A. Davis Company

Use of Scarce Resources in Prolonging Life (cont’d) § Should care be restricted? § How do you feel about universal health-care coverage? § Should taxpayers pay for people who do not take care of their health—smokers, drug abusers? § What criteria should be used to determine who gets advanced health-care technologies? Copyright © 2015. F. A. Davis Company

Use of Scarce Resources in Prolonging Life (cont’d) § The Right to Die § Active versus passive euthanasia § Advance Directives § Living will versus durable power of attorney for health care § Assisted suicide Copyright © 2015. F. A. Davis Company

HIV and AIDS § HIV and AIDS have evoked strong emotions in both the public and the medical community. § Ethical issues § § Right to privacy Right to care Distributive justice (cost to society) Nurses’ responsibilities Copyright © 2015. F. A. Davis Company

Rights of Children § The legal and ethical factors surrounding the decisions that health-care providers must make about child health issues are complicated and sometimes contradictory, ranging from laws about reporting suspected abuse to obtaining permission for treatment. Copyright © 2015. F. A. Davis Company

Rights of Children (cont’d) § Child abuse § There is a general legal requirement in most states that suspected child abuse must be reported by health-care providers as well as by anyone who suspects that child abuse has occurred. Copyright © 2015. F. A. Davis Company

Rights of Children (cont’d) § A conflicting ethical principle that is sometimes forgotten in the reporting of suspected child abuse is the family’s right to privacy and self-determination. § Decisions about reporting suspected child abuse or neglect rest on the underlying ethical principles of beneficence and protection of the best interests of the child. Copyright © 2015. F. A. Davis Company

Rights of Children (cont’d) § The role of the nurse who cares for the very young or abused child is one of client advocate. § Abused children need help and protection, and at times, for their very survival, must be taken out of an abusive home setting. Copyright © 2015. F. A. Davis Company

Child Health Care § One important difference between adults and children that always needs to be included in ethical decisions about child health issues is that children are dependents. § As dependents, children generally are not attributed the right to self-determination that is fundamental to adult decision-making. Copyright © 2015. F. A. Davis Company

Child Health Care (cont’d) § Young children are given immunizations and medications, have blood drawn for tests, and even have operations such as tonsillectomies or myringotomies, all without being asked for their permission. § When do they develop the capacity for rational decision-making? § How should they be treated until they develop this capacity? Copyright © 2015. F. A. Davis Company