Chapter 9 Bioethical Issues in Healthcare Copyright 2012

Question • What is Bioethics? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams

The History of the Evolution of Bioethics • Study of ethical issues • Result from technologic and scientific advances – Biology – Medicine • Increased number of issues surrounding the delivery of healthcare Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? All bioethical issues are associated with conditions related to the beginning of life. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bioethical Issues Related to the Beginning of Life • Family planning • Problems of consent and family planning • Abortion • Prenatal testing • Sterilization Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bioethical Issues Related to the Beginning of Life (cont. ) • Artificial insemination • Assisted reproductive technology • Choosing children outside of marriage • Surrogate mothers • Sperm banks • Right to genetic information Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Fundamental bioethical issues concerning death are affected by the changing definition of death. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • True • Rationale: Fundamental bioethical issues concerning death are affected by the changing definition of death and the decision about when it occurs. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bioethical Issues Concerning Death • Death defined • Planning for end of life issues – Futile treatments – Ethical issues surrounding advance directives and living wills • Euthanasia – Negative euthanasia – Positive euthanasia Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Although many courts, based on individual circumstances, have accepted positive euthanasia, negative euthanasia remains controversial. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • False • Rationale: Although many courts, based on individual circumstances, have accepted negative euthanasia, positive euthanasia remains controversial. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bioethical Issues Concerning Death (cont. ) • Rights issues surrounding death – Withdrawing and withholding treatment – Positions on withholding and withdrawing treatment – Assisted suicide – The right to refuse treatment Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bioethical Concerns Related to Sustaining Quality of Life • Organ and tissue transplantation • Concerns about organ procurement • Artificial organs • Minority groups and organ donation • Concerns about allocation of organs • Xenotransplantation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? The area of human genetic

Answer • True • Rationale: The area of human genetic research has raised many ethical questions, including how this knowledge should be used, rights to privacy, and who in the healthcare delivery system carries the responsibility for making testing, diagnosis, and cost-effective care available to patients. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Human Genome Project • Identify all the approximate 30, 000 genes in human DNA • Determine the sequences of the 3 billion chemical pairs that make up human DNA • Store this information in databases • Improve tools for data analysis • Transfer related technologies to the private sector • Address the ethical, legal, and social issues that may arise from the project Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Gene theory holds great promise for diseases and conditions for which there is no cure, is laden with bioethical concerns, particularly those related to whether a blastocyst should be considered a human life. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • False • Rationale: Stem cell research, which holds great promise for diseases and conditions for which there is no cure, is also laden with bioethical concerns, particularly those related to whether a blastocyst should be considered a human life. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gene Theory • Can take the form of somatic or germ cells • Somatic gene therapy results in the recipient’s genome being changed, but the change is not passed down to the next generation • Decisions on clinical applications of gene therapy approaches are under the oversight of the federal government • Primarily experimental • Experienced more failures than successes Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stem Cell Research • Stem cell—special kind of cell that is able to renew itself and give rise to specialized cell types • Holds great promise for diseases and conditions for which there is no cure • Major bioethical concern is related to whether a blastocyst should be considered a human life Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? The area of behavior control

Answer • True • Rationale: The area of behavior control is subject to bioethical review. Recent legislation focused on patient self-determination and rights have provided guidance in this area. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Other Bioethical Issues • Truth telling and healthcare providers • Ethical concerns and behavioral control • Rationing of healthcare Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins