Legal Aspects of Healthcare Ch. 7

Define Bioethics
The study of ethical issues that result from technologic and scientific advances, especially in biology and medicine.

Three major areas of bioethical dilemmas society has faced during the past 50 years.
Relating to the:
– Beginning of Life = Family Planning, Abortion, Perinatal Ethics, Eugenics
– Sustaining and Improving Quality of Life = HIV/AIDS, Organ transplantation, Genetic Science (stem cell research, gene therapy etc)
– Death and Dying = End of Life Planning, Euthanasia, Withholding/withdrawing life support

Family Planning
The behavior associated with controlling the size of one’s family or births within that family; encompasses controlling family size thru contraception and increasing family size thru adoption or infertility.

What is contraception and which ethical components are related to related to it?
Contraception is Birth Control; efforts to interfere with conception or impregnation thru voluntary or artificial means.
Ethical Components:
– Autonomy
– Best Interest Standard
– Paternalism
– Right to personal liberty

Explain three methods of infertility treatment
1. Artificial Insemination
2. In Vitro Fertilization (fertilized outside human body)
3. Surrogate Mother
** All may have ethical issues – for which autonomy, beneficence/nonmaleficence, justice & rights must be considered.

Artificial Insemination
planting of sperm into a woman’s body to facilitate conception

In Vitro Fertilization
Fertilization of human eggs (gametes) outside the human body in a test tube or other artificial environment

Surrogate Mother
One who agrees to bear a child conceived throu artificial means, and relinquishes it upon its birth to others for rearing.

Define abortion and list the three different forms of abortion.
The termination of pregnancy before the viability of the fetus (sometimes considered a form of family planning)
1. Spontaneous Abortion/ Miscarriage
2. Therapeutic Abortion
3. Elective Abortion
Therapeutic and Elective are focus of ethical issues.

Spontaneous Abortion / Miscarriage
Loss of pregnancy due to natural causes

Therapeutic Abortions
Performed for medical reasons (i.e. no heartbeat found; for down syndrome)

Elective Abortions
Performed for personal reasons (do not want the child)

What was the landmark legal case brought before the U.S. Supreme Court that decided the abortion question from a rights perspective by recognizing state laws restricting abortion impaired a woman’s right to privacy and personal liberty?
Roe vs. Wade……. As a result, abortion restrictions on pregnancy were split by trimester.
1st trimester = no restrictions on abortion
2nd trimester = abortion ok in special circumstances
3rd trimester = strict restrictions on abortions

What are perinatal ethics?
Ethical questions involved in or occuring during the period closely surrounding birth. Prenatal testing, genetic screening, and prenatal surgery.

What is PRENATAL TESTING? (give 2 examples)
Tests performed after conception but before birth that are designed to detect fetal abnormalities. i.e.
– Amneocentesis
– Chronic Villus Samplins (CVS)
– Sonograms or other technological ways of viewing fetus in utero.
All pose risks to mother and fetus, and results may bring about difficult ethical decisions. (autonomy & personal liberty)

What is genetic screening and why might it be done?
Testing of a person’s genetic makeup to reveal a predisposition to certain diseases or other abnormalities. Searching for genetic defects that may affect the developing fetus.

What is prenatal surgery and why is it risky?
Surgery conducted on the fetus prior to birth. Performed so rarely..considered experimental. Fetus can contract infection after surgery, could die in utero, mother could get surgery related infection, mother could die.

What is eugenics and what were the two most common practices in eugenics during the Nazi Germany rule?
the effort to improve the human species through control of hereditary factors in mating. A breeding practice aimed at producing superior offspring.
1. Encouragement of reproduction by those groups deemed desirable
2. Sterilization of people who group of authority deems inferior
Ethical issues encompass: no justice; lack of autonomy; nonmaleficence; defines human rights

What is sterilization?
The actions taken to make an individual incapable of reproducting. may be done by: removing the reproductive organs or by preventing them from functioning effectively.

What does HIV and AIDS stand for and what are the most common causes?
HIV= Human Immunodeficiency Virus and AIDS = Acquired Immunodeficiency Syndrome. Intravenous drug use, sharing or contaminated needles, tainted blood supply used for transfusion purposes; sexual intercourse; and direct mucous-to-mucous contact.

Which is the disease: HIV or AIDS?
AIDS

Which methods can be used to contain the spread of HIV and aids?
Clean needle exchange programs for IV drug users, extensive screening of blood supplies, sexual abstinence programs, and the use of condoms during sexual intercourse.

What ethical issue do HIV/AIDS raise?
Autonomy
Confidentiality
Double-effect principle
Justice
Prohibitions exist against health-care provider disclosing status of HIV infected patient.

Why is confidentiality so important to patients who have HIV or AIDS?
Many inflicted whith HIV/AIDS have suffered from stigmatization or outright discrimination as a result of unauthorized disclosure. Without a legal reporting requirement, health-care providers may not disclose a patient’s HIV/AIDS status to third persons without consent.
Prohibition against disclosure may even continue after patient’s death.

Besides keeping confidentiality secure for HIV/AIDS patients, what ethical issues arise for healthcare workers who need to treat HIV/AIDS patients?
The helath-care provider has a duty to provide care to the infected patient… it is difficult for some providers to separate the patient suffering from HIV/AIDS from the high-risk behavior that led to the patient contracting it. **Many H.C. organizations have incorporated HIV/AIDS provisions in their code of ethics reauiring health-care provider to treat.

What are “UNIVERSAL PRECAUTIONS”?
Guidelines for use in creating a barrient to infection, thereby reducing risk to the health-care provider. (gloves, masks, protective eyewear when a threat of exposure to blood or body fluids of any patient.)

Organ transplantation is another wonderful development that improves the quality of life for some patients. Define ORGAN TRANSPLANTATION.
A form of surgery wherein one body part (tissue or organ) is transferred from one site to another or from one individual to another.

Types of Transplants:
Autografts
Allografts/ Homografts
Xenografts/ Heterografts

Autografts = transplant using one’s own body parts
Transplants using one’s own body parts

Allografts / Homografts
Transplants using a donor’s body parts

Xenografts / Heterografts
Transplants involving animal tissue, cells or organs into human bodies (usually temporary until human organ, tissue arrives)

how has the U.S. Federal Government minimized the concept of profiting from selling human organsfor profit?
1. US promotes regulations that require hospitals that receive fed. govt. funds to ensure they have in place policies requesting permission from the next of kin for the removal of organs after death.
2. Educational efforts to encourage organ donation

What is the United Network for organ Sharing and what is its purpose?
A Gov’t funded org. formed to assist with dilemmas associated with organ allocation. It serves as a CLEARINGHOUSE FOR ORGAN PROCUREMENT and MATCHING. It looks for compatibility in the tissue/blood type btw. donor & recipient.

What is one answer to the scarcity of human tissue and organ donations and where would these come from?
The use of nonhuman tissue & organs. Created artificially in a laboratory or may come from animals. Used only as temporary support until a human organ is available.

What is the Human Genome Project (HGP)?
MAPPING of THE GENES FOUND IN HUMAN DNA. The 46 Human Chromosomes together are the Human Genome. Mapping determines the sequences of the chemical base pairs that make up human DNA.

What are some of the benefits of HGP?
It contributes to diagnoses and treatment of diseases. Scientists hope to someday prevent diseases and disorders affecting humankind.

What ethical issues do HGP dilemmas present?
Justice
Fairness
Privacy
Confidentiality
of genetic information

What are some of the risks of participating in HGP as a patient?
The practice of HGP shows promise, but no real success yet. It is not known if there are harmful ramifications from this type of testing.

What is GINA?
Genetic Information Nondiscrimination Act.

What is GINA designed to do?
– It addresses the ethical issue of confidentiality of genetic information.
– It provides protection of genetic information in the contexts of insurance and employment.
– Prohibits use of genetic info. as a condition of eligibility for insurance
– Prohibits employment discrimination based on genetic info.

What is gene therapy?
Genetically altering organisms for various purposes. It is Genetic Engineering (i.e. supplying the missing portion of a strand of DNA that is causing sickle cell anemia or cystic fibrosis) VERY EXPERIMENTAL

Is Gene Therapy testing don on Humans?
No… it is done on mice or other animals

Ethical issues presented with Gene Therapy.
Ethical concerns are: Will it be harmful to alter DNA and genetic makeup?

What is stem cell research?
Study of special cells that are not committed to specific function and that has the capability to renew itself and differentiate into specialized cells. Viewd as a promising area for medical advancement

Where do stem cells come from?
From adult cells (rare) or
From early human embryos or umbilical cord (less rare)

Ethical debates related to embryonic stem cell research…
When does human life begin?
Are embryonic stem cells human life?
Can it be justified that the cells are being used for good… for research to cure disease?
Should financing of this research be publically funded?

What is the definition of an ADVANCE DIRECTIVE (AD)
Various written documents that provide insturctions describing the dind of health care the patient wishes to have/not have if he/she becomes incapacitated. End of Life Care instructions.

Which federal law caused states to recognize Advance Directives (AD)?
Based on substantive legal rights found in state law… also recognized at the Federal level through PSDA (Patient Self Determination Act)

What are the two main types of Advance Directives?
Living WIll and Durable Power of Attorney for Health Care.

Living Will
executed while patient is competent; provides direction for decision-maker as to medical care the patient should receive in the event he/she is incapacitated or unable to make personal decisions. It specifies the patient’s wishes, thereby lessening the decision-making burden on family members and health-care providers concerning what actions they should/should not take with regard to the patient’s care.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE
allows a competent individual to name someone else (an agent) to exercise health-related decisions on his/her behalf in the event that the individual becomes incapacitated or unable to make decisions. The Person(s) empowered to act by proxy have the duty to the patient to make decisions using the Best-Interest Standard.

What is EUTHANASIA?
The act of practice of causing death panlessly, with the aim to end suffering.

What are the 2 types of EUTHANASIA?
Passive Euthanasia
Active Euthanasia

PASSIVE EUTHANASIA (negative euthanasia)
No heroic measures are taken to preserve patient’s life if vital processes have ceased to function on their own. Includes DNR = Do Not Resuscitate or “No-Code” directives.

ACTIVE EUTHANASIA (positive euthanasia)
Involves the practice of actions that speed the process of dying. i.e. the provider will prescribe, supply, or administer an agent that results in death. (Dr. Kavorkian)

What is a DNR order?
Practice of Passive Euthanasia. A Do Not Resuscitate order instructs health care providers not to engage in extraordinary measures (like CPR) or otherwise attempt to revive those persons whose vital processes have ceased to function on their own. (NO HEROIC MEASURES TO REVIVE)

What is the difference between withholding and withdrawing treatment and when would these two end-of -life practices occur?
WHITHHOLDING TREATMENT = the decision of the patient, his family, or his legal guardian to refrain from giving permission for healthcare treatment to be started.
WITHDRAWING TREATMENT = the decision of the patient, his family or his legal guardian to discontinue actiities or remove forms of patient care (like withdrawing life support machines.)

Why should healthcare providers be aware of bioethical issues?
Whthout this understanding of bioethical issues, it is virtually impossible for the healthcare provider to function or to protect both the patient and the provider.

Name the ethical concepts at issue concerning the access of minors to contraception
there are three:
a) The best interest standard
b) principle of paternalism
c) the minor possess a “right” to control her reproduction. The rights concept conflicts directly with the best interest standard and paternalism

What ethical concerns are expressed about prenatal ethics?
concerns about personal liberty and autonomy are part of ethical discussion of pernatal test, genetic screening and prenatal surgery, as a re concerns of humans “Playing “G_d.”