1. 11 Ethical and Bioethical Issues in Medicine
Journal Topic: What are some ethical issues of organ transplantation.

2. Learning Objectives Define the key terms.
List and discuss at least 10 bioethical issues the modern physician and healthcare professional face.
Describe how an ethical decision-making model, such as the Seven-Step Decision Model, can be used when confronted with difficult ethical dilemmas.
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3. Learning Objectives
Discuss ethical issues relating to genetic testing.
Describe the advances in human stem cell research.
Summarize the ethical issues of organ transplantation.
Discuss the importance of codes of ethics such as the Nuremberg Code.

4. Early History Hippocratic Oath, 400 B.C.
Hippocrates, "Father of medicine"
Principles for his medical students to follow
Principles stated in oath found in many professional codes of ethics today

5. Ethical Standards and Behavior
Moral principles or practices
Customs of the medical profession
Matters of medical policy
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6. Ethical Standards and Behavior
If accused of unethical behavior or conduct
Can be issued warning or censure (criticism)
The AMA Board of Examiners may recommend expulsion (forced out) or suspension
If convicted of crime, may result in fine, imprisonment, or revocation of license

7. Codes of Ethics Adopted by professional organizations
Summarize basic principles and behavior expected by all in that discipline
Meant to govern conduct of members of given profession

8. American Medical Association (AMA) Principles of Medical Ethics
Discusses
Human dignity
Honesty
Responsibility to society
Confidentiality
Need for continued study
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9. American Medical Association (AMA) Principles of Medical Ethics
Discusses
Patient autonomy
Responsibility to improve community
Responsibility to patient
Support access to medical care for all people

10. Judicial Council Opinions of the AMA
Comprised of nine members
Interpret Principles of Medical Ethics
Council's interpretation or clarification published for AMA members
All members are expected to cooperate with physician in upholding these principles

11. Codes of Ethics for Other Medical Professionals
Nurses' Code of Ethics
Developed by American Nurses Association (ANA)
Code discusses nurses' obligation to protect privacy, respect dignity of patient, maintain competence, and assume responsibility and accountability for judgments
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12. Codes of Ethics for Other Medical Professionals
Code of Ethics of the American Association of Medical Assistants (AAMA)
Provides guidance for many of the dilemmas regarding right and wrong that medical assistants face on an almost daily basis
Concerned with doing the right thing at the right time

13. Bioethical Issues Issues resulting from advances in medical technology
Cloning
Harvesting embryos
In-vitro fertilization
Scientists are able to decode our genetic composition
Stem cell research has become an important topic

14. Organ and Tissue Donation
People may voluntarily donate their organs and tissues
Advance directives
Law prohibits sale of organs
National Organ Transplant Law of 1984
United Network for Organ Sharing (UNOS) system
More than 106,000 people listed on the waiting list

15. United Network for Organ Sharing (UNOS)
Legal entity in United States
Responsible for allocating organs for transplant
Gives half weight to consideration of medical need and other half to considerations of justice

16. The Ethics of Transplant Rationing
Criteria for rationing transplants are controversial
In donation model, organs are taken (harvested) with consent of donor (or donor's surrogate representative)
The Uniform Anatomical Gift Act permits competent adults to allow or forbid use of their organs after death
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17. The Ethics of Transplant Rationing
Social utility method of allocation
Careful screening and matching of the donor
Survival probability evaluated
Justice
Gives everyone an equal chance

18. Ethical Issues and Personal Choice
May have a personal, religious, or ethical reason for not wishing to be involved in particular procedure
Preference should be stated before one is hired
Ethics of employer must be in agreement with ethics of the health care professional

19. The Ethics of Biomedical Research
Human beings cannot be used for testing unless they consent to participate
Must obtain consent
Nontherapeutic research
Justification for all medical research is that benefits must outweigh risks
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20. The Ethics of Biomedical Research
Researcher must abide by established standards for testing
Department of Health and Human Services (HHS) implements government standards
Institutes that receive federal research funds must have Institutional Review Board (IRB) to oversee research

21. Consent
Informed consent necessary when patient involved in therapeutic research
Must be made aware of all risks involved
Must be informed about type of research design that is used
Physician must explain all facts of research, even if this means patient may decide not to participate

22. Clinical Trials Organized medical studies
Overall objective is to determine if the product is safe and effective
Many patients who participated in clinical trials have received benefit
Not all clinical trials have a positive outcome.

23. When Research Can Resolve Debate over the Best Treatment
Medical research does not always give the answers
Sometimes treatment actually harms the subject

24. Conflict of Interest
May arise if researcher's interests are placed above interests of the patient

25. Ethics of Randomized Test Trials
Many believe it is unethical to use control groups because participants have no hope of benefiting from the study
Race-based control group may produce ethical dilemmas; for example, it is unethical unless evidence suggests participants will benefit by the therapy

26. Problems with the Double-Blind Test
Neither experimenter nor patient knows who is getting research treatment
Ethical question arises with informed consent
Are patients fully aware that they may not be receiving any treatment whatsoever?

27. Human Genome Project
Begun in early 1990s and completed in 2003, the Human Genome Project is a research program by federal government
Its purpose is to determine or "map" and sequence total number of genes
Complete set of genes known as human genome
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28. Human Genome Project
Provides better understanding of process of human evolution
Provides improved understanding of relationship between certain genes and disease
Goal is eventual elimination or control of genetic diseases

29. Genetic Engineering Cloning
Group of genetically identical cells that come from a single common cell
Permits study of genetic development and genetic diseases
Opposition
Mutation
Emotional risks
Abuse of technology
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30. Genetic Engineering Gene therapy
Gene is spliced onto the DNA of body cells to control the production of a particular substance
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31. Gene Therapy Still in its infancy Opportunities are limitless
Scientists are investigating many unanswered questions
Many ethical and moral problems

32. Genetic Engineering Human stem cell research
Master cells in the body that can generate specialized cells
Stem cells can grow into any cell or tissue in the body
Controversy over the use of frozen embryos to conduct the research
Congress banned all federal financing for new stem cell research

33. Whistle Blowing Publicly reporting a dangerous situation
Employee needs to
Exhaust all other means
Have documented evidence
Believe that changes to prevent harm or injury will take place