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11 Ethical and Bioethical Issues in Medicine
Journal Topic: What are some ethical issues of organ transplantation.
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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. continued on next slide
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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.
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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
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Ethical Standards and Behavior
Moral principles or practices Customs of the medical profession Matters of medical policy continued on next slide
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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
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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
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American Medical Association (AMA) Principles of Medical Ethics
Discusses Human dignity Honesty Responsibility to society Confidentiality Need for continued study continued on next slide
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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
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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
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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 continued on next slide
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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
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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
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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
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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
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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 continued on next slide
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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
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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
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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 continued on next slide
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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
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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
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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.
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When Research Can Resolve Debate over the Best Treatment
Medical research does not always give the answers Sometimes treatment actually harms the subject
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Conflict of Interest May arise if researcher's interests are placed above interests of the patient
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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
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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?
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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 continued on next slide
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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
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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 continued on next slide
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Genetic Engineering Gene therapy
Gene is spliced onto the DNA of body cells to control the production of a particular substance continued on next slide
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Gene Therapy Still in its infancy Opportunities are limitless
Scientists are investigating many unanswered questions Many ethical and moral problems
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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
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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
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