Download Chapter 11 - ROP Ethics in Health Care

Medical Law and Ethics
FIFTH EDITION
Ethical and Bioethical
Issues in Medicine
CHAPTER
11
Journal Topic: What are
some ethical issues of
organ transplantation.
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
1. Define the key terms.
2. List and discuss at least 10 bioethical
issues the modern physician and
healthcare professional face.
3. Describe how an ethical decisionmaking model, such as the SevenStep Decision Model, can be used
when confronted with difficult ethical
dilemmas.
continued on next slide
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Learning Objectives
4. Discuss ethical issues relating to
genetic testing.
5. Describe the advances in human stem
cell research.
6. Summarize the ethical issues of organ
transplantation.
7. Discuss the importance of codes of
ethics such as the Nuremberg Code.
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Ethical Standards and Behavior
• Moral principles or practices
• Customs of the medical profession
• Matters of medical policy
continued on next slide
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
American Medical Association
(AMA) Principles of Medical Ethics
• Discusses





Human dignity
Honesty
Responsibility to society
Confidentiality
Need for continued study
continued on next slide
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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.
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
When Research Can Resolve
Debate over the Best Treatment
• Medical research does not always give
the answers
• Sometimes treatment actually harms
the subject
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Conflict of Interest
• May arise if researcher's interests are
placed above interests of the patient
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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?
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
Gene Therapy
• Still in its infancy
• Opportunities are limitless
• Scientists are investigating many
unanswered questions
• Many ethical and moral problems
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved
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
Medical Law and Ethics, Fifth Edition
Bonnie F. Fremgen
Copyright © 2016, 2012, 2009 by Pearson Education, Inc.
All Rights Reserved