Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Constitutional Law - Mercer University
Document related concepts
Transcript
Contemporary Ethical Dilemmas Jody Blanke Distinguished Professor of Computer Information Systems and Law Mercer University Ethical Dilemmas An ethical dilemma arises in situations where a choice must be made between unpleasant alternatives Ex. Should I choose life knowing an unborn child will be born with severe disabilities? Ex. Should I adhere to my spouse’s wishes not to be placed on a respirator? Noteworthy Historical Events 58,000 to 68,000 BC Neanderthal Burial Sites Evidence of belief in an afterlife 1932–1972 Tuskegee Study of Syphilis study 1933–1945 Holocaust 1946 - Military Tribunal for War Crimes Nuremberg Code 1949 – International Code of Medical Ethics 1954 – Guidelines on Human Experimentation – The First Kidney Transplant 1960s – Cardiopulmonary resuscitation – prolonging life beyond what was reasonably expected 1964 – WHO guidelines for medical doctors conducting biomedical research – Declaration of Helsinki is the basis for advanced clinical practices today 1968 – Harvard Ad Hoc Committee on Brain Death 1970 – Patient as a Person 1971 – Kennedy Institute of Ethics established 1972 – Informed consent – reasonable man standard 1973 – Right to Abortion – Roe v. Wade 1974 – National Research Act – created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1975 – First successful cloning of frogs 1976 – Karen Ann Quinlan case – First living will legislation enacted 1978 – Commission for the Study of Ethical Problems in Medicine 1980 – Hemlock Society formed to advocate for physician-assisted dying 1983 – California passes first durable power of attorney legislation 1990 – Patient Self-Determination Act – Nancy Cruzan case – Dr. Kevorkian assists terminally ill patients in suicide – Derek Humphry publishes Final Exit 1994 – Oregon’s Death with Dignity Act – Michigan - assisted suicide illegal 1996 – HIPAA – Cloning of Dolly 1997 – Dr. Kevorkian charged with murder – Supreme Court – “laboratory of the states” 1999 – Dr. Kevorkian convicted of murder 2001 – President’s Council on Bioethics created – U.S. Attorney General’s failed attempt to challenge Oregon's Death with Dignity Act 2003 – Human gnome system fully sequenced 2007 – Supreme Court blocks Bush administration’s attempt to punish doctors who prescribe drugs in Oregon Abortion Many interests Rights of the Woman Autonomy Rights of the Fetus Rights of the Spouse Rights of the State Protecting life Abortion Many ethical questions When does life begin? Who decides? Who protects the unborn fetus? What are the rights of the child or woman who has been raped? What are the rights of the spouse? What are the religious implications? When does control over one’s body begin, and when does it end? Roe v. Wade (1973) Woman’s right to privacy Recognition of state protecting the unborn First Trimester: abortion decision between woman and physician Second Trimester: state may reasonably regulate abortion procedure Third Trimester: state may prohibit all abortions except those deemed necessary to protect maternal life or health Planned Parenthood v. Casey (1992) Reaffirmed a woman’s right to an abortion Rejected Roe v. Wade’s trimester approach Reaffirmed the state’s power to restrict abortions after fetal viability as long as the rule does not impose an undue burden It is not an undue burden To require that a woman be informed of the nature of the abortion and of the risks involved To be provided with information about alternatives To require informed consent before the procedure To require parental consent for a minor (as long as there is a judicial bypass option) To require a 24-hour waiting period Funding Denial of Financial Assistance for Elective Abortions Funding Not Required for Therapeutic Abortions Funding Bans Unconstitutional in California Funding Discrimination Prohibited in Arizona Refusal to Fund Abortion Counseling Not Unconstitutional Spousal Consent Husband’s Interest Insufficient Husband’s Required Consent Unconstitutional Eugenic Sterilization Buck v. Bell (1927) Supreme Court approved of sterilization of the mentally deficient and feebleminded Wade v. Bethesda Hospital (1971) Supreme Court reversed its position Negligent Sterilization The improper performance of sterilization may result in lawsuits based on such theories as wrongful birth wrongful life wrongful conception Wrongful Birth, Wrongful Life, Wrongful Conception These case have generally not be successful on claims for the costs of raising normal healthy children Some claims have been successful regarding Additional medical costs Pain and suffering Lost wages Damages associated with children born with genetic defects Artificial Insemination Homologous artificial insemination semen of spouse used to impregnate Heterologous artificial insemination semen from donor other than husband additional issues regarding consent and confidentiality Surrogacy Method of reproduction whereby a woman agrees to give birth to a child for another party Surrogate may be child’s genetic mother gestational carrier Ethical and Legal Issues Legal right to enter a surrogacy contract? Parental rights of commissioning couple? Long-term effect of surrogacy contracts? Psychological impact on child? Organ Donations Federal regulations require protocols regarding an organization’s organ procurement responsibilities specific notification duties requirements informing families of potential donors Who lives? Who dies? Who decides? Research, Experimentation, and Clinical Trials Ethical considerations Honesty Integrity Autonomy Self-determination Hippocratic maxim of do no harm Justice How to fairly conduct blind trials Nuremberg Code and Declaration of Helsinki International Code of Ethics governs human research Result of Nazi medical atrocities Requires human subjects be fully informed Food and Drug Administration Regulates the conduct of clinical trials Approval of a new drug often costs much money and takes much time But, FDA must be cautious Ex. thalidomide Institutional Review Board Federal regulations require hospitalbased Institutional Review Boards (IRB) IRB Functions review proposed research studies approve protocols for research conduct research oversight Informed Consent Organizations must Fully disclose to the patient the inherent risks, benefits, and treatment alternatives Determine competency of the patient to consent Obtain written consent from the patient Genetic Information Nondiscrimination Act (GINA) Law prohibits discrimination on basis of genetic information with respect to the availability of health insurance and employment Prohibits group health plans and insurers from denying coverage to a healthy individual based on genetic predisposition to develop a specific disease Prohibits employers from using genetic information when making hiring, firing, job placement, or promotion decisions Genetic Markers A genetic marker is a gene or DNA sequence that has a known location on a chromosome and can be associated with a particular gene or trait Genetic markers can identify certain diseases Stem Cell Research Use of embryonic stem cells to create organs and various body tissues Highly controversial issue generally involving religious beliefs Concerns as to how far scientists might go in their attempt to create AIDS Deadliest epidemic in human history First case appeared in literature in 1981 More than 35 million people have died from AIDS Can be spread by direct contact with infected blood or bodily fluids Disclosure of Physician’s HIV Status Physician cut his hand during a surgical procedure Question about whether his blood contacted patient’s open surgical incision Physician tested positive for HIV Pennsylvania Supreme Court held that a compelling need existed for at least partial disclosure Patients were not given physician’s name, but were told of the potential risk “The welfare of the people is the supreme law”
