Contemporary Ethical Dilemmas

1. Contemporary Ethical Dilemmas Jody Blanke Distinguished Professor of Computer Information Systems and Law Mercer University

2. 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?

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Abortion • Many interests • Rights of the Woman • Autonomy • Rights of the Fetus • Rights of the Spouse • Rights of the State • Protecting life

11. 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?

12. 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

13. 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

14. 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

15. Spousal Consent • Husband’s Interest Insufficient • Husband’s Required Consent Unconstitutional

16. 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

17. Negligent Sterilization • The improper performance of sterilization may result in lawsuits based on such theories as • wrongful birth • wrongful life • wrongful conception

18. 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

19. 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

20. 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

21. 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?

22. 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?

23. 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

24. Nuremberg Code and Declaration of Helsinki • International Code of Ethics • governs human research • Result of Nazi medical atrocities • Requires human subjects be fully informed

25. 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

26. Institutional Review Board • Federal regulations require hospital-based Institutional Review Boards (IRB) • IRB Functions • review proposed research studies • approve protocols for research • conduct research oversight

27. 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

28. Genetic InformationNondiscrimination 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

29. 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

30. 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

31. 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

32. 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”