Bioethical Issues in Healthcare PDF

Bioethical Issues in Healthcare Coordinator: Dr. Eman KH. Ebrahim LEARNING OUTCOMES: After completing this chapter, you should be able to: 1. Identify major areas where bioethics are applied. 2. Explain the bioethical issues related to the beginning of life. 3. Explain bioethical i...

Bioethical Issues in Healthcare Coordinator: Dr. Eman KH. Ebrahim LEARNING OUTCOMES: After completing this chapter, you should be able to: 1. Identify major areas where bioethics are applied. 2. Explain the bioethical issues related to the beginning of life. 3. Explain bioethical issues concerning death. 4. Discuss the bioethical issues related to sustaining quality of life.  Introduction Bioethics is defined as a “discipline dealing with the ethical implications of biological research and applications, especially in medicine.” This area of study is also called biomedical ethics because of its association with medical practice.  “Bioethical Issues Related to the Beginning of Life” Many bioethical issues with which we wrestle today are focused on the process by which conception occurs, the products of conception, and the beginning of life, including whether it should occur. Family planning methods and issues related to conception have been a subject of debate for many years.  Family Planning: Family planning refers to the various methods used to control the size of one’s family or to space births. It can employ natural methods, pharmaceutical preparations, or barriers. The religious beliefs and personal values of individuals usually influence the methods and approaches used. During your career as a nurse, you will care for patients who represent many differing viewpoints. When caring for individuals whose personal beliefs prohibit the use of artificial birth control, you must be knowledgeable about natural methods of family spacing, such as fertility awareness methods, that will meet the patient’s needs.  If your personal views regarding contraception differ, your values must be set aside as you focus on assisting the patient in selecting a method that is compatible with the patient’s values and beliefs. If you are unable to do this, find a colleague who can provide answers to the questions and supply the needed information. Central to all discussions of contraception is the issue of freedom of a woman to control her own body. This immediately raises a second question: Who has that right? Is it the woman’s right because it is her body? What if the partners disagree about family planning practices?  Abortion In medical terms, abortion is the termination of pregnancy before the viability of the fetus— that is, any time before the end of the sixth month of gestation. Ethically, the entire debate revolves around the definition of human life and when the fetus should be considered a human being. There are two major schools of thought about the nature of the fetus: One supports the belief that new life occurs at the moment of conception; the other contends that human life does not exist until the fetus is sufficiently developed biologically to sustain itself outside the uterus. ▪ Pro-choice view (supporting a woman's right to choose): Common argument is that abortion is legally permissible, regardless of the morality involved. A woman has a basic right to make up her own mind about choices of pregnancy or abortion, and her right always prevails over any other right, including any fetal rights. Believe that abortion is morally and legally permissible Support the use of emergency contraceptives, or postcoital birth control measures preventing pregnancy. ▪ Personhood (pro-life or anti-abortion) view: The personhood (pro-life) view stems from a fundamental understanding that the embryo or fetus is a person. Common argument: Life and full moral status begin at conception, and abortion is immoral and murderous and should be illegal. The belief that life begins at conception. It also includes the belief that moral status is conferred at conception, based on faith values and cultural origins.  Speaking out: Legal and moral debates about abortion and women’s reproductive rights continue. The center of the pro-choice and pro-life debates is about human rights: the right to life of the fetus or the woman’s right to control her own body by choosing whether or not to carry a pregnancy to term, have a baby, and parent it.  Partial-birth abortion consists of physicians delivering a live fetus vaginally, yet only partially, for the sole purpose of terminating a pregnancy by way of an intact D&E. President George W. Bush signed into law the Partial- Birth Abortion Ban Act of 2003. Late-term abortion refers to late-term or third-trimester abortions by way of a procedure called intact dilation and extraction (intact D&E).  As a nurse, these issues present difficult questions you will need to answer. To what extent do you believe you can personally participate in the abortion procedure? Would the stage of pregnancy and type of procedure make a difference? As a nurse, you have the right to refuse, based on your own ethical beliefs, to be involved in abortion procedures or the care of patients  Prenatal Testing A major breakthrough in our ability to detect genetic abnormalities in the fetus occurred in the 1970s with the development of techniques to carry out amniocentesis and has created a different dimension in the abortion debates. Amniocentesis involves aspirating and analyzing amniotic fluid and is performed between 14 and 20 weeks after the woman’s last menstrual period.  From these cells, many genetic problems of the fetus can be diagnosed prenatally, including such conditions as Down syndrome (which accounts for about one third of the cases of mental retardation), hemophilia, and problems related to the brain and spinal column (e.g., spina bifida). When amniocentesis reveals a genetic condition, a woman may choose to have an abortion.  Sterilization For years, surgical operations resulting in permanent sterilization, such as the removal of reproductive organs to stop the spread of cancer, have been performed for therapeutic purposes. With increasing frequency, voluntary sterilization has been requested by individuals to terminate reproductive ability with more women seeking the surgery than men. Many people see it as the right of an individual; others find any type of  Reproductive Technology Infertility is generally defined as a woman not being able to become pregnant after trying to conceive for 1 year. Because of infertility, 1% of all infants born in the United States are conceived with assisted reproductive technology. Assisted reproductive technology (ART) is the handling and management of sperm and eggs and every kind of fertility treatment or drug used for the purpose of retrieving eggs to be used in the treatment. An example of ART is: In vitro fertilization (IVF) ❑Ethical issues about reproductive technologies are divided into five groups: 1. The risk resulting from technology 2. Surrogacy 3. The handling of surplus reproductive products 4. The implications of sperm sorting or gender selection 5. Genetic modification and enhancement.  Surrogate Mothers A surrogate mother is one who agrees to bear a child and to relinquish the baby at birth to others for rearing. While initially the individual who agreed to be the surrogate was a friend or family member, now it is more often a contractual arrangement with a stranger to the family. One of the most important aspects of the process is finding a good match between the surrogate and the contracting family. Surrogate mothering within a family has caused fewer problems than have been seen when a stranger serves as the surrogate mother.  The majority of serious conflicts have occurred in situations in which a woman has been paid to serve as a surrogate mother. A formal, contractual relationship is usually established. The couple who wishes to have the child agrees to pay all expenses associated with the pregnancy and to pay the surrogate mother an agreed sum for her time and involvement—usually between $25,000 and $75,000. What if the surrogate becomes attached to the child and refuses to give up custody?  Surrogate Mothers  Bioethical Issues Concerning Death One of the most important areas of ethical debate revolves around the topic of death and dying. The ideal death Death anxiety is a “dread of death that resides in the unconscious, a dread that is formed early in life at a time prior to the development of precise conceptual formation, a dread that is terrible and exists outside of language and image.” Nurses need to take into account the possibility that some patients manifest ill effects or behaviors as a result of experiencing death anxiety. Three standards of death: Cardiopulmonary death Whole-brain death or permanent brain failure Higher brain death * Three organs—the heart, lungs, and brain—assume special significance … because their interrelationship is close and the irreversible cessation of any one very quickly stops the other two and consequently halts the integrated functioning of the organism as a whole (Stanford Encyclopedia of Philosophy, 2016).  Medical Futility Futile treatments (medications, devices, or therapy) are those that are evaluated by the healthcare team, the family, or both as being nonbeneficial or harmful to the patient in as much as they cannot cure or reverse the underlying disease. For example, when an individual is dying of terminal cancer, treatment for a respiratory infection may be deemed futile because it will not alter the fact that the person is dying and will not restore a satisfactory quality of life. Identifying whether further treatment is futile may be extremely difficult.  Euthanasia Euthanasia, meaning “good or painless death,” may be classified as either negative or positive. The word, as it is generally applied, refers to the act or method of causing death painlessly so as to end suffering. 1) Negative, or passive, euthanasia is the intentional withholding or withdrawing of medical treatments or life- sustaining treatments. The concept of negative euthanasia has resulted in what are called “no codes” (DNR—do not resuscitate) in hospital environments. In these situations, hospital personnel do not attempt to revive or bring back to life persons whose vital processes have ceased to function on their own.  Withdrawing and Withholding Treatment Withdrawing treatment is defined as stopping treatment that is considered medically futile, that is, will not provide a cure or control the disease. Withholding treatment occurs when this type of treatment is not provided at all. Although withholding and withdrawal of therapies have been described mainly in situations related to technical interventions (ventilator, hemodialysis), they can also be applied by extension nutrition as long as the aim of this therapy is to prolong life beyond expectation. 2) Positive, or active euthanasia is the intentional and purposeful act of causing the immediate death of another person. On some occasions, a physician prescribes strong narcotics for a terminally ill patient and requests that the medication be given frequently enough to keep the patient comfortable. However, nurses may be reluctant to administer a medication that they realize has a potentially fatal effect when given in that dosage.  Voluntary euthanasia occurs when patients with decision- making capacity authorize physicians to take their lives. Has become associated most with the term physician- assisted suicide, which is taking of one’s own life with a lethal dose of physician-ordered medication Nonvoluntary euthanasia occurs when persons are not able to express consent to end their lives and are unaware that they are going to be euthanized. Involuntary euthanasia is when a person’s consent may be possible but is not sought, and a physician could euthanize someone without express consent.  Bioethical Issues Related to Sustaining Quality of Life Organ and Tissue Transplantation Developments in the area of organ transplantation have created several issues deserving consideration. Organ transplantation is the process by which an entire organ is removed and replaced by a corresponding part. Some organs (e.g., the heart) must be transplanted immediately, or the tissue will die. Others, such as the kidney, can be stored for short periods. Many tissues, such as bone and skin, may be preserved for long periods of time.  The skill of modern technology has resulted in the development and implantation of artificial organs such as the heart. Over the years, the use of artificial organs has not proven effective for long-term use, but artificial organs have made it possible for individuals to live with the hope that a transplantable organ will become available.  The Human Genome Project A genome may be defined as an organism’s complete set of deoxyribonucleic acid (DNA), a chemical compound that contains the genetic instructions needed to develop and direct the activities of every organism, including the genes that carry information for making the proteins required by all organisms. These proteins determine such things as how the organism looks, how well its body metabolizes food and fights infection, and sometimes even how it behaves. The goal of the Human Genome Project was to map the entire human genome. Genomes have been studied for many reasons, including disease prevention, determination of the effects of radiation and chemicals on living species, and more recently, genetic therapy.  The ethical and bioethical concerns that can evolve from this research are many and varied. Among them are the issues of access to and use of new genetic information and technology to improve health, research that would involve human participants, and the implications of the discovery of genetic contributions related to diseases, non-disease attributes, and various behavioral traits such as cognition, mental illness, and aging for how we understand health and illness.