Ethical and Bioethical Issues in Medicine CH 11

The study of healthcare ethics is an applied ethics, which means that it is more than just a study of theory. You need to understand the role of ethics in the practice of their medical discipline. A critical-thinking approach to ethics requires that you look for a solution that includes fairness to patients, respect for society, and a concern for the future implications of the decision. This must be a decision in which the dignity of the individual is always respected.

I. Early History In 400 B.C., Hippocrates, a Greek physician referred to as “the Father of Medicine,” wrote a statement of principles for his medical students to follow that is still important in medicine.

II. Ethical Standards and Behavior A. AMA definition—Ethical behavior, according to the AMA, refers to the following: 1. Moral principles and practices 2. The customs of the medical profession 3. Matters of medical policy B. Allege means “declare without proof.” C. Censure is a warning issued to a physician who is accused of unethical behavior or conduct in violation of ethical standards. D. Expulsion—The AMA Board of Examiners may recommend the expulsion (forcing out) or suspension of a physician from membership in the medical association.

III. Codes of Ethics A. People’s behavior must match their set of values. B. Some codes of ethics developed in direct response to atrocities. 1. Declaration of Geneva—medical vow adopted by the Second General Assembly in Geneva, Switzerland, September 1948. 2. Declaration of Helsinki—Recommendations guiding medical doctors in biomedical research involving human subjects, adopted by the Eighteenth World Medical Assembly, Helsinki, Finland, 1964. 3. The Nuremberg Code—See Appendix A of the text

C. American Medical Association (AMA) Principles of Medical Ethics discuss the following: 1. Human dignity 2. Honesty 3. Responsibility to society 4. Confidentiality (privacy) 5. The need for continued study 6. Freedom to choose patients 7. A responsibility of the physician to improve the community 8. Responsibility to the patient is of paramount importance 9. Support access to medical care for all people

D. Judicial Council Opinions of the AMA 1. The Council on Ethical and Judicial Affairs of the AMA is comprised of nine members who interpret the Principles of Medical Ethics. 2. Summary of Opinions of the Council Opinions of the AMA: a. Abuse b. Accepting patients c. Allocation of health resources d. Artificial insemination e. Confidential care of minors f. Euthanasia g. Fee splitting h. Futile care i. Gene therapy j. Ghost surgery k. HIV testing l. Mandatory consent to abortion m. Physician-assisted suicide n. Quality of life o. Withholding or withdrawing life-prolonging treatment

IV. Codes of Ethics for Other Medical Professionals A. Nurses’ Code of Ethics—Discusses the role of nurses as they relate to people, their practice, society, their coworkers, and their profession. B. Code of Ethics of the American Association of Medical Assistants (AAMA)—“Sets forth principles of ethical and moral conduct as they relate to the medical profession and the particular practice of medical assisting.”

V. Bioethical Issues—Many areas of medical ethics concern problems for which there is no conclusive answer. A. Organ and tissue donation—There is a short supply of organs and tissue for donation, which can result in unethical behavior. B. The ethics of transplant rationing C. Ethical issues and personal Choice

VI. The Ethics of Biomedical Research A. Ethics of the biomedical researcher B. Consent C. When research can resolve debate over the best treatment D. Conflicts of interest E. Ethics of randomized test trials F. Problems with the double-blind test—A test conducted when neither the researcher nor the patient knows who is getting the research treatment. G. Human Genome Project—A federal government project determined or “mappel” the sequence of each gene within the 23 chromosomes.

VII. Genetic Engineering A. Cloning B. Gene therapy C. Human stem cell research

VIII. Healthcare Reform A. Concern for the 46 millions uninsured Americans B. Decline in number of physicians caring for the uninsured

glossary terms Allege—to assert or declare without proof. Censure—to find fault with, criticize, or condemn. Chromosome—threadlike structures within the nucleus (center) of a cell that transmit genetic information. Clone—a group of identical matching cells that come from a single common cell. Control group—research subjects who receive no treatment. Double-blind test—a research design in which neither the experimenter nor the patient knows who is getting the research treatment. Euthanasia—the administration of a lethal agent by another person to a patient for the purpose of relieving intolerable and incurable suffering. Expulsion—the act of forcing out. Gene markers—list of genes that are responsible for disease. Gene therapy—the replacement of a defective or malfunctioning gene. Genetics—a science that describes the biological influence that parents have on their offspring. Harvest—remove organs or embryos. Human genome—the complete set of genes within the 23 pairs of human chromosomes. Human Genome Project—a research program funded by the federal government to “map” and sequence the total number of genes with the 23 pairs, or 46 chromosomes. Institutional Review Board (IRB)—a hospital or university board of members who oversee any human research in that facility. National Organ Transplant Law of 1984—federal law that forbids the sale of organs in interstate commerce. Nontherapeutic research—research conducted that will not directly benefit the research subject. Posthumous—after death. Revocation—the act of taking away or recalling, such as taking away a license to practice medicine. Social utility method of allocation—a method of determining the allocation of organs by giving them to people who will benefit the most. Stem cells—master cells in the body that can generate specialized cells. Therapeutic research—a form of medical research that might directly benefit the research subject. United Network for Organ Sharing (UNOS)—the legal entity in the United States responsible for allocating organs for transplantation.