PowerPoint to accompany Law & Ethics For Medical Careers Fourth Edition Judson · Harrison · Hicks Chapter 10—The Beginning of Life and Childhood Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display

The Beginning of Life and Childhood Objectives Define genetics and heredity Distinguish between DNA, chromosomes and genes List several situations in which genetic testing might be appropriate Discuss genetic discrimination

The Beginning of Life and Childhood Objectives continued Define cloning and explain why it is a controversial issue Discuss some of the pros and cons of genetic engineering Explain why stem cells are useful for scientific research Distinguish between mature and emancipated minors and discuss those situations where such minors might legally make their own health care decisions

Influence of Technology on the Beginning of Life Genetics The study of heredity Human Genome Project Project to identify and map the human genomes Completed in 2000, available to all physicians and scientists who could use it

Genetic Testing DNA testing has become a reliable source of testing for Forensics Determining parenthood/tracing lineage Screening for inherited diseases or conditions How test results are used has become an important ethical and legal issue

Genetic Testing and Discrimination Genetic discrimination Differential treatment of individuals based on their actual or presumed genetic differences Examples of where potential genetic discrimination may exist -employment -life insurance -health insurance benefits

Genetic Testing and Discrimination continued Most states prohibit genetic discrimination based on genetic testing for purchase of health insurance HIPAA prohibits discrimination as part of the portability of group health insurance ADA offers some protection Under Executive Order, genetic testing for employment is prohibited

Genetic Engineering Manipulation of DNA within the cells of plants and animals to ensure that certain traits will appear and be passed on A clone is an organism from a single cell of a parent and is genetically identical to the parent Useful in medicine and potential for transplantation-but ethical issues create controversy

Human Stem Cell Research An early stage stem cell (blastocyst) has the ability to become any type of tissue May be used in therapeutic research to develop treatments for many diseases The use of stem cells in reproductive research is considered by most as unethical

Human Stem Cell Research Controversy Blastocysts are removed from the frozen products of in vitro fertilization Blastocysts are removed from those products that would eventually be destroyed Those who argue that an embryo is life argue that the embryo is entitled to legal protection, thus the controversy

Gene Therapy Gene therapy may involve Replacing a deficiency or blocking an overactive pathway Inserting a normal copy of gene into a patient with a specific genetic disease Current research into turning “off” a gene to avoid a disease

Conception and the Beginning of Life Infertility Options In vitro fertilization (IVF) Egg and sperm develop into an embryo in a test tube or petri dish Artificial insemination Injection of viable semen into the vagina Homologous-use of husband’s sperm Heterologous-use of donor sperm

Conception and the Beginning of Life Infertility options continued Surrogacy Use of surrogate—a woman who agrees to carry a child to term Used when mother is unable to carry embryo to term Gestational surrogacy—when surrogate is not related to embryo Traditional surrogacy—when surrogate is related to embryo

Conception and the Beginning of Life Adoption Both State and Federal laws regulate adoption Agency adoptions State-licensed, public or private, agency that places children with adoptive parents Private adoptions No agency involvement; some states prohibit

Rights of Children Common law Parents have the right to make health care decisions for minor children Doctrine of parens patriae State may act as parental authority for the child’s “best interest” Allows the state to remove abused or neglected children from parents

Rights of Children-Newborns Under the 1974 Child Abuse Protection and Treatment Act (with subsequent Child Abuse Amendments) physicians may legally withhold treatment from infants who are chronically and irreversibly comatose will most certainly die and to treat would be futile would suffer inhumanely if treatment was provided

Rights of Children-Abandoned Infants Safe haven laws in many states allow abandonment of an infant at a fire or police station or a hospital Laws vary as to prosecution, age of infant, whether medical history is necessary Safe haven law controversial; may be seen as condoning abandonment

Rights of Children — Minors Mature minors Considered mature enough to understand a physician’s recommendation and give informed consent Emancipated Minors Legally live outside parent or guardian control Court may declare minors emancipated if they are self supporting, married or serving in the armed forces

Ethics Guide Discussion Your best friend comes to you with a problem. She was adopted at birth and due to strict privacy laws when she was adopted, knows little about her birth parents—only that she was born to a Jewish mother from Germany. She is very worried about breast cancer and learns that German Jews with a mutated BRAC1 gene have a very high incidence of breast and other cancers. What advice will you give her?