1. Chapter 7 Bioethical Issues
Joseph T. Catalano

2. Code of Ethics
The earliest codes of ethics made obedience to the physician the nurse’s primary responsibility.
The present code of ethics recognizes that the primary responsibility of the nurse is the client’s well-being.
This reflects nursing’s increased self-awareness, independence, and growing accountability for its actions.

3. Abortion Polarizing issue
Has religious, ethical, social, and legal implications
Elective abortion: voluntary termination of a pregnancy before 24 weeks’ gestation
Self-selected, or elective, abortions are those performed solely on the mother’s own decision.

4. Abortion (cont’d)
Roe v. Wade in 1973, the Supreme Court changed the legal status of elective abortion in the United States.
Ethical basis and moral status of this decision remain controversial.
No decision was made about the ethics or morality of elective abortion.
Based on the belief that people have a right to determine what they can do with their bodies (i.e., the right to self-determination) and that such a right includes termination of a pregnancy.

5. Abortion (cont’d)
Fundamental issues at the heart of the abortion debate center on the question of when life begins and the right of freedom of choice.
As a client advocate, should a nurse be for or against abortion?
How can a nurse avoid influencing the woman’s decision about abortion?
Can a nurse ethically and legally refuse to assist at abortions?

6. Abortion (cont’d) Abortion has become a hot political issue again.
Many states with conservative legislatures have passed laws that basically prevent abortions.
Restrictive state laws have closed many abortion clinics.
This may violate the national law and be ruled unconstitutional.

7. Genetics and Genetic Research
Genetically altered plants and animals are in common use in the United States.
As with most scientific research and techniques, the techniques of genetic engineering are ethically neutral.
The potential for misuse of genetic procedures is great.

8. Genetics and Genetic Research (cont’d)
Mandatory genetic screening would most likely be unethical; although the concept is not unrealistic.
Because it requires just one blood sample from a person at some point during that person’s life, it is possible that this type of screening could even be done without the individual’s knowledge or consent.

9. Genetics and Genetic Research (cont’d)
Ethical issues involved in genetic research
Informed consent
Confidentiality
Emotional impact
Self-determination

10. Fetal Tissue Research
Traditional fetal tissue research has been generally limited to taking living cells from an aborted fetus.
Scientists are now growing their own fetal tissue in the laboratory through artificial insemination and in vitro fertilization procedures.
Legislation to control this practice has been passed.

11. Fetal Tissue Research (cont’d)
Stem cells are the very early cells present in the developing fetus that have not yet begun to differentiate.
All the cells are identical and contain all the genetic material needed to reproduce an identical individual.
They can be separated and then placed in an environment where they will form more stem cells.
The genetic material from the stem cell can be removed and replaced, or the genetic material can be removed, manipulated, and then replaced.

12. Cord Blood Banking
Cord blood banking uses the stem cells present in umbilical cord blood to treat disease.
Embryonic (pluripotent) stem cells come from fetal tissue.
Cord blood supplies hematopoietic stem cells responsible for the development of red blood cells, white blood cells, and platelets.
Cord blood can be a viable treatment option for blood and immune system diseases, cancers, and congenital defects in adults and children.

13. Cord Blood Banking (cont’d)
Public cord blood banks take in donations that can be used for anyone in need.
Cord blood banking is mostly accepted by the general medical community.
Banks must follow the stringent guidelines set in place to allow the donated cord blood to be added to a public registry.

14. Cord Blood Banking (cont’d)
The National Marrow Donor Program keeps a list of public regional cord blood banks on their website.
Most public banks do not charge processing or storage.
Once cord blood is donated to a public bank, the family has no way to access the unit should it be needed by them in the future.

15. Cord Blood Banking (cont’d)
Private banks charge processing and storage fees, as well as “biological insurance” premiums.
These fees can be rather high.
They may use coercive marketing designed to play on the fears of expectant parents.
Regulated by the Food and Drug Administration’s Code of Federal Regulations.

16. Cord Blood Banking (cont’d)
General consensus: Public cord blood banking, because of its altruistic nature and low cost to the donors, is more widely accepted than private cord blood banking.
The American Academy of Pediatrics advises against private cord blood storage, unless there is a family history of specific genetic diseases.

17. Organ Transplantation
Whenever a human organ is transplanted, many people are involved.
Donor
Donor’s family
Medical and nursing personnel
Recipient and his or her family
All have rights and obligations.

18. Organ Transplantation (cont’d)
Three primary sources for organ and tissue donations
Living related donors
Living unrelated donors
Cadaver donors

19. Organ Transplantation (cont’d)
Neurological death = death
Ethical questions still linger about what constitutes death.
Because organs such as the heart, lungs, and liver need to come from a donor whose heart is still beating, some clinicians fear that there will be a tendency for physicians to declare that a person is dead before death actually occurs.

20. Organ Transplantation (cont’d)
The Uniform Anatomical Gift Act was passed to increase the supply of donor organs and reduce some of the confusion over organ donation.
The national organ recipient list attempts to list and rank, in a nondiscriminatory manner, all people who need organs.
Criteria for ranking
Need, length of time on the list, potential for survival, prior organ transplantation, value to the community, and tissue compatibility

21. Use of Scarce Resources in Prolonging Life
An issue of distributive justice.
Most public money allocated for health care is spent during the last year of life for many elderly clients.
The traditional belief has been that life should be preserved at all cost and by any means available.
The hospice care movement and a growing number of physicians and other health-care professionals support palliative care for the terminally ill that provides pain relief and comfort measures but does not try to prolong the person’s life.

22. Use of Scarce Resources in Prolonging Life (cont’d)
The ethics of tube feeding
Tube feeding is a relatively simple procedure.
It is a way of maintaining nutrition and hydration, two of the most basic needs of life.
When do tube feedings stop being beneficial to clients?
Is there a right to death with dignity?
What ethical rationales could be used for removal of the feeding tube in this case?

23. Use of Scarce Resources in Prolonging Life (cont’d)
Should care be restricted?
How do you feel about universal health-care coverage?
Should taxpayers pay for people who do not take care of their health—smokers, drug abusers?
What criteria should be used to determine who gets advanced health-care technologies?

24. Use of Scarce Resources in Prolonging Life (cont’d)
The Right to Die
Active versus passive euthanasia
Advance Directives
Living will versus durable power of attorney for health care
Assisted suicide

25. HIV and AIDS
HIV and AIDS have evoked strong emotions in both the public and the medical community.
Ethical issues
Right to privacy
Right to care
Distributive justice (cost to society)
Nurses’ responsibilities

26. Rights of Children
The legal and ethical factors surrounding the decisions that health-care providers must make about child health issues are complicated and sometimes contradictory, ranging from laws about reporting suspected abuse to obtaining permission for treatment.

27. Rights of Children (cont’d)
Child abuse
There is a general legal requirement in most states that suspected child abuse must be reported by health-care providers as well as by anyone who suspects that child abuse has occurred.

28. Rights of Children (cont’d)
A conflicting ethical principle that is sometimes forgotten in the reporting of suspected child abuse is the family’s right to privacy and self-determination.
Decisions about reporting suspected child abuse or neglect rest on the underlying ethical principles of beneficence and protection of the best interests of the child.

29. Rights of Children (cont’d)
The role of the nurse who cares for the very young or abused child is one of client advocate.
Abused children need help and protection, and at times, for their very survival, must be taken out of an abusive home setting.

30. Child Health Care
One important difference between adults and children that always needs to be included in ethical decisions about child health issues is that children are dependents.
As dependents, children generally are not attributed the right to self-determination that is fundamental to adult decision-making.

31. Child Health Care (cont’d)
Young children are given immunizations and medications, have blood drawn for tests, and even have operations such as tonsillectomies or myringotomies, all without being asked for their permission.
When do they develop the capacity for rational decision-making?
How should they be treated until they develop this capacity?

32. Child Health Care (cont’d)
Best interest versus rights in trust