1. AMA 103 Ethical Concepts

2. Human Genome Project Completed in 2003 Numbers of encoded genes unknown International Human Genome Sequencing Consortium established in 2004 –Led by United States and Dept of Energy –Working on encoding genes –Successful or not?

3. Genetic Procedures Genetic screening and testing –Voluntary –Mandatory –Used to treat diseases –Screening for pregnant women

4. Genetic Counseling Voluntary Provides information Does not dictate decisions Becomes part of medical record

5. Sterilization World’s most popular form of birth control Carriers for serious disease may consider sterilization Ethical considerations Legal considerations

6. Assisted Reproduction Artificial insemination –AIH –AID –Legal implications –Ethical implications

7. In vitro Fertilization “Fertilization in glass” Woman has donor’s eggs fertilized by husband’s sperm; implanted into her uterus Woman carries embryo of donor’s ova and donor’s sperm Woman receives donated embroys from completed in vitro fertilization (embryo adoption)

8. Surrogacy Substitute Potential options –Sperm injected into surrogate to fertilize her egg –Retrieve egg, inseminated by partner, transferred to surrogate –Donor sperm, donor egg creates embryo, transferred to surrogate

9. Legal and Ethical Issues Informed consent Agreements in writing Confidentiality Cost of assisted reproduction Legal parentage Infant rights

10. Fetal Tissue Research Holds promise for medical research and treatment of diseases Has politically rocky road Federal funding first restricted; then released; restricted again Controversy of cells coming from induced abortion Ethical and legal considerations

11. Considerations for Employees Keep knowledge up-to-date, current Demonstrate professional attitude Protect confidentiality Assist in informed consent process Explore personal views prior to employment

12. Fetal Development/When Does Life Begin? Spermatozoon + ovum Zygote Mitosis Blastocyst Embryo Fetus Conception Brain function Quickening Viability Birth

13. Ethics and Abortion Are there any reasons to justify abortion? Are current laws regarding abortion consistent, fair, and just? Are abortions appropriate methods of birth control?

14. Professional Protocol Understand personal feelings, beliefs Participate within the law Provide accurate medical knowledge Obtain written, informed consent Provide counseling

15. Professional Protocol Refer if needed Keep records confidential Seek legal counsel when indicated Be understanding, compassionate

16. Legal Issues Living Will Advance Directive The Patient Self-Determination Act Durable Power of Attorney for Health Care

17. Choices in Dying Personal decisions? Controlled by technology and advanced medicine? Uniform Determination of Death Act established by three organizations; identified criterion for death –Irreversible cessation of all circulatory and respiratory functions –Irreversible cessation of all functions of entire brain, brain stem

18. Legal Implications Who decides? Prolong life or postpone death? Karen Ann Quinlan Theresa (Terri) Schiavo

19. Ethical Considerations Who decides? Role of politics? Economics? Role of providers, family, insurance? Philosophy on life? Good life versus good death?

20. Professional Protocol Follow the law Recognize religious and cultural practices Protect clients’ rights Respect clients and their families Refer for legal counsel as needed

21. Living With Dying Dying is personal No two people die alike Most want an “easy death” Pain, suffering, dependence are feared most

22. Suffering in Dying Old age and debility Life-threatening illness Pain and agony Loss of control Fear of leaving loved ones Medical experimentation/technology

23. Psychological Aspects Anger Depression Inability to make decisions Change in relationships Loss of self-image Change in goals Communication difficulties

24. Physiological Aspects Use of pain medication Loss of communication skills Loss of bodily functions Changes in sexual identity and involvement

25. Kübler Ross’ Stages of Grief Denial Anger Bargaining Depression Acceptance

26. Death Considerations Hospice Death with Dignity Act Uniform Anatomical Gift Act Autopsy

27. Professional Protocol Determine personal attitudes toward pain, suffering, dying Converse without fear, anxiety Listen Pay attention to family needs Refer as indicated Recognize grieving