Ethical Health Care Provision

1. Ethical Health Care Provision

2. Ethics • Ethical issues: dilemmas involving important moral principles • Involves trying to determine which of a number of courses of action is most appropriate

3. Issue 1: The Blood Supply

4. Issue 1: The Blood Supply • Canadian Red Cross: was responsible for collecting and storing and distributing blood products • Mid 1980’s more the 1200 Canadians contracted human immunodeficiency virus (HIV) can lead to acquired immune deficiency syndrome (AIDS) • Some contracted Hepatitis C can destroy the liver causing death

5. Issue 1: Blood Supply • Screening process was too simple, allowed people who did not know they were infected to continue being donors • CRC, charitable association that was limited to the amount they could spend on operations • New agency had to be created, had to decide if it would be, for profit agency, government controlled or independent responsible to governements

6. Issue 1: The Blood Supply • Is it unethical for a private company to profit from providing a vital medical need ? • Did not really consider government • Is it unethical for governments to be the suppliers of the blood supply? • New agency funded by federal and provincial government was created but independent of them Canadian Blood Services

7. Issue 1: the Blood Supply • Was an independent but government funded agency the best ethical choice available for assuring a reliable blood supply? • Was it the more ethical solution given the other choices?

8. Issue 2: Organ Harvesting • Multiple Organ Retrieval and Exchange • Signing consent card with drivers licence authorizes doctors to harvest any tissues or organs or those specified by you, upon your death • Most doctors will not harvest organs, despite a donor card, if family does not consent

9. Issue 2: Organ harvesting • In 1999 only 617 transplant procedures were carried out in Ontario while 1720 were waiting for organs, 100 of those people died • The Issues : practical and ethical • Practical relates to grieving family members and how we define death • Organs would most likely come from a young healthy person who died because an accident • Have intact bodies even though their brains have stopped functioning

10. Issue 2: Organ harvesting • Family members are usually not prepared to cope with the sudden loss • Not usually able to make rational decisions, • If heart is still beating feel as though they are still alive • Ethical Issue: as living we own all the organs and tissues in our own bodies but dead is this still the case

11. Issue 2: Organ Harvesting • In Spain operates on the principle of presumed consent, unless there is evidence that the person specifically resisted organ donation • doctors are required to pass details on to the Spanish central registry for organ donation • The Gift of Life is to be created to oversee organ donation, doctors required to believe all organ donors and report to TGL

12. Issue 2: Organ Harvesting • Is it ethical to forcibly take the kidneys from a brain dead child whose parents are strongly opposed to this action? • Whose interests are paramount those of the parents or those of the recipient? • Some countries demand greater than supply • Pennsylvania 300 dollars towards funeral with organ donation • Is this ethical?

13. Issue 3: Medical Research • Cloning: to create a living mammal including humans through asexual reproduction • Ability to clone may lead to developments such as incurable conditions being reversed (spinal cord damage, Alzheimer’s, Parkinson’s disease, cancer etc. • Many ethical dilemmas related to this

14. Issue 3: Medical Research • Whether scientists and doctors have the right to manipulate human cells • Is it ethical to clone embryos (fertilized human eggs) for research and medical treatments? • Should scientists develop technology that could be used unethically by others • Medical Ethicists: research and write about which medical techniques should be morally permissable

15. Issue 3: Medical Research • They believe should not let promise of cures override responsibility to ensure techniques are humane and ethical • Nuremberg Code: • Nazi’s experimented on inmates of concentration camps, became public at end of World War II • December 1946-August 1947 23 Nazi Doctors were tried in Nuremberg, Germany for performing cruel and inhumane experiments on prisoners

16. Issue 3: Medical Research • Approx. 100 000 people died horrible deaths in the concentration camps • How long could survive in cold water, how long could survive drinking sea water, lungs burst due to atmospheric pressure • Informed Consent: the subject of the medical procedure or experiment must be able to understand the risks involved and give permission for it to proceed, knowing these risks

17. Issue 3: Medical Research • Seven were executed and eight were sent to long term prisons • Nuremburg code: ethical guideline for researchers, had no legal authority, was a powerful statement to future courts • 1930s-1970s US Public Health Service studied 400 African American men , did not tell they had disease or offer treatment

18. Issue 3: Medical Research • Stem Cell Research: cells from which stem all the branches of an organism • Hope can eventually cure diabetes, Parkinson’s disease by growing new cells to replace damaged ones • What constitutes a live human, stem cells in umbilical cords and bone marrow but most potent in embryos

19. Issue 3: Medical Research • Cloning, in vitro fertilization • Treatment for infertility, eggs and sperm are donated by potential parents and fertilized in petri dish • Normally harvest a number of eggs, any embryos not required are destroyed or stored • Stem cell researchers have asked why they cannot use these embryos to help cure disease • Is it ethical to harvest stem cells from these embryos for experimentation?

20. Questions • 1. What definition do medical practitioners normally use when deciding whether human organs or tissues can be harvested? What problems arise from this definition? • 2. Two values that many people hold are belief in the value of life and a belief that the dignity of the person should be respected. How might these two values conflict in a consideration of the ethical issues related to organ donation? • 3. What is the Nuremberg Code? What circumstances led to its creation? • 4. Make a list of five ethical issues surrounding the issue of stem cell research. For each issue, outline two opinions based on two different perspectives.