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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?