Term Paper on "Hospital Ethics"

Term Paper 20 pages (5897 words) Sources: 2 Style: APA

[EXCERPT] . . . .

Hospital Ethics

TO DO or NOT to DO

Abortion

Pro-life and pro-choice advocates clash over this issue, which centers on life or human life and what it really means (Oliver 2005). As Mother Theresa and Yasser Arafat said, personhood refers to "the nature of someone like us and entitled to the same protection of the law." The first issue focuses on whether the fetus is a person or has that personhood. The second issue determines the proper behavior when there is disagreement on the first issue. Among the questions to settle are when personhood begins, what life is and if life exists independently of mortal thoughts. Reason tells that it is not dependent on human determining. The human mind is imperfect and quite often incorrect. It also changes often. In that sense, the State would be incorrect and morally wrong in deciding that a Black person is not a life or a person. Neither tradition nor science has helped very much. Science admits that a fetus is alive and human and possesses DNA distinct from its mother's. In the landmark case, Roe v Wade, science fixed the personhood of a fetus to the stage of viability. This implied that abortion is allowed before the stage of viability. But legislations cannot stand on this position. Two mistakes can quickly follow from it. One is allowing abortions if the consensus is that the fetus is a person. The other is prohibiting abortions if the fetus is not a person. As the debate statement says, if there is a chance that abortion may irreversibly damage a human being, lack of certainty on its personhood cannot be a reason to allow it. The choice must be made despite the lack of certainty on that personhood. Those who all

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ow abortion should be ready to be seriously wrong. And those who oppose it should decide on how to behave towards that lack of certainty of the fetus' personhood. All sides would adopt a "precautionary principle" and not accept the risk of killing a human being. The Precautionary Principle states that scientific certainty of harm is not necessary in taking action to avoid or avert the harm (Oliver).

The Supreme Court decided in Roe v Wade that before the viability of the fetus, a woman could not be prohibited from exercising her "right to privacy," including procuring an abortion (Oliver 2005). In 1973, this viability was established at 28 weeks or earlier. After this period, it ruled that the State must safeguard the life of the fetus, except when the life or health of the mother required an abortion. In another decision, the Court so defined and expanded maternal "health" as to limit the states' ability to protect the fetus after viability. The Court thus fixed its own definition of life as "viability." By not referring to the fetus as "life," it implicitly authorized its destruction (Oliver).

An online Harris poll indicated that those who supported the Roe v Wade decision had gone down from 57% in 1998 to 52% in February, 2005 (Hollander 2005). In comparison, those who opposed the decision increased from 41% to 47%. Fifty-one percent of American adults said they were pro-choice, while 44% said they were pro-life today. In 1992, the same Harris poll reported that 58% were pro-choice and 35% were pro-life. Only 23% of them would allow abortion in all circumstances. In comparison, 55% would allow it in certain situations while 21% rejected it in all circumstances. The proportions have essentially remained through the years. The number of those who supported tighter restrictions went up from 34% to 42% between 1992 and 2005. On the other hand, those who favored easing restrictions decreased from 18% to 13%. Today as in 1998, 3 out of 5 Americans believe abortion should be legalized in the first three months of pregnancy, 1 in 3 during the next three months and 1 in 10 during the last three months (Hollander).

Issue 2: Germline Experimentation

Reproductive regeneration or cloning is welcomed by those with infertility problems and want to have their own biological child (Billings 2002). The trend began with the birth of Louise Brown following in vitro fertilization or in a test tube instead the natural womb. The technology has since evolved. The only concerns left were the safety of the mother and the child and who should develop the technology. The fact is that germline experimentation has been confined to animals. The success rate has only reached 3%. At best, it has been a hit-and-miss affair when Dolly was cloned. Scientific advancements, however, now allow up to 80% success with animals. But that success is confined to sheep and goats. It cannot be assumed to work as well on humans. In order to discover or calculate success, germline experimentation must use human subjects (Oliver).

Those who oppose it contend that cloning can seriously adversely affect an entire family (Oliver 2005). It involves the transfer or transplantation of the nucleus and the genome within from a mature cell into an a-nucleated human egg or stem cell and the implantation for gestation and birth. Human development involves an entire process. This includes chromosome changes, rearrangement of genes and the change of size of DNA segments. Successful cloning requires a reprogramming of this process. During the transfer, the genome can be manipulated and bring on germline genetic changes. These changes will affect an entire family. There is as yet no guarantee of system safety. So far, observed effects have included premature death and major developmental anomalies. They can only be subtle in human subjects and result in altered mental development or some neurologic functions (Billings).

Scientific probabilities are no longer limited to "creating" human beings in the laboratory. These human beings may also be "designed" according to specifications. Princeton University microbiologist Lee M. Silver believed that, by 2010 to 2050, parents could ensure that their offspring would be free of certain predetermined defects (Deneen 2001). Parents could have an extra gene inserted into single-cell embryos within a day after conception to ward off AIDS, overweight or alcoholism. Professor Silver was referring to the Human Genome Project, which on June 26, 2000, completed the draft of a genetic blueprint for a human being. Many details were still needed to create a human being from scratch but the attempt had been started. This 15-year project should be completed in 2015 at a budget of $3 billion. Creating the human genome would need identifying 3.2 billion chemical "letters" in DNA strands found in every human cell. Researchers already know the arrangement but not all the chemical "letters." These contain the instruction in producing the proteins making up the human body. Approximately half of the sequencing task had been completed (Deneen).

If the experiment succeeds, Professor Silver foresees that a few centuries from now, there will be two species of human beings: the standard "natural" and the gene-enriched (Deneen 2001). Gene-enriched people will be those elite children produced from costly designer genes. They may be free of cystic fibrosis, diabetes, heart disease and other big killers, alcoholism and mental illness. The American Association for the Advancement of Science said that experiments cannot be safely and responsibly conducted on human beings without reliable techniques for gene correction or replacement was developed according to standards. Genome supporter-scientists said that the question was not whether genetic manipulation should occur or be done but only how and when.

Analysts argued that now would be the time to sort out the ethical and societal implications of our global and scientific society. Find out if we really want to modify nature. It is also important to consider that many nations have banned genetic engineering but the United States has not (Deneen).

Issue 3: Randomized Clinical Research

Before any drug is introduced into the market, it must pass many and prolonged tests and scrutiny (National Women's Health Resource Center 2005). It must withstand lab experimentations, clinical trials on human beings and the scrutiny of the Food and Drug Administration. FDA review and approval can take 10 or more years. Clinical testing is the supreme test of any new drug. Even approved drugs are monitored for long-term safety and effectiveness. Trials are performed throughout the U.S.A., in major cities and small towns, in universities, hospitals and doctors' offices (NWHRC). But the risks involve the participation of human subjects.

Reports say that every year, more than 100,000 patients take part in clinical trials conducted by the National Institutes of Health (NWHRC 2005). Many of them are very ill patients who need more effective treatments. Others want to contribute to medical advancement. Benefits in participation include access to new treatments not yet available and the chance to help others, contribution to medical research and access to top medical care. If the new treatment is effective, participants may be offered the treatment. There are risks too. It may cost them some inconvenience, side effects or adverse reactions. The design of the trial may require them to go to the study site… READ MORE

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Quoted Instructions for "Hospital Ethics" Assignment:

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Stand-Alone Project: County Hospital Director of Public Relations and Ethics (300 points)

You have been appointed Director of Public Relations and Ethics at County Hospital. The hospital is facing several urgent situations regarding the following issues. (A 20-page, double-spaced, response is required.) (300 points)

1. Abortion

2. Germline Experimentation

3. Randomized Clinical Research

4. Rationing Health Care

5. Organ transplants

Part A: You are charged with preparing white papers on these topics. White papers present various positions, explaining the strengths and weaknesses of each; they do not give or defend the author*****s position. Using the Required Readings, your textbook, and articles and Web sites you find by doing your own research, write a two-page paper on each of the topics listed above. Include a bibliography formatted in APA style. (150 points) (10 pages)

Part B: You must also organize the hospital's Ethics Committee to discuss these issues in depth and revise the hospital's ethics handbook. As part of your work with the Ethics Committee, you must choose its permanent members, as well as members who will participate in discussing the specific concerns listed above. The permanent committee should have 6 to 8 members who reflect the ethical, practical, financial, administrative, and legal concerns of the hospital and patient advocacy groups. The permanent committee should be augmented by two (2) or three (3) additional members selected to deal with each particular issue (abortion, germline experimentation, etc.) For each of these members, give two (2) or three (3) concerns that they might have (lawsuits, finances, clarity of mission, life of fetuses, rights of mothers to choose, etc.). Then write a 2-page document describing the concerns that each of these members would likely bring to the discussion. Since you will want some diversity of opinion on the committee, you may include paragraphs that describe individual members***** qualifications with an explanation about why you want someone with those attributes. Then, draft three (3) questions that will guide Ethics Committee deliberations for each topic.

(75 points) (4 pages)

Part C: In addition to the white papers, you are charged with preparing 1-page summaries of your own position on each of these topics in the form of a flyer that clearly states hospital policy and the rationale behind it. (In real life, this flyer would state the position and rationale of your ethics committee.) Each summary should contain less than 300 words and should cover the main ethical issues that patients and their families might have. (75 points) (5 pages)

A suggested outline for these summaries is as follows.

1. State the position clearly in one paragraph.

2. Allot one paragraph for each ethical position, giving reasons for and against each of them.

3. Restate your position and give persuasive arguments for it.

4. Indicate that hospital personnel are available to discuss ethical issues with family members.

Please make sure the Bibliography is in APA format.

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