PowerPoint to accompany

Law & Ethics For Medical CareersFourth 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

ObjectivesDefine genetics and heredityDistinguish between DNA, chromosomes

and genesList several situations in which genetic

testing might be appropriateDiscuss 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

GeneticsThe study of heredity

Human Genome ProjectProject to identify and map the human

genomesCompleted in 2000, available to all

physicians and scientists who could use it

Genetic Testing

DNA testing has become a reliable source of testing forForensicsDetermining parenthood/tracing lineageScreening for inherited diseases or

conditionsHow test results are used has become

an important ethical and legal issue

Genetic Testing and Discrimination

Genetic discriminationDifferential 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 Discriminationcontinued

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 involveReplacing a deficiency or blocking an

overactive pathway Inserting a normal copy of gene into a

patient with a specific genetic diseaseCurrent 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

SurrogacyUse of surrogate—a woman who agrees to carry

a child to termUsed when mother is unable to carry embryo to

termGestational surrogacy—when surrogate is not

related to embryoTraditional surrogacy—when surrogate is related

to embryo

Conception and the Beginning of Life

AdoptionBoth State and Federal laws regulate

adoptionAgency adoptions

State-licensed, public or private, agency that places children with adoptive parents

Private adoptionsNo agency involvement; some states prohibit

Rights of Children

Common lawParents have the right to make health care

decisions for minor childrenDoctrine 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 comatosewill most certainly die and to treat would be

futilewould 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 minorsConsidered mature enough to understand a

physician’s recommendation and give informed consent

Emancipated MinorsLegally live outside parent or guardian

controlCourt 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?