The impact of technology on nursing and healthcare.

Current technology makes it possible to restart arrested hearts, use machines to breathe for people, correct deformities, assist the body in dealing with disease through use of medications and other interventions, eliminate diseased parts through surgery, and even to replace malfunctioning or diseased vital organs.

Principles of Beneficence and Nonmaleficence

When dealing with technology, the principles of beneficence and nonmaleficence may be in conflict.

A particular technology, which may be implemented with the intention of doing good (beneficence), may result in much suffering for the patient.

In circumstances in which there is little or no expectation of recovery or improved functioning, the essential question is whether the harm imposed by technology outweighs the good intended by its use.

Understanding Quality of life

Is a subjective appraisal of factors that make life worth living and contribute to a positive experience of living, means different things to different people.

Is a personal perspective that is determined by each individual.

Recognizing this, we should not judge the quality of another’s life based on our values.

Practice Issues Related to Technology

Organ and tissue procurement; Organ transplantation.

Death and the Dead Donor Rule.

The Federal Omnibus Budget Reconciliation Act of 1986

“That all facilities receiving Medicare or Medicaid funding must have policies in place to identify potential organ donors and to inform families about the option to donate.”

Legal Aspects of Organ Donation

Laws do not require the consent of a family member to retrieve organs if donor has already declared his wish to donate (must be 18 years of age or older).

Choice to donate an organ must be a written document – a donor card, a will, or an advanced directive signed by the client.

Legal Aspects of Organ Donation

Providers are reluctant to act without a family member’s permission because of fear of being sued.

Some states have limited the family’s involvement in the donation process.

Legal Aspects of Organ Donation

Hospitals are required by law to contact donor team so they may give families the information they need to make an informed decision about organ donation.

The Uniform Anatomical Gift Act protects those who are involved in organ procurement from liability, but provider must “act in good faith” and must provide next of kin with complete and accurate information.

Allocating organs.

United Network for Organ Sharing –clients awaiting transplant (heart or kidney) are assigned priority according to medical need.

Ethical question.

Should more desperately ill receive preference or should priority be given to healthier clients?

Organ donor potential Review specific facility’s death criteria. Brain death, generally accepted criteria. Cause of client’s injury known. Exhibit no brain stem reflexes No CNS depressant present. Temperature greater than 90 degrees F. Exhibits no spontaneous responses. Unresponsive to noxious stimuli.

Practice Issues Related to Technology

Genetic diagnosis, engineering and screening.

Medicalization

Genetic Diagnosis, Engineering, and Screening

Advances in molecular biology, new reproductive technologies, and the Human Genome Project have prompted rapid breakthroughs in genetic research.

Burkhardt and Nathaniel 2008 p., 252

Genetic Diagnosis

Genetic diagnosis, which is usually done within an in vitro fertilization program, involves a process of biopsy of embryos to determine the presence of genetic flaws and gender prior to implantation.

Genetic Engineering

Genetic engineering, is the ability to alter organisms genetically for a variety of purposes, such as developing more disease-resistant fruits and vegetables, or eventually being able to alter embryos genetically so that the fetus and baby will be healthier.

Genetic Screening

Genetic screening, is the possibility to determine if persons are predisposed to certain diseases, and whether couples have the possibility of giving birth to a genetically impaired infant

Medicalization In what has been termed the medicalization of

American society, nursing has struggled to overcome the prejudices of a society that historically embraced the biomedical curative model of health care. As diversified consumers of health care are demanding more sophisticated and culturally congruent care, nurses are in prime position to provide cost-effective, high quality care. If nursing is to be successful in this and other arenas, it must concomitantly address issues of territoriality, power, and authority within its own ranks as well as with other health care professionals.

Controversial Technologies

Cloning is the process of creating a cell or an entire organism that is identical in every way to another.

The overall stance within nursing and other organizations that promote health and human rights is that cloning is ethically unacceptable and violates the right to one’s unique genetic identity, human dignity, and integrity (ANA, 2000, Anderson & Rorty, 2001).

Human stem cells used in research vary depending on the origin of the stem cells (Biotechnology Online 2005).

Adult stem cells

Embryonic stem cells

Embryonic germline stem cells

Adult stem cells ASC are cells found in adults that can

replace old cells by reproducing new ones. Blood cells and liver cells are two examples. Bone marrow transplant are examples of the use of ASC in therapy.

Stem cells retrieved from umbilical cord blood following birth have similar properties to ASC and are also used for the treatment for some leukemias.

Embryonic stem cells ESC are collected from the inner cell mass

of an early embryo, thus destroying the embryo.

These cells are unspecified (or pluripotent), meaning that they have the ability to develop into any type of cell in the body except the placenta.

They also are able to renew themselves indefinitely in the laboratory.

Embryonic germline stem cell

EG stem cell are immature cells that can become sperm and egg cells.

The main controversy surrounding stem cell research

Whether the destruction of the human embryo constitutes the killing of a human being

If one considers that research on human embryos is not wrong in itself, would it lead to a slippery slope of treating human life as a commodity through practices that are dehumanizing such as using fetuses for spare parts.

End of Presentation

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