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OCTOBER 2017

Shaping the future of healthcare bioethics

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What is bioethics?

Bioethical issues

Common bioethical issues involve the rights of patients, the responsibilities of healthcare professionals, and the interests of society.

abortion

new reproductive technologies

death and dying

privacy

genetics

organ transplants

informed consent

research on human subjects

Types of issues

Bioethics is the multidisciplinary study and discussion of the legal, medical, and ethical questions that surround health care, health science, and health policy.

“Bioethics includes questions about life and death, relationships, and personhood—everything that is essential to being human. It addresses a very complicated question: what does it mean to be a human being? It’s a hard question, but we can’t stop asking and discussing it.”

Janet L. Dolgin, JD Jack and Freda Dicker Distinguished Professor of Health Care Law at Hofstra Law

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Informed consent and its challenges

Salgo v. Leland Stanford Jr. University Board of Trustees (1957)

The term “informed consent” first emerged during the Martin Salgo case. Physicians advised the arteriosclerosis sufferer to submit to a procedure. With Salgo under sedation, physicians injected his aorta with a chemical that enhances X-ray images, after which they recorded abdominal aorta blockages. The next day, Salgo couldn’t move his lower extremities.

Legislation resulting from the case mandates that physicians must exercise good judgment in fully disclosing procedural risk. Consequently, physicians violate their ethical duty by withholding any information that a patient requires to make an informed decision about medical procedures.

Landmark legal case that changed bioethics

Insight from Professor Dolgin

“This is the first case to use the term “informed consent,” which is now well accepted. Despite this, obtaining informed consent is still challenging in today’s world of practice with increased pressures on providers’ time. What do you tell a patient and when and how?

The task of talking to patients about their options demands a serious comprehension of complex clinical issues and the capacity to understand nuance and compassion. It’s crucial that healthcare professionals know that part of being a healer is talking to patients in a manner and a language they can understand. Nurses are in a wonderful position to ensure patients receive informed consent.”

Bioethics is the multidisciplinary study and discussion of the legal, medical, and ethical questions that surround health care, health science, and health policy. Great bioethical legal cases of the past have shaped healthcare practice and will continue to do so. Here are three cases, with commentary from Professor Dolgin.

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Landmark legal case that changed bioethics

Insight from Professor Dolgin Patient privacy and reproductive rights

Griswold v. Connecticut (1965)

The Estelle Griswold case established privacy as a guaranteed right and marked the first time the Supreme Court granted privacy rights that extend constitutional guarantees. This privilege, called a penumbral right, relates to “making express guarantees fully meaningful” as spelled out in the Bill of Rights.

Griswold was a director of a Planned Parenthood center whom authorities arrested, along with the director of another center. At the time, state law decreed that contraception and assisting others in using contraception was illegal. The case resulted in a ruling that delineated marriage as a relationship that the constitution deems private and protected from state intervention, thus setting a precedent for future privacy related issues.

“The notion of patient privacy was important before, but the Griswold case brought the notion of privacy into the context of reproductive rights. It declared it a constitutional right to distribute, buy, and use contraception for married people. It wasn’t until 1972 that the Supreme Court extended the right to unmarried people.

In some ways, this case foreshadowed the jurisprudential framework underlying Roe v. Wade, which is still one of the most controversial cases ever decided by the Supreme Court. That case, of course, provided women with a limited right to abortion. The real issue now is financial resources. There is no constitutional right to health care, and there is no constitutional right to have the government, including Medicaid, pay for abortion.”

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Landmark legal case that changed bioethics

Changing how unborn children are viewed

Davis v. Davis (1993)

In this case, divorcees Lewis and Mary Sue Davis disagreed over what to do with the couple’s preserved embryos. After consulting with the American Fertility Society, the court determined that although embryos don’t represent individuals or personal property, they should receive special treatment because of their potential to create human life.

As a result, the court created a system to classify priorities when hearing similar cases.

1. The court considers the wishes of the natural parents.

2. If the natural parents have opposing desires or are unsure of how they would like to proceed, the court defers to any previously established agreements.

3. If a pre-established agreement does not exist, the court will make a judgment based on the parents’ interests. Priority will be given to the parent seeking to avoid natural childbirth in either of the two previous circumstances. That is, if the other parent can produce offspring naturally and within reason or wants to donate existing genetic material to another party.

This case, along with several others, changed how society and medical professionals view unborn children.

Insight from Professor Dolgin

“The first baby born conceived by invitro fertilization was born in 1978. This event has led to many dis-putes and challenges about the right to control gametes and embryos.

The Davis case was heard by three Tennessee courts. Every court had a different vision of what the embryos were. The trial court said they were children, the appellate court said they were property, and the Tennessee State Supreme Court said they were pre-embryos like tissue or organs with a special status. The court also recommended that couples enter into contracts before they freeze embryos, and that these prior contracts will prevail. This case became a model in many other states.

Today there are similar disputes about embryos gestated by surrogates, and there will potentially be comparable cases involving human cloning and genetic engineering in the future. ”

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Get involved with bioethics issues

Every new technology and medical advance brings new bioethical questions and issues that touch on the practice of nurses and other healthcare professionals. Take these steps to stay on top of issues and act as an advocate as needed.

Be familiar with the American Nurses Association Code of Ethics for Nurses with Interpretive Statements. It can help you make choices when you’re in difficult situations.

Meet with your legislators to establish a relationship. The time invested will pay off when you want your voice heard on a bill related to an ethical issue.

Get involved in your professional associations. You’ll be able to support the association’s initiatives.

Stay informed by connecting with associations offering resources.

n American Nurse Association Center for Ethics and Human Rights Access the code of ethics, along with articles and position statements.

n American Society of Law, Medicine, and Ethics Network and learn more about major bioethical and legal issues with far-reaching social ramifications.

n American Society for Bioethics and Humanities Connect with bioethics professionals and learn more about bioethics, professional development, and career opportunities.

Organization resources

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Shape your future with a degree

As the issues and litigation surrounding bioethical concerns grows more complex, the demand will rise for more individuals skilled in navigating the courtroom. Nurses and other healthcare professionals are in an optimal position to shape the future of bioethics in today’s rapidly changing healthcare system.

Opportunities in health law

n Bioethics consultation in healthcare organizations, government agencies, and private organizations

n Providing expert testimony in courts of law

n Healthcare administration

n Legal nurse consulting

n Teaching

n Ethics committees

Who benefits from a health law degree

n Registered nurses and advanced practice nurses

n Health administrators

n Insurance professionals

n Health educators

n Healthcare social workers

n Social community service managers

n Compliance officers

n Clinical ethicists and organization ethicists

“It’s critically important for nurses to learn about bioethics because they are at the forefront of providing good health care for everybody. A master of arts in health law and policy opens doors for nurses that are already before them.” Janet L. Dolgin, JD Jack and Freda Dicker Distinguished Professor of Health Care Law Professor of Science Education Hofstra Northwell School of Medicine

ABOUT THE SPONSOR

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Working to improve health care through law and policy can effect change across the nation, assuring a more effective, affordable and positive experience when patients require care. While you may be considering a MHA or MBA program, Hofstra Law’s Online Master of Arts in Health Law and Policy can provide legal expertise unmatched by other degrees.

Designed by health law experts, our program covers topics making headlines today. Take courses that focus on key areas of health law and policy, such as:

n Health care reform

n Bioethics

n Business transactions

n Compliance

n Drug development

n Public health

Phone: 855-424-0282

Healthlaw.Hofstra.eduadmissions@healthlaw.hofstra.edu

Working to improve health care through law and policy can effect change across the nation, assuring a more effective, affordable and positive experience when patients require care. While you may be considering a MHA or MBA program, Hofstra Law’s Online Master of Arts in Health Law and Policy can provide legal expertise unmatched by other degrees.

Designed by health law experts, our program covers topics making headlines today. Take courses that focus on key areas of health law and policy, such as:

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