1 Chapter 6 Proposals for Human Cloning: A Review and Ethical Evaluation 3 What is a Clone? • Cloning requires the ability to produce cells that are totipotent. This means that the cell can access genes to make different kinds of cells. • Clones are divided into two categories: – Reproductive clones – Research clones 4 Benefits of Research Clones • Benefits include creating tissues, organs, or other treatments that can be matched to individual patients or diseases. • Creating cloned embryonic stem cell models for research on specific human diseases and how they arise during development. • Using cloned embryonic stem cells for research on human reproduction and development in general. 5 Human Cloning for Research Purposes • The goal of research cloning is to create stem cell lines. • Cells may be able to be separated to form new stem cell lines. • These lines will be used to study specific diseases. • Interventions can be identified from this research. 6 Human Cloning for Research Purposes • The stem cell lines might be used to create transplantable tissue. • Even if this is not achieved, the use of stem cell lines from clones could add to the body of knowledge. • Benefits are speculative at this point. 7 Human Cloning for Research Purposes • A new technique is now available to induce pluripotency to adult cells. • These cells are called iPSCs and mimic the patterns found in embryonic cells. • This discovery has enabled scientists to reprogram a variety of human cells. • This research could lead to patient-specific treatment of disease. 8 Human Cloning for Reproductive Purposes • Safety will be a critical issue in reproductive cloning. • Cloning could become an ART option. • Reproductive cloning might redefine what it means to have one’s own child. • Genetic reductionism is a concern. 9 Ethical Issues in Human Cloning • There is controversy regarding the public’s support or lack of support for stem cell and cloning research. • Cloning produces embryos without the use of sperm. • Knowing this is important to the argument that stem cell research destroys embryos. 10 Ethical Issues in Human Cloning • Some argue that embryos produced by cloning do not have the same moral standing as a human fetus. • This raises issues about different status for different human organisms based on intent of use. • However, many recognize the benefits of stem cell research. 11 Ethical Issues in Human Cloning • The ANT and iPSCs techniques may create stem cell lines without destruction of human embryos. • Proponents would say we need all forms of research to achieve answers or treatments. 12 Attention to Faulty Assumptions • While research could be done that investigates diseases, it is limited by the harm it does to humans. • What is good for research may not be what ...

1. 1
Chapter 6
Proposals for Human Cloning:
A Review and Ethical
Evaluation
3
What is a Clone?
• Cloning requires the ability to produce cells
that are totipotent. This means that the cell
can access genes to make different kinds of
cells.
• Clones are divided into two categories:
– Reproductive clones
– Research clones
4

2. Benefits of Research Clones
• Benefits include creating tissues, organs, or other
treatments that can be matched to individual
patients or diseases.
• Creating cloned embryonic stem cell models for
research on specific human diseases and how they
arise during development.
• Using cloned embryonic stem cells for research on
human reproduction and development in general.
5
Human Cloning for Research Purposes
• The goal of research cloning is to create stem
cell lines.
• Cells may be able to be separated to form new
stem cell lines.
• These lines will be used to study specific
diseases.
• Interventions can be identified from this
research.
6

3. Human Cloning for Research Purposes
• The stem cell lines might be used to create
transplantable tissue.
• Even if this is not achieved, the use of stem
cell lines from clones could add to the body of
knowledge.
• Benefits are speculative at this point.
7
Human Cloning for Research Purposes
• A new technique is now available to induce
pluripotency to adult cells.
• These cells are called iPSCs and mimic the
patterns found in embryonic cells.
• This discovery has enabled scientists to
reprogram a variety of human cells.
• This research could lead to patient-specific
treatment of disease.
8

4. Human Cloning for Reproductive Purposes
• Safety will be a critical issue in reproductive
cloning.
• Cloning could become an ART option.
• Reproductive cloning might redefine what it
means to have one’s own child.
• Genetic reductionism is a concern.
9
Ethical Issues in Human Cloning
• There is controversy regarding the public’s
support or lack of support for stem cell and
cloning research.
• Cloning produces embryos without the use of
sperm.
• Knowing this is important to the argument
that stem cell research destroys embryos.
10
Ethical Issues in Human Cloning
• Some argue that embryos produced by
cloning do not have the same moral standing
as a human fetus.

5. • This raises issues about different status for
different human organisms based on intent of
use.
• However, many recognize the benefits of stem
cell research.
11
Ethical Issues in Human Cloning
• The ANT and iPSCs techniques may create
stem cell lines without destruction of human
embryos.
• Proponents would say we need all forms of
research to achieve answers or treatments.
12
Attention to Faulty Assumptions
• While research could be done that
investigates diseases, it is limited by the harm
it does to humans.
• What is good for research may not be what is
good for society.
• Human cloning research may not lead to
earlier treatment of diseases.

6. 13
What is the Goal?
• If the goal is to treat those with terrible
diseases, then resources should be shifted to
delivery and prevention.
• However, biomedical research also benefits
society.
• Decisions must be made regarding the nature
of research, benefits, and limitations.
14
Other Ethical Issues
• The risk to women from harvesting human
eggs for cloning research is great.
• Many groups have raised ethical issues with
this practice.
• Given the risks, it must be proven that what is
good for science is good for society.
15

7. Other Ethical Issues
• Issues about cloning for reproduction include
a decision about the right to have genetically-
related offspring.
• One needs to consider this situation in light of
the morality of a society.
• Society can decide if cloning is a right or not
based on its collective morality.
16
Other Ethical Issues
• Another argument is that if we do not do this
research, other countries will.
• The history of the effects of jumping to
technology too soon needs to be considered.
17
In Summary…
18
Slide Number 1Chapter 6Slide Number 3What is a
Clone?Benefits of Research ClonesHuman Cloning for Research
Purposes Human Cloning for Research Purposes Human Cloning
for Research Purposes Human Cloning for Reproductive

8. Purposes Ethical Issues in Human Cloning Ethical Issues in
Human Cloning Ethical Issues in Human CloningAttention to
Faulty AssumptionsWhat is the Goal?Other Ethical IssuesOther
Ethical IssuesOther Ethical IssuesIn Summary…
1
Chapter 8
Older People and Long-Term
Care: Issues of Access
3
Why the New Interest in Long-term Care?
• The Baby Boomers are adding to the growth in
the population over 65.
• There is increasing fear of dependency on
long-term care.
• Adult children of the elderly having to find
care for their parents.
• Healthcare reform promises great changes
that are not well understood.

9. 4
The Growing Population Needing Care
• The need for ADL and IADL assistance
continues to grow.
• Table 8-1 presents the broad range of services
needed by the disabled.
• Most of the population needing long-term
care do not live in nursing homes.
• Many factors contribute to the inability to
predict the exact number needing services in
the future.
5
The Growing Population Needing Care
• Future populations may be better educated
which is associated with lower levels of
disability.
• Ethnic composition suggests a greater need
for care and government support.
• Boomers will bring greater numbers of people
needing services.

10. • The number those over 75 will greatly
increase.
6
The Growing Population Needing Care
• Disability rate will increase among those who
are not in nursing homes.
• The most common disability is physical.
• In addition, the nursing home population is
expected have profound increases until it
triples by 2030.
• The number of younger persons with disability
has also increased.
7
Issues of Access
• The current system is far from ideal.
• There is not an adequate supply particularly
for the poor.
• The system itself continues to be so
fragmented that many are not aware of what
is offered.

11. • Financing is an underlying problem.
8
The Costs of Care
• Expenses for this care are sizable and will
increase in the future.
• Private insurance only pays for a small
percentage of the care.
• Medicaid pays for over 85% of nursing home
care.
9
The Costs of Care
• Annual costs of nursing home care can
average $58,000 per year and may exceed
$100,000. For many, the costs of this care is
just not affordable.
• With the addition of the Baby Boomers, costs
will most certainly increase in the future.
• The effects of reform are not currently known.
10

12. The Care-Giving Role of Families
• About 74% of dependent community-based
elders receive care from family members.
• The majority of caregivers are women.
• The number and willingness of family
caregivers may decline as the Boomers
become in need for assistance.
11
The Role of Private Insurance
• Private insurance for long-term care is a
relatively new product.
• Improvements in coverage are being made,
but only an estimated 20% of the population
will use it.
• CCRCs and LCAHs hold promise for the future.
12
The Role of Medicaid
• Medicaid is changing under PPACA to include
more eligible adults who will receive
benchmark coverage.

13. • Medicaid is used for those elders who do not
qualify for other assistance.
• Medicaid does not pay for the full range of
services including home-based care.
• Some states are using a waiver to offer non-
medical home-care services.
13
The Role of Medicaid
• Some elders qualify for Medicaid once they
are institutionalized and have used all of their
assets.
• Other elders are trying to shelter their assets
so that they can be poor without really being
poor.
• Healthcare reform requires an office within
CMS to address the issue of dual edibility.
14
Forces for Improving Access
• Advocates for Alzheimer’s disease patients
and for others have worked for changes.

14. • The Pepper Bill and other legislation
recommended changes.
• Attempts to limit the grow of Medicaid are
part of the national health care debate.
15
Future Prospects
• Baby Boomer numbers and healthcare reform
will result in changes to the system.
• Government involvement will increase as
demand increases without the funding for
access.
• Government involvement may not be the only
or best answer.
16
Future Prospects
• Future elders are concerned about what their
care will be like under healthcare reform.
• The political climate must be willing to
address future concerns.
• Ethical questions such as beneficence,

15. autonomy, and justice need to be part of
policy discourse.
17
Future Prospects
• Issues of the elderly and non-elderly disabled
need to be addressed.
• Given the cost and complexity, the medical
model is not the only one to be considered.
• Long term care needs to be part of health
care.
18
Update from a Practitioner’s View
• Even with healthcare reform the trends and
issues for long-term care are the same.
• Barriers to real change are driven by the
political climate that controls funding.
• What will be America’s legacy about the
treatment of its elderly?
19

16. In Summary…
20
Slide Number 1Chapter 8Slide Number 3Why the New Interest
in Long-term Care?The Growing Population Needing CareThe
Growing Population Needing CareThe Growing Population
Needing CareIssues of AccessThe Costs of CareThe Costs of
CareThe Care-Giving Role of FamiliesThe Role of Private
InsuranceThe Role of MedicaidThe Role of MedicaidForces for
Improving AccessFuture ProspectsFuture ProspectsFuture
ProspectsUpdate from a Practitioner’s View In Summary…
1
Chapter 7
Competency: What It Is, What
It Isn’t, and Why It Matters
3
Why is Competency an Issue?
• Competent adults have the right to refuse
treatment.

17. • But when a person refuses life saving
treatments, we become uneasy.
• We find our refuge in the idea of competency.
• Therefore, it is important to understand what
it is and how it impacts practice
4
Consider Competency
• It is not a medical judgment.
• It may not be based on rational thinking.
• It is a legal and social decision about the
ability to make decisions.
• The criteria used is not precise and may
include our prejudices.
5
Seeking a Definition
• There is no standard definition that fits all
cases.
• Rules of competency differ by situation.
• Definitions are divided into those that
represent end results, and

18. • Those that represent processes.
6
Seeking a Definition
• Definitions concerning end results ask:
• What is the patient’s condition?
• What are the end results of the patient’s
thinking and decision?
• Would an incompetent person make decisions
that lead to serious consequences?
• However, this definition may not work in all
cases.
7
Seeking a Definition
• Definitions also include thought processes.
• These definitions examine a patient’s view of
reality and ability to make rational judgments.
• You need to determine if the patient is making
sense in his or her decisions.
• There is a need to determine the essence of
competency to define it.

19. 8
The Essence of Competency
• Competency involves the patient’s ability to
make a decision in any given situation.
• First, the patient must understand the
situation to make a competent decision.
• Determining patient’s understanding level
may be difficult in situations which can lead to
end of life.
9
The Essence of Competency
• We define rational as being sensible to our
way of thinking.
• We use the idea that most people would want
the treatment as a criteria.
• Patients who make decisions based on facts
and logic appear to be competent.
• If the decision does not logically flow from the
facts, we see the patient as being
incompetent.

20. 10
Religious Refusals
• Religious beliefs need to be considered
differently since they may not appear to be
rational.
• In this case, the patient is competent if he/she
understands the situation and is making a
decision based on religious beliefs that are
within our common understanding.
11
Religious Refusals
• Think about the decision processes of patients
A and B.
• Both demonstrate “irrational” thinking but
Patient A’s belief fits within our understanding
of religious faith.
• Patient B would be seen as incompetent
because the decision is not based on an
understood faith.
• This criteria is also used in court cases.
12

21. Religious Refusals
• Think about the decision processes of patients
C and D.
• Patient C would be considered incompetent
because her belief is outside of common
religious practice and she does not
understand her situation.
• What about Patient D?
13
Conclusions Related to Competency
• What would a Medical Miranda Card say
about refusing medical treatment?
• If the answers to all four questions shown in
the Chapter are “yes”, the patient should be
considered competent.
• If the answer to any of them is “no”, the
competency is not assured.
14
Why it Matters

22. • Consider what happens when you decide that
a patient is not competent.
• You force your choice on a person against
his/her will.
• You are making a decision that affects the
person’s nature.
• You negate the person’s autonomy in an effort
to assure your determination nonmaleficience
and beneficence.
15
Conclusions
• You must determine competency before you
decide to accept a patient’s refusal.
• Competency is a label we give to patients who
understand their situation and whose reasons
for choices make sense to us.
• It is a serious action to declare a person
incompetent and make choices for him/her.
16
In Summary…

23. 17
Slide Number 1Chapter 7Slide Number 3Why is Competency an
Issue?Consider CompetencySeeking a DefinitionSeeking a
DefinitionSeeking a DefinitionThe Essence of CompetencyThe
Essence of CompetencyReligious Refusals Religious Refusals
Religious Refusals Conclusions Related to CompetencyWhy it
MattersConclusions In Summary…
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References:
Li X, Bazer FW, Johnson GA, Burghardt RC, Erikson DW,
Frank JW, Spencer TE, Shinzato I, Wu G. Dietary
supplementation with 0.8% L-Arginine between days 0 and 25
of gestation reduces litter size in gilts. J Nutr. 2010:140.
Li X, Bazer FW, Johnson GA, Burghardt RC, Frank JW, Dai Z,

25. Wang J, Wu Z, Shinzato I, Wu G. Dietary supplementation with
L-arginine between days 14 and 25 of gestation enhances
embryonic development and survival in gilts. Amino Acids.
2014:46.
Wu G, Bazer FW, Johnson GA, Herring C, Seo H, Dai Z, Wang
J, Wu Z, Wang X. Functional amino acids in the development of
the pig placenta. Mol Reprod Dev. 2017:Accepted author
manuscript.
Wu G, Bazer FW, Satterfield MC, Li X, Wang X, Johnson GA,
Burghardt RC, Dia Z, Wang J, Wu Z. Impacts of arginine
nutrition on embryonic and fetal development in mammals.
Amino Acids. 2013:45.
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2
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