This document discusses several contemporary ethical dilemmas including abortion, sterilization, artificial insemination, surrogacy, organ donations, research ethics, human genetics, stem cell research, and AIDS. It provides background information on key court cases related to abortion rights, outlines ethical issues around different medical procedures and technologies, and summarizes federal regulations pertaining to research ethics and informed consent.

1. Chapter 2
Contemporary
Ethical
Dilemmas

2. No right is held more sacred, or is more carefully
guarded, by the common law, than the right of
every individual to the possession and control of
his own person, free from all restraint or
interference of others, unless by clear and
unquestioned authority of law.
-Union Pac. Ry. Co. v. Botsford

3. Learning Objectives – I
• Describe various historical events that have had
an impact on the resolution of ethical dilemmas.
• Common ethical dilemmas:
– Abortion
– sterilization
– Artificial insemination
– Surrogacy

4. Learning Objectives – II
• Organ donations
• Research, experimentation, and clinical trials
• Human genetics
• Stem cell research
• AIDS

5. Ethical Dilemmas
• Ethical dilemmas arises in situations where a
choice must be made between unpleasant
alternatives.
• Occur when a choice involves giving up
something good & suffering some bad.
– should I choose life knowing an unborn child
will be born with severe disabilities.

6. Noteworthy Historical Events
58,000 to 68,000 BC
– Neanderthal Burial Sites
• Evidence of belief in an afterlife
1932–1972
– Tuskegee Study of Syphilis study
1933–1945
– Holocaust

7. 1946 - Military Tribunal for War Crimes
1949 - International Code of Medical Ethics
1954 - Guidelines on Human Experimentation
- The First Kidney Transplant
1960s - Cardiopulmonary resuscitation
1964 – WHO guidelines for medical doctors
conducting biomedical research

8. 1968 - Harvard Ad Hoc Committee on Brain Death
1970 - Patient as a Person
1971 – Kennedy Institute of Ethics established
1972 - Informed consent (Canterbury v. Spence)
1973 - Women’s Right to Abortion
- Roe v. Wade

9. 1974 - National Research Act
- created the National Commission for the
Protection of Human Subjects of Biomedical
& Behavioral Research
1975 - First successful cloning of frogs
1976 - Substitute Judgment—Karen Ann Quinlan
- First Living Will Legislation Enacted

10. 1978 – Commission for the Study of Ethical
Problems in Medicine
1980 – Hemlock Society formed to advocate for
physician-assisted dying.
1983 – California,1st durable power of attorney
legislation
– Compassion and Choices

11. 1990 – Patient Self-Determination Act
– Cruzan could have feeding tube removed
– Kevorkian’s assists terminally ill patients in
suicide
– Timothy Quill & Prescription for Death
– Derek Humphry’s author’s the “Final Exit”
1993 – Patient’s Wishes Honored

12. 1994 - Oregon’s Death with Dignity Act
- Michigan Assisted Suicide Illegal
1996 - HIPAA
- Cloning of Dolly
1997 - Kevorkian charged with murder in MI
- Supreme Court (States May Enact Assisted
Suicide Laws)

13. 1998 - OR voters reaffirm Death with Dignity Act
- MI voters ban physician suicide
1999 - Kevorkian convicted murder

14. 2001 - President’s Council on Bioethics created
- District Court Judge upholds Oregon
“Deathwith Dignity Act”
2003 - Human gnome system fully sequence
2004 - U.S. Ct. of App. Upheld OR’s “Death with
Dignity Act”

15. 2006 - U.S. Supreme Ct. Upheld OR “Death with
Dignity Act”
2009 - Right to Know End-of-Life Options
2010 - California 1st
legislation to build organ
registery
2013 - Information and Referral Service for Kidney
Donors

16. Abortion
The termination of pregnancy by the removal or
expulsion from the uterus of a fetus or embryo
before it is viable

17. Ethical & Legal Issues – I
• Rights of the Woman
– Autonomy
• Rights of the Fetus
• Rights of the Spouse
• Rights of the State
– protecting life

18. Ethical & Legal Issues – II
• When does life begin?
• Who decides?
• Who protects the unborn fetus?
• What are the rights of the child or woman who
has been raped?
• What are the rights of the spouse?

19. Ethical & Legal Issues – III
• Should the principles of autonomy and right to
self-determination prevail?
• Should an abortion be considered murder?
– a form of killing by preventing a birth that
might have otherwise occurred?
• What are the religious implications?

20. Ethical & Legal Issues – IV
• Is an abortion for mere convenience morally
wrong?
• Should a child or woman who has been raped
have a right to abortion?
• What role should education play in the woman’s
decision to undergo an abortion?

21. Ethical & Legal Issues – V
• What alternatives should the woman be
educated about (e.g., the choice of adoption)
before undergoing an abortion?
• At what age should the decision to abort be that
of the mother?
• Should the feelings of guilt that may accompany
an abortion and how those feelings may haunt
the mother through the years be explained?

22. Ethical & Legal Issues – VI
• Should the feelings that might occur after giving
birth be explained to the victim of a rape (e.g.,
anger and resentment)?
• When does control over one’s body begin, and
when does it end?

23. Abortion
U.S. Supreme Court Decisions

24. Woman’s Right to Privacy
1973 - Roe v. Wade
• Right to Abortion
• Recognition of state protecting the unborn.
– First Trimester: abortion decision between
woman & physician.
– Second Trimester: state may reasonably
regulate abortion procedure.
– Third Trimester: state may prohibit all
abortions except those deemed necessary to
protect maternal life or health.

25. Abortion Restrictions Struck Down
• Abortion Committee Review
• Abortion Counseling
• Undue Burden Rule

26. Funding
– Denial of Financial Assistance for Elective
Abortions
– Funding Not Required for Therapeutic
Abortions
– Funding Bans Unconstitutional in California
– Funding Discrimination Prohibited in Arizona
– Refusal to Fund Abortion Counseling Not
Unconstitutional

27. Spousal Consent
• Husband’s Interest Insufficient
• Husband’s Required Consent Unconstitutional

28. Parental Consent
• Competent Persons Under 18
• Incompetent Persons
• Parental Notification Permitted
• Emancipated Minor
• Parental Notification Not Required

29. Informed Consent
• The Fifth U.S. Circuit Court of Appeals
determined that a Texas law requiring a
pregnant mother to undergo an ultrasound prior
abortion is constitutional. Although a pregnant
woman cannot be compelled to view the
ultrasound image, the physician is required to
describe what the image shows.

30. States May Protect Fetus
1979 - Colautti v. Franklin
• States may seek to protect a fetus which a
physician has determined could survive outside
the womb.

31. Abortion Rights Narrowed
1989 – Webster v. Reproductive Health
Services
• Missouri statute upheld:
– public employees & public facilities may not
be used in performing or assisting in abortions
unnecessary to save mother's life.
– physicians should conduct viability tests
before performing an abortion.

32. Partial Birth Abortion
1998 - Women’s Med. Prof. Corp. v.
Voinovich
• Supreme Court denied certiorari for first partial-
birth case to reach federal appellate courts.
• 6th Circuit Court of Appeals held statute banning
any use of D&X ("Dilation & Extraction")
procedure unconstitutionally vague.

33. Partial Birth Abortion Struck Down
2000 - Stenberg v. Carhart
• Supreme Court struck down Nebraska ban on
"partial birth abortion."

34. 2003 - Partial Birth Abortion Ban Made
Law
• President Bush signed 1st
federal restrictions
banning late term partial birth abortions.
• Both houses of Congress passed ban.
• Ban permits no exceptions when woman's
health at risk or fetus has life threatening
disabilities.

35. Law & Morality of Abortion
The obligation of society is to define the liberties of
all and not to mandate one’s own moral code.

36. Law & Morality of Abortion - II
• The courthouse is not the proper forum to
address abortion issues that have no legal
foundation.
• Conflicting Beliefs
• Matter of
– philosophy
– ethics
– Theology

37. Sterilization – I
• Sterilization
– Termination of the ability to produce offspring.
• Elective Sterilization
– Voluntary sterilization

38. Sterilization – II
• Therapeutic Sterilization
– Performed to preserve life or health
• Eugenic Sterilization
– Involuntary sterilization
• described in statutes
• mentally deficient
• feeble-minded

39. Negligent Sterilization
• The improper performance of sterilization can
result in lawsuits based on such theories as
wrongful birth, wrongful life, and wrongful
conception.

40. Wrongful Birth
• A claim that but for a breach of duty by the
defendant(s) (e.g., improper sterilization), child
would not have been born.

41. Wrongful Life
• Wrongful life claims
– initiated by the parent(s) or child based on
harm suffered as a result of being born.

42. Wrongful Conception
• A claim by parents of unexpected child based on
allegation that conception resulted from a
– negligent sterilization procedures
– defective contraceptive device

43. Artificial Insemination
• Injection of seminal fluid into a woman to induce
pregnancy.
• Homologous artificial insemination
– semen of spouse used to impregnate
• Heterologous artificial insemination
– semen from donor other than husband

44. Artificial Insemination
• Consent
• Confidentiality

45. Surrogacy
• Method of reproduction whereby a woman
agrees to give birth to a child for another party.
• Surrogate may be
– child’s genetic mother
– gestational carrier

46. Ethical & Legal Issues
• Legal right to enter a surrogacy contract?
• Parental Rights of commissioning couple?
• Long-term effect of surrogacy contracts?
• Psychological impact on child?

47. Organ Donations
• Federal regulations require
– protocols regarding an organization’s organ
procurement responsibilities
– specific notification duties
– requirements informing families of potential
donors
– sensitivity in dealing with families
– educating hospital staff on organ donation
– facilitate timely donation & transplantation

48. Uniform Anatomical Gift Act
• Statute enacted by all 50 states
– Has detailed provisions that apply to the wide
variety of issues raised in connection with the
making, acceptance, & use of anatomic gifts.

49. Research, Experimentation,
& Clinical Trials
• Ethical principles
– Respect for person
– Beneficence
• Hippocratic Oath – physicians to benefit
patients
– Justice
– Autonomy

50. Justice
• Each person to be treated equally.
• Each person to treated
– according to need?
– according to value to society (societal
contribution)?
– according to merit?

51. Nuremberg Code & Declaration of
Helsinki
• International Code of Ethics
– governs human research
• Result of Nazi medical atrocities
• Requires human subjects be fully informed

52. Federal Regulations
Control Experiments Involving
• Drugs
• Medical devices
• Medical procedures

53. Conducting Clinical Trials
• Organization must provide for:
– education in ethical decision-making
– nurse participation in ethical decision-making
– on-going monitoring of approved protocols

54. Institutional Review Board
• Federal regulations require hospital-based
Institutional Review Board (IRB)
• IRB Functions
– review proposed research studies
– approve protocols for research
– conduct research oversight

55. Informed Consent
• Organizations must disclose
– risks, benefits, & treatment alternatives
• Determine competency of patient consent
• Obtain written consent from patient

56. Informed Consent
• Disclose treatment costs
• Educate Staff
– potential side effects of treatments
– implementation of protocols
– monitoring of protocols

57. Human Genetics
• Describes study of inheritance as it occurs in
human beings. It includes:
– stem cell research
– clinical genetics
• genetic disease markers
– molecular genetics

58. Genetic Information
Nondiscrimination Act – I
• Law prohibits discrimination on basis of genetic
information with respect to the availability of
health insurance & employment.
• Prohibits group health plans & insurers from
denying coverage to a healthy individual based
on genetic predisposition to develop a specific
disease.

59. Genetic Information
Nondiscrimination Act – I
• Prohibits employers from using genetic
information when making hiring, firing, job
placement, or promotion decisions.

60. Genetic Markers
• A genetic marker is a gene or DNA sequence
that has a known location on a chromosome and
can be associated with a particular gene or trait.
• Genetic markers can identify certain diseases

61. Stem Cell Research
• Use of embryonic stem cells to create organs &
various body tissues.
• Highly controversial issue generally involving
religious beliefs.
• Fears as to how far scientists might go in their
attempt to create.

62. AIDS
Introduction
• Deadliest epidemic in human history.
• 1st case appeared in literature in 1981.
• More than 21 million people have died from
AIDS.

63. AIDS
Introduction
• AIDS caused by Human Immunodeficiency Virus
(HIV).
• Highly contagious blood-borne virus.
• Destroys body’s capacity to ward off bacteria.

64. Spread of AIDS
• Body Fluids
– Vaginal secretions
– Semen
– Breast milk
• Blood Transfusions
• AIDS & Health Care Workers

65. Confidentiality
Disclosure of Physician’s IV Status
The physician cut his hand with a scalpel while
he was assisting another physician. Because of
the uncertainty that blood had been transferred
from Doe’s hand wound to the patient through
an open surgical incision, he agreed to have a
blood test for HIV. His blood tested positive for
HIV & he withdrew himself from participation in
further surgical procedures.
Discuss the ethical & legal issues.

66. Confidentiality- Ethical Issues
• Physicians right to privacy v. patients right to
know
• Utilitarianism
– advocates the greatest good for the greatest
number
• Conscientiousness
– a person who has moral integrity & a strict
regard for doing the right thing

67. Confidentiality – Legal Decision
Failure to notify the patients at risk could result
in the spread of the HIV virus to other non-
infected individuals through sexual contact &
through exposure to other body fluids. Doe’s
name was not revealed to the patients, only the
fact that a resident physician who participated in
their care had tested HIV-positive. “No principle
is more deeply embedded in the law than that
expressed in the maxim Salus populi suprema
lex, . . . (the welfare of the people is the
supreme law).

68. REVIEW QUESTIONS
• Discuss under what circumstances ethical
dilemmas arise.
• Discuss the controversy over the Supreme Court
decision in Roe v. Wade.
• What ethical principles surround the abortion
issue? Discuss these principles.
• Do you agree that individual states should be
able to impose reasonable restrictions or waiting
periods on women seeking abortions? Who
should determine what is reasonable?

69. • Should a married woman be allowed to abort
without her husband’s consent?
• Discuss the arguments for and against partial
birth abortions.
• Why is the medical issue of abortion an example
of legislating morality?
• What is artificial insemination? What questions
should be asked when considering artificial
insemination?

70. • Discuss the importance of organ donations.
• Describe the ethical considerations that should
be addressed before conducting research on
human subjects.
• Why is it important that written consent be
obtained from each patient who participates in a
clinical trial?
• What is sterilization, as discussed in this
chapter? Do you agree that eugenic sterilization
should be allowed? Explain your answer.

71. • Describe the distinctions among wrongful birth,
wrongful life, and wrongful conception. Discuss
the moral dilemmas of these concepts.
• Describe the controversy over surrogacy.
• Discuss why there is controversy over genetic
markers and stem cell research.