Chapter 2 Case Study & Questions:
Alabama Governor Signs Abortion Ban Into Law, npr.gov, May 14, 2019:
"Alabama Gov. Kay Ivey signed a controversial bill that bans nearly all abortions into law Wednesday evening.
It's considered the most restrictive abortion law in the United States. The law makes it a crime for doctors to perform abortions at any stage of a pregnancy, unless a woman's life is threatened or there is a lethal fetal anomaly.
Under the new law, doctors in the state face felony jail time up to 99 years if convicted. But a woman would not be held criminally liable for having an abortion.
The law does not take effect for several months.
The Alabama Senate passed the bill Tuesday evening. The state House had already overwhelmingly approved the legislation. It's part of a broader anti-abortion strategy to prompt the U.S. Supreme Court to reconsider the right to abortion."
Questions: - Ethical and legal issues:
1.
What are the ethical and legal issues posed by the conflicting sides of this legislation?
2.
Do you think Governor Ivey should have vetoed the bill? Why or why not?
3.
How does the fact that this bill challenges the 1973 Supreme Court ruling inRoe v. Wadeinfluence your thinking?
Remember...although these issues may be controversial and a little difficult to discuss, I want a healthy discussion. Consider all options and sides of the case.
***The attached reference files are required for this paper***
© Fo to vik a/ Sh ut te rst oc k. CHAPTER 2 Contemporary Ethical Dilemmas No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the pos- session 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 ▸ LEARNING OBJECTIVES Upon completion of this chapter, the reader will be able to: ■ Describe various historical events that have had an impact on the resolution of ethical dilemmas. ■ Describe common ethical dilemmas and the various ethical issues that have in many instances divided many segments of the population. Topics include abortion; sterilization; artificial insemination; surrogacy; organ donations; research, experimentation, and clinical trials; human genetics, stem cell research; and AIDS. 54 and tools, suggests that Neanderthal man believed in life after death. Their concept of the afterlife must not have been that much dif- ferent than the life they experienced on earth; they provided the dead with food, tools, and other everyday items, much like the Egyptians did for their journey to the next life.1 AD 1932–1972 Tuskegee Study of Syphilis The Tuskegee Study of Syphilis, involving African American men, was designed to analyze the natural progression of untreated syphilis. The study was con- ducted from 1932 through the early 1970s. The partic- ipants were not told during the study that there was a cure for syphilis at the time of the study. It is reported that some of the participants in the study had syphilis and others were intentionally given syphilis during the study. The participants believed that they were receiving adequate care and unknowingly suffered unnecessarily. The Tuskegee syphilis study used disadvantaged black men to investigate the untreated course of a disease, one that is by no means confined to that population. We know now that the selection of research subjects must be closely monitored to ensure that specific classes of individuals (e.g., terminally ill patients, welfare patients, racial and ethnic minorities, or persons confined to institutions) are not selected for research studies because of their easy availability, compromised position, or manipulability. Rather, they must be selected for reasons directly related to the research being conducted. 1933–1945 The Holocaust The Holocaust was one of the most violent events in human history. Over 6 million Jews were murdered as well as millions of people from other cultural groups, including Slavs, homosexuals, and Gypsies. Doctors have always been thought of as the saviors of mankind, the healers, and caretak- ers of our utter existence. Even ancient civili- zations revered the medicine men as having special power to protect life. The trust of a physician is sacred. This is why the practice of medicine by the doctors of the Third Reich is egregious, outrageous, and shocking. The Nazi doctors violated the trust placed in them by humanity. The most painful truth is for the most part the doctors escaped their crimes against Humanity and lived a life, unlike their victims.2 ▸ INTRODUCTION An ethical dilemma arises in situations where a choice must be made between unpleasant alternatives. It can occur whenever a choice involves giving up some- thing good and suffering something bad, no matter what course of action is taken. Ethical dilemmas often require caregivers to make decisions that may break some ethical norm or contradict some ethical value. For example, should I choose to continue a pregnancy knowing that an unborn child will be born with severe disabilities, or should I choose abortion with the goal of preventing pain for both parent and child? Should I adhere to my spouse’s wishes not to be placed on a respirator, or should I choose life support technology, disregarding her wishes and right to self-determina- tion? Should I encourage my daughter—the victim of a gang rape—to have an abortion, or should I advocate that she do no harm to the unborn child? Such dilem- mas give rise to conflicting answers. There is a wide range of ethical and legal issues impacting the healthcare system. This chapter focuses on some of the more common ethical and legal dilem- mas facing the providers of health care. In reviewing this chapter, the reader should apply court decisions and the ethical theories, principles, and values previ- ously discussed. ▸ NOTEWORTHY HISTORICAL EVENTS I was created at the end of the Renaissance, watched pirates rule the oceans as Ivan the Terrible ruled Russia, and witnessed the arrest of Galileo for believing the earth revolved around the sun. —I Am History The historical events presented in this section describe some of the many milestones that have had a signifi- cant impact on healthcare ethics. 68,000–58,000 BC Neanderthal Burial Sites Evidence of belief in an afterlife was found in Nean- derthal burial sites, where various implements and supplies were buried with the deceased. According to anthropologist F. Clark Howell the flexed position of the body, and discover- ies of other sites where stone slabs were placed over the Neanderthal graves, along with food NOTEWORTHY HISTORICAL EVENTS 55 1964 WMA Guidelines for Conducting Biomedical Research The World Medical Association established guidelines for medical doctors conducting biomedical research involving human subjects.6 The WMA’s Declaration of Helsinki laid the foundation for advanced clinical practices today.7 1968 Harvard Ad Hoc Committee on Brain Death The Harvard Ad Hoc Committee on Brain Death pub- lished the following criteria to aid in determining a permanently nonfunctioning brain, a condition it referred to as “irreversible coma,” now known as brain death: 1. Patient shows total unawareness to exter- nal stimuli and unresponsiveness to painful stimuli. 2. No movements or breathing; all sponta- neous muscular movement, spontaneous respiration, and response to stimuli are absent. 3. No reflexes; fixed, dilated pupils; no eye movement even when hit or turned, or when ice water is placed in the ear; no response to noxious stimuli; no tendon reflexes. In addition to these criteria, the report recommended adding the presence of a flat elec tro encephalogram.8 1970 Patient as a Person The Patient as a Person by Paul Ramsey discusses the question of paternalism. As physicians are faced with many options for saving lives, transplanting organs, and furthering research, they also must wrestle with new and troubling choices, for example, who should receive scarce resources (e.g.., organ transplants), how to determine when life ends, and what limits should be placed on care for the dying. 1971 Kennedy Institute of Ethics The Joseph P. and Rose F. Kennedy Institute of Eth- ics was established at Georgetown University in 1971 by a generous grant from the Joseph P. Kennedy Jr. Foundation. Today it is the world’s oldest and most 1946 Military Tribunal for War Crimes In 1946, the Military Tribunal for War Crimes began criminal proceedings against 23 German physicians and administrators for war crimes and crimes against humanity. As a direct result of these proceedings, the Nuremberg Code was established, which made it clear that the voluntary and informed consent of human sub- jects is essential to research and that benefits of research must outweigh risks to human subjects involved.3 1949 WMA International Code of Medical Ethics The World Medical Association International Code of Medical Ethics was adopted in October 1949 after it was learned that the Nazis conducted numerous inhumane experiments on prisoners in concentration camps. Prisoners were exposed to cholera, diphtheria, malaria, mustard gas, yellow fever, and typhus and forced to participate in other horrendous experiments, ultimately claiming thousands of lives. This exploita- tion of unwilling prisoners as research subjects was condemned as a particularly flagrant injustice. The code has been amended several times since its initial adoption—first in August 1968, then in October 1983, and most recently in October 2006 at the 57th WMA General Assembly, Pilanesberg, South Africa.4 1954 Guidelines on Human Experimentation The National Institutes of Health published guidelines on human experimentation following the first kidney transplant5 conducted in 1954. The transplantation of human organs has generated numerous ethical issues (e.g., the harvesting and selling of organs, who should have first access to freely donated human organs, how death is defined). 1960s Cardiopulmonary Resuscitation Raises Ethical Dilemmas Cardiopulmonary resuscitation was developed, lead- ing to numerous ongoing ethical dilemmas because it involves the prolonging of life beyond what would rea- sonably be expected. Should limited resources, for exam- ple, be spent on those who have been determined to be in a comatose vegetative state without hope of recovery? Or, should limited resources be spent on preventative medicine, aimed at improving the quality of life? 56 Chapter 2 Contemporary Ethical Dilemmas 1973 Women’s Right to Abortion The Roe v. Wade13 abortion case gave strength to a woman’s right to privacy in the context of matters relating to her own body, including how a pregnancy would end. 1974 National Research Act (NRA) of 1974 Because of publicity from the Tuskegee Syphilis Study, the National Research Act (NRA) of 1974 was passed. The NRA created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the commission’s charges was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and to develop guidelines to ensure that such research is conducted in accordance with those principles.14 The commission was directed to consider the following:15 1. The boundaries between biomedical and behavioral research and the accepted and routine practice of medicine 2. The role of assessment of risk-benefit cri- teria in determining the appropriateness of research involving human subjects 3. Appropriate guidelines for the selection of human subjects for participation in such research 4. The nature and definition of informed con- sent in various research settings 1976 Substituted Judgment— Karen Ann Quinlan The New Jersey Supreme Court in the Matter of Karen Ann Quinlan16 rendered a unanimous decision pro- viding for the appointment of Joseph Quinlan as per- sonal guardian of his daughter, Karen Ann Quinlan, a young woman in a persistent vegetative state who was being kept alive on a respirator against her par- ents’ wishes. A conflict arose when hospital officials refused to remove the respirator, concerned that they would be charged with homicide if they complied. The record was remanded to the trial court to implement without further testimonial hearing: To appoint Joseph Quinlan as guardian of the person of Karen Quinlan with full power to comprehensive academic bioethics center. The insti- tute and its library serve as an unequaled resource for those who research and study ethics, as well as those who debate and make public policy. The Ken- nedy Institute is home to scholars who engage in research, teaching, and public service on issues that include protection of research subjects, reproductive and feminist bioethics, end-of-life care, healthcare justice, intellectual disability, cloning, gene therapy, eugenics, and other major bioethical issues. Institute scholars figure prominently among the pioneers of the discipline. They are extending the boundaries of the field to incorporate emerging issues of racial and gender equality, international justice and peace, and other policies affecting the world’s most vulnerable populations.9 1972 Informed Consent Informed consent in the Canterbury v. Spence10 case set the reasonable man standard, requiring informed consent for treatment. Patients must be informed of the risks, benefits, and alternatives associated with recommended treatments. The court found that Dr. Spence negligently failed to disclose a risk of serious disability inherent in the operation and that the Washington Hospital Center provided negligent postoperative care.11 The U.S. Court of Appeals Jus- tice Spottswood W. Robinson III described what led up to the Court’s decision remanding the case to the District Court, which had previously ruled in favor of the appellees: The record we review tells a depressing tale. A youth troubled only by back pain submit- ted to an operation without being informed of a risk of paralysis incidental thereto. A day after the operation he fell from his hospital bed after having been left without assistance while voiding. A few hours after the fall, the lower half of his body was par- alyzed, and he had to be operated on again. Despite extensive medical care, he has never been what he was before. Instead of the back pain, even years later, he hobbled about on crutches, a victim of paralysis of the bowels and urinary incontinence. In a very real sense, this lawsuit is an understandable search for reasons.12 . . . In the case before us, appellant’s evidentiary presentation on negligence survived the