LESSON 1 TITLE: Obligations of a Professional

Entering a Health Care Profession

• Allied Health
– Twentieth century: over 200 specialties added to health care team
– Provides over 80% of direct patient care
– Combines science and technology with patient care
• Essential Characteristics of a Profession
– Competence in specialized body of knowledge and skill
– Provision of particular service to society
– Standards of education and practice
– Self-regulation
• Legal Practice Act
– Outlines activities providers perform in delivery of patient care
– Develops code of ethics to assist in self-regulation
– Outlines profession’s mission and objectives
• Specialty Practice Acts
– Scope of professional practice
– Requirements and qualifications for licensure or certification
– Exemptions to basic requirements.
– Grounds for administrative actions
– Penalties and sanctions for unauthorized practice
• Sanctions for Lapse in Ethical, Legal, and Professional Etiquette
Ethical conduct – right or wrong?
– Sanction: loss of professional reputation, loss of professional affiliations
Legal requirements – legal or illegal?
– Sanction: punishment as prescribed by law
Professional etiquette – proper or improper?
– Sanction: loss of professional respect and fellowship

Professional Etiquette
• Avoid talking badly about another practitioner (especially in front of patients)
• Maintain appropriate relationships at the worksite
• Stay within role boundaries of your specialty
• Rules of etiquette help maintain order and civility
Health Care Ethics
- Ethical questions: values, morals, individual culture, intense personal beliefs, and faith
- Ethics: how we make judgments in regard to right and wrong

The Foundation of Law

Law
- Body of rules of action or conduct prescribed by controlling authority; having binding legal force
- Minimum standard of expected performance between individuals in a society
• Common Law
– Emanates from judicial decisions
• Statutory Law
– Arises from legislative bodies
• Administrative Law
– Flows from rules and regulations and decisions of administrative agencies
• Fundamental Principles of Law
– Concern for justice and fairness
– Plasticity and change
– Acts judged on universal standard of reasonable person
– Doctrine of Individual Rights and Responsibilities
• Misunderstandings about Nature of Law
– Law is incomplete and always growing
– There are areas of law where there are no previous legal rulings; growth and change occurs
– Wise to view the law as guide to proper behavior; mistake to confuse legal and ethical behavior
The Lawsuit
Plaintiff
• Person who brings an action in a court of law
Defendant
• Person against whom an action is brought
Prima facie
• legally sufficient to establish a case

Steps in a civil lawsuit:

- Complaint
- Answer
- Discovery
- Trial and Judgment
- Appeal
1. Complaint
- Plaintiff files complaint or petition with court that addresses elements of prima facie case
- Plaintiff has the burden of proof
- Defendant has period of time in which complaint must be answered
2. Answer
- Defendant three choices: (1) admit, (2) deny, or (3) plead ignorance to each allegation in complaint
- Filing an answer moves case into pre-trial phase
3. Discovery: fact-finding phase
- Interrogatories
- Document requests
- Depositions
4. Trial and Judgment
- Case tried before a judge only or before a judge and jury
- During the trial, each side presents witnesses and evidence collected is placed in record
- Jury’s decisions not put into effect until judge makes a judgment
5. Appeal
- Losing party may appeal a trial court decision to a higher court

Philippine judicial system consists of the following courts:

Lower Courts
I. Municipal Trial Courts and Municipal Circuit Trial Courts
II. Metropolitan Trial Courts and Municipal Trial Courts in Cities
III. Regional Trial Courts
IV. Shari'a Courts
V. Court of Tax Appeals
VI. Sandiganbayan
VII. Court of Appeals
The Highest Court - Supreme Court
The Supreme Court is the highest Court in the Philippines
https://www.chanrobles.com/courtsinthephilippines.htm#.Xw0RcecRXIU
- Appellate court is a trier of law
Arbitration: neutral third party of whom both sides have agreed will have power to decide outcome
and render a binding decision.

CHECK FOR UNDERSTANDING

1. Which of the following is NOT considered one of the four essential characteristics of a profession?
A. Competence in a specialized body of knowledge and skill
B. The provision of a particular service to society
C. Grounds for administrative actions
D. Standards of education and practice
2. Specialty practice acts will vary in emphasis, but the majority will address which of the following?
A. Requirements and qualifications for licensure or certification
B. Penalties and sanctions for unauthorized practice
C. Scope of professional practice
D. All of these apply
3. In regard to clients and patients, practitioners have a(n) relationship which requires them to act
primarily inthe best interest of those they serve.
A. Fiduciary
B. Proper
C. Formal
D. Formulaic
4. It is often the longest part of a lawsuit and, in many instances, ends the case when information is
detrimental to one ofthe sides.
A. Complaint
B. Answer
C. Discovery
D. Appeal
5. All but one is the fundamental principles of law?
A. Plasticity and change
B. Concern for justice and fairness
C. Acts are judge on the universal standard of the reasonable person
D. Patient’s Bill of Rights
6. It is one of the sources of modern law that emanates from judicial decisions?
A. Common Law
B. Administrative Law
C. Statutory law
D. All of the above
7. This a person who brings an action in a court law?
A. Plaintiff
B. Defendant
C. Complaint
D. Answer
8. Which of the following is NOT a major element of discovery?
A. Investigation
B. Interrogatory
C. Document request
D. Deposition
9. This is the opportunity for each side to question witnesses and parties to a suit to elicit information
about the case?
A. Arbitration
B. Appeal
C. Trial
D. Deposition
10. In the foundation of law, the use of the principle of stare decisis provides the system with needed
stability, and yet it hasallowed for the creation of new principles as changing patterns of facts have
emerged. Stare decisis means?
A. Legally sufficient to establish a case
B. Let the decision stand
C. Let the law prevail
D. Legal case
LESSON 2 TITLE: Human Value Development and the System of Public Law
What are the steps in civil lawsuit?
1. Complaint
2. Answer
3. Discovery
4. Trial and Judgment
5. Appeal
What are the 3 basic sources for modern law and where did it originated or arises?
1. Common law- emanates from judicial decisions
2. Statutory law- arises from legislative bodies
3. Administrative law- flows from the rules and regulation of administrative agencies.

Value Development
As humans we are born with a series of undifferentiated potentials. As an example, we have the
capacity to learn a language,but the particular language is not prescribed by our genetic heritage. In
the same sense, humans have an innate ability toacquire ethical beliefs. But the value system we
develop is dependent on the cultural framework in which we live in.
• World view or value system
– An inner subjective set of feelings, attitudes, beliefs, and opinions
• Maslow’s Hierarchy of Needs
– Survival or Physiological (foods, shelter, water)
– Safety (security like purchasing a weapon)
– Belonging and Love (love, affection, intimacy, family, joining a club)
– Prestige and Esteem (becoming president of the club)
– Self-actualization (fulfillment of personal potential)

According to Maslow’s Hierarchy of needs, feelings of isolation result in needs satisfying activities like
joining a bowling team.Under most situations, our actions are explainable using this model as we
seem to satisfy a given set of needs. As each need level is satisfied the needs of the next level become
the dominant motivators of our actions. If hierarchy of needs is correct, an observer who could
determine what level of need you were operating on could predict the nature of your next actions.
• Hume’s Law
– Unbridgeable gap between fact and value; between “is” and “ought”
• Facts of physical universe can tell us what is
• Our values guide us to understanding what ought to be as it relates to our behavior
-Individuals experiences will shape the way these values will be considered in personal decision
making.
-Difference between needs and values: Our needs tell us what “is” in a particular situation, for
example we are broke and find a wallet. Our needs may tell us to take the money in the wallet,
whereas our values provide guidance in regard to what “ought” to be done as it relates to human
behavior.

Value Development Models

Lawrence Kohlberg created a value development model with three stages and associated value
orientation. Developmentwas intimately tied to the individual’s cognitive and psychomotor
development. For Kohlberg, the highest personal value forhumans was equality, where the individual
issues based on an internal set of personal principles or rules.

Kohlberg’s Stage of Moral Reasoning

*Preconventional (Age 3-7)
• Punishment/Obedience
• Egotism (satisfy one’s desires)-self-importance, self-centered, thinking that you are superior to
others
*Conventional (Age 7-12)
• Please others
• Respect rules
*Postconventional (12 and above)
– Social contract- they believe that some laws are unjust and need to be change
– Personal conscience

Kohlberg concluded in his original research model that females were often found not to progress to
the final autonomousstage of value development (Post conventional level) but seemed arrested in the
conventional level. Females seem to reach plateau in value orientation based on pleasing others
rather than being true to their own moral compass.

Carol Gilligan argued that Kohlberg’s research methods flawed and gender biased that’s why she
made a separate value development pathway for females results in different highest values for each
sex. Personality responsibility for female and legalistic equality for males.

And this was confirmed by profile developed by Isabel Myers and Katherine Briggs. According to
Myers Briggs instrument men and women score equally on the major dimensions. Except on decision
making where men are predominantly on “thinking” category more comfortable following rules, laws
and “feeling” category for women decisions are based on personal relationship and outcomes.

Value Development Models

GENERATIONAL THEORY
- This theory popularized in the 1970s and 1980s by sociologist Morris Massey
- Historical time period in which individual is born shapes development of their world view
- Value systems formed in first decade by families, friends, communities, significant events
- “Who You Are Is Where You Were When" this phrase used to explain value differences between the
cohorts

Generational Cohorts and Core Values

• Silent Generation (born 1929-1945)

– Great Depression and World War II
– Conformity, stability, security etc.
• Baby Boomers (born 1946-1960s)
– Civil rights, moon landings, freedom riders, calls for change
– Thought as the “ME Generation”
– Personal and social expression, idealism, health, and wellness
• Generation X (born 1968-1989)
– Programmed in an era of social change
– Free agency, independence, cynicism, strive for balance in their lives
• Millennials (born mid 1980s-2000)
– Defined by events immediately following Cold War
– Collaboration, social activism, tolerance for diversity, globally aware
• Generation Z (late 1990s-2025)
– Foreign wars, September 11th and other terrorist attacks, both overseas and on homeland
– Unsettled time; personal and fiscal insecurity
– Masters at multitasking, techno-savvy, personally tolerant regarding social and ethnic diversity,
thrive on instant gratification, fiscally pragmatic

CHECK FOR UNDERSTANDING

1. According to Kohlberg’s stage theory of moral reasoning, a child between the ages of 3 and
characteristic of satisfying his or her desires is operating at the stage?
A. Pre conventional
B. Conventional
C. Post conventional
D. Nonconventional
2. Carol Gilligan believes that for females, the highest value consideration is based on _.
A. Pleasing others
B. Personal responsibility C.
D. Respect for rules
E. Legalistic equality
3. He is a humanist psychologist who is known for his work regarding the interaction of needs and
behavior which the Hierarchy of needs?
A. Aristotle
B. Abraham Maslow
C. Abraham Lincoln
D. Isabel Myers
4. Who is the foremost theorist of value development?
A. Katherine Briggs and Isabel Myers
B. Maslow and Barrie
C. Kohlberg and Piaget
D. Aristotle and Maslow
5. In Kohlberg’s theory what stage does these following characteristics; social contract and personal
conscience fall under?
A. Nonconventional
B. Preconventional
C. Conventional
D. Postconventional
6. What do you call a term between each generational group?
A. Space
B. Generational gap
C. Cusp
D. Overlap
7. These are constructs from generational theory, which holds that generation occupy a 20-year span
of time?
A. Value cohorts
B. Need
C. Behavior
D. Attitude
8. The Generation Z is best described by which of the following characteristics?
A. Law and order
B. Techno savvy multitaskers
C. Social Activist
D. Street smart
9. He is a sociologist who popularized the phrase “Who You Are Is Where You Were When”?
A. Morris Johnson
B. Morris Massey
C. Carol Gilligan
D. Lawrence Kohlberg
10. Which generation received its value programming by the events surrounding the Great
Depression and World War 2?
A. Silent Generation
B. Baby Boomer Generation
C. Millennial Generation
D. Generation X
LESSON 3 TITLE: Human Value Development and the System of Public Law
Identify what generational cohorts is being describe?
1. Baby Boomers -born 1946-1960s
2. Generation Z- Masters at multitasking
3. Millennials- Collaboration, social activism, tolerance for diversity, globally aware
4. Generation Z- born in late 1990s-2025
5. Generation X- Programmed in an era of social change
6. Millennials- born mid 1980s-2000
7. Silent Generation- Also known as “Traditionalist”
8. Silent Generation- Great Depression and World War II
9. Baby Boomers- Personal and social expression, idealism, health, and wellness
10. Generation X- born in 1968-1989

World View and Public Law

World view-system of thoughts, feelings, opinions, and beliefs with which we screen events occurring
around us

Moral nihilism
- There are no moral truths, moral rules, moral knowledge or responsibilities
- Heinous acts would not necessarily be wrong
Ethical relativism
- All morality is relative to society in which one is brought up
- is the theory hold morality is relative to the norms of one’s culture? Whether action is right or wrong
depends on moral norms of the society
• Acts considered ethically wrong regardless of cultural orientation:
– Rape-forcing someone on sexual activity
– Slavery- exhausting a person in labor
– Genocide- Deliberate killing of a large group of people those of a particular ethnic group
– Torture- inflicting severe pain on someone as punishment
– Sexism- is a prejudice or discrimination based on a person’s sex or gender but it primarily affects
women and girls. It is linked to gender roles and may include the belief that in sex or gender is
intrinsically superior to another.
• Hedonistic value systems
– Is and ought the same; individual devoid of other-regarding impulses. For such an individual, the
major guideposts for decisions are desire and aversion and nothing can be right or wrong apart from
them. Value associated with this world view would include:
● Power
● Self preservation
● Self aggrandizement
● Maneuverability
● Pleasure
● Security
• Standpoint theory
– Try to adopt or listen to standpoint of most marginalized and vulnerable persons involved
– One of the useful concept that helps avoid the problems of self interest in deciding ethical issues.

The System of Public Law

• Private Law
– Deals with relationships between citizen and citizen, or with definition, regulation, and enforcement
of rights in cases where both parties involved are private citizens

• Public Law
– Deals with relationships between private parties and the government; concerned with the state in
its political or sovereign capacity
• Constitutional
• Administrative
• Criminal
Public Law consists in the following forms:
• Constitution supreme law of the land; highest level of American law
o If any conflicts exist between federal and state laws, federal laws must govern
o Constitutional Law: national and state law that deals with organization, invested powers, and
framework of government

• Statutory Law: created by legislative bodies

– Health care providers practice and licensure acts
– Informed consent
– Peer review
– Good Samaritan Act
– Living will statute
– Competencydetermination
– Emergency medical services
–
• Administrative Laws: rules, regulations, orders, and decisions created by administrative agencies to
implement their powers and duties
– Rulemaking, adjudication, or enforcement of specific regulatory agenda
• Criminal Law: prohibits conduct injurious to public order and provides for punishment of those
found to have engaged in prohibited practices
– Felony: serious breach of law; punishable by death or imprisonment in state or federal penitentiary
– Misdemeanor: crime punishable by less than a year incarceration in jail or house of correction
• International Law
– Regulates relations of nations to each other
– Customs and usages, treatise, and decisions of tribunals such as International Court of Justice and
International Court of Human Rights

CHECK FOR UNDERSTANDING (10-15 minutes)

1. Those in society who believe that there are no moral truths, no moral rules, no moral knowledge
and responsibilities subscribe to a philosophy of moral.
A. Felony
B. Misdemeanor
C. Nihilism
D. Immunity
2. The law that deals with the relationships between citizen to citizen is called?
A. Public Law
B. Private Law
C. Administrative Law
D. International Law
3. Which of the following is NOT included in Unethical Acts according to most culture?
A. Procrastinating
B. Rape
C. Sexism
D. Genocide
4. This theory holds that one should always try to adopt or listen to the standpoint of the
marginalized and vulnerable person involved.
A. Generational theory
B. Moral reasoning theory
C. Standpoint theory
D. Kohlberg’s theory
5. Crimes are divided by their seriousness and levels of punishment. A crime punishable by less than a
year of incarceration in a jail or house of correction is known as?
A. Felony
B. Misdemeanor
C. Kidnapping
D. Rape
6. This deals with relationships between private parties and the government; concerned with the
state in its political or sovereign capacity?
A. Private Law
B. Public Law
C. Tort
D. Contract Law
7. This termed as the unequal and harmful treatment based on gender?
A. Rape
B. Slavery
C. Sexism
D. Genocide
8. Human bondage is also known as?
A. Genocide
B. Slavery
C. Sexism
D. Torture
9. This theory believes that all morality is relative to society in which one is brought up?
A. Standpoint Theory
B. Ethical Relativism
C. Virtue ethics theory
D. Moral reasoning
10. A system of thoughts, feelings, opinions, and beliefs with which we screen events occurring
around us?
A. World view
B. Ethics
C. Values
D. Morals

LESSON 4 TITLE: Decision Making in Value Issues and Private Law

Value Confrontation
• Values
– Tell us what is right and wrong, good and evil
– Imply a preference to correct human behavior
– Attempt to be constructive, not destructive, over issues involving personal values

Essential Mental Attributes for Ethical Reasoning

*Ethical humility- awareness of the limits of one’s own ethical insights
*Ethical courage- willingness to assess fairly ideas, beliefs, and viewpoints differing from your own
*Ethical empathy- willingness to attempt to understand the opinions of others and try to see the issue
from their position.
*Ethical fair-mindedness- to hold one’s own beliefs and opinions to the same standard of proof and
evidences that we require for the opinions of others.

As professionals, it is necessary, even in our opposition, to attempt to be constructive, not destructive,

in the methods we use when we come to disagreements over issues involving personal values. When
trying to come to mutual understanding regarding value disagreements it is wise to follow J.M Barrie’s
admonition “Never ascribe to an opponent motives meaner than your own.”

Teleological (Consequence-oriented) Theories

- Judge rightness or wrongness of decisions based on outcomes or predicted outcomes
- The right thing to do is the good thing to do
Utilitarianism
- Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) – Fathers of utilitarianism
- The good resides in promotion of happiness or greatest net increase of pleasure over pain
- Happiness as higher-order pleasures: intellectual, aesthetic, and social enjoyments as defined by
Stuart Mill
There are criticisms that this kind of reasoning might lead to situations in which group derives
pleasure from the pain of others
-to overcome this objective or this criticism some consequentialist have required the principles of
equal consideration of interest
Utilitarian theory uses when they seek to divide scarce resources such as health care.

Act Utilitarianism
- Decision based on possible alternatives for action
- Weighing each to amount of pleasure or utility it provides
- Selecting course of action that maximizes pleasure
Equal Consideration of Interest
- Individual not allowed to increase his share of happiness at expense of another
- One ought to act to produce greatest balance of happiness over unhappiness, everyone considered

Consequence-OrientedReasoning
(FLOW) DESCRIBE PROBLEM- LIST SOLUTIONS- COMPARE SOLUTIONS WITH UTILITY- ARRIVE AT
CORRECT ANSWERS

• Criticisms of Utilitarianism
– Calculation of all possible consequences of our actions, or inactions, appears impossible
– May be used to sanction unfairness and violation of rights
– Not sensitive to agent-relativity of duty
– Does not seem to give enough respect to persons
– Justifiable to prevent others from doing what we believe to be harmful acts to themselves
– Does not provide basis for our own moral attitudes and presuppositions
• Rule Utilitarianism
– Action deemed to be right if it conforms to a rule validated by the principle of utility
– Principle of utility: rule brings about positive results when generalized to variety of situations

Deontological (Duty-Oriented) Theories

• Duty-oriented Theories
– Basic rightness or wrongness of act depends on its intrinsic nature rather than on situation or
consequences
– Act in itself right or wrong; it could not be both
• Immanuel Kant (1724–1804)
– Morality derived from rationality, not from experience
– Based his moral philosophy on the crucial fact that we are rational beings, and a central feature of
this rationality was that principles derived from reason are universal.
– Obligation grounded in pure reason
– Categorical imperative: do not admit exceptions
• Imperative
– Command derived from a principle
– Maxim understood as universal law
3 elements
• Universal application (i.e., binding on every individual)
• Unconditionality
• Demanding an action

Categorical emperative- an action is known to be right when it was in accordance with rule that
satisfied a principle.
Duty-Oriented Reasoning

• Criticisms of Kant
– Too rigid for real life
– Morality cannot be derived from pure reason
– Disregard of consequences of our actions can lead to disastrous results
– Even though nonhuman animals feel pain and pleasure, they do not have independent moral
standing since they are not rational beings
– Possible to be faced with a conflict between two duties equally supported by an imperative
• Contract Theory of John Rawls
– Individual in social situation requiring value choice without knowing role he was playing in situation
– Individual would choose alternative that best supported or favored most disadvantaged person
– Secure basic liberties for all

CHECK FOR UNDERSTANDING

1. The most common form of consequence-oriented reasoning is known as?
A. Divine command theory
B. Deontological theory
C. Utilitarianism
D. Virtue ethics
2. held that morality Is derived from rationality, not from experience, and obligation is grounded in
pure reason.
A. JeremyBentham
B. Immanuel Kant
C. John Stuart Mill
D. Aristotle
3. Utilitarianism is a form of what type of reasoning?
A. Consequence-oriented
B. Duty oriented
C. Virtue ethics
D. Divine mandate
4. For the ethicist, the basic wrongness of an act depends on the intrinsic nature of the act itself?
A. Consequence-oriented
B. Duty oriented
C. Virtue ethics
D. Divine mandate
5. is a form of utilitarianism that holds that an action can be deemed to be right if it
conforms to a rule that has been validated by the principle of utility.
A. Act of utilitarianism
B. Rule of utilitarianism
C. Kantian ethics
D. Ethics of care
6. The “categorical imperative is part of __ ethics.
A. Duty oriented
B. Virtue
B. Kantian
C. Consequence oriented
7. “Groundwork of the Metaphysic of Morals “is the classic work of?
A. Immanuel Kant
B. John Rawls
C. Lawrence Kohlberg
D. Aristotle
8. In the principle of categorical imperative, the imperatives seem to have three elements, which of
the following is NOT part of the elements?
A. Demanding action
B. Unconditionality
C. Golden Rule
D. Universal application
9. A Scottish author that quoted “Never ascribe to an opponent motives meaner than your own.”
A. Immanuel Kant
B. J.M Barrie
C. John Rawls
D. Morris Massey
10. Who are considered the Fathers of Utilitarianism?
A. Jeremy Bentham and John Stuart Mill
B. J.M Barrie and John Rawls
C. Morris Massey and J.M Barrie
D. Mahatma Gandhi and Aristotle

LESSON 5 TITLE: Decision Making in Value Issues and Private Law

Value Ethics
• Focus on characteristics, traits, or virtues a good person should have
• Personal character and moral habit development rather than a particular action

• Aristotle’s Traits of a Virtuous Character

– Virtuous acts must be chosen for their own sakes
– Choice must proceed from firm and unchangeable character
– Virtue is a disposition to choose the mean

Virtue- oriented Reasoning

(FLOW) DESCRIBE PROBLEM- LIST SOLUTIONS- COMPARE SOLUTIONS WITH TRADITIONS- ARRIVE AT
CORRECT ANSWERS

• Divine being set down finite series of rules that adherents claim can provide guidance to most, if not
all, moral decisions
– Judeo-Christian Ten Commandments
– Buddhism’s Four Noble Truths and Eight-Fold Path

Private Law
– Recognition and enforcement of rights and duties of private citizens and organizations
– Two basic types are tort and contract law
– Tort action
• Existence of legal duty from defendant to plaintiff
• Breach of that duty
• Damages which are a proximate result
• Tort Categories
– Negligent torts
– Intentional torts
– Liability assessed irrespective of fault
• Negligence
– Unintentional commission or omission of act a person would or would not do under same or similar
circumstances
Common forms of negligence
– Malfeasance: execution of unlawful or improper act
– Misfeasance: improper performance of act that leads to injury
– Nonfeasance: failure to perform an act, when there is a duty to act
– Criminal negligence: reckless disregard for safety of another

• Intentional torts in health care practice

– Assault- no physical contact, verbally cursing or threatening someone
Battery- offensive touching and bodily injury
– Defamation of character
Libel- written defamation, harmed reputation of others
Slander- spoken or oral defamation
– False imprisonment- illegal confinement against individual against his or her violates confined
individual right to be free from constraint.
– Invasion of privacy- in health care we only need to know the information centered on patient care.if
its not for health care reason for examinings patient’s record.

CHECK FOR UNDERSTANDING

1. The question, “How should I carry out my life if I am to live well,” is representative of which of the
following theoretical positions?
A. Duty-oriented
B. Consequence- oriented
C. Virtue ethics reasoning
D. Utilitarianism
2. All of the following are elements of a torte, EXCEPT:
A. The existence of a legal duty owing from plaintiff to defendant
B. A breach of duty owing from defendant to plaintiff
C. The existence of a legal duty owing from defendant to plaintiff
D. Damages as a result of a breach of duty
3. To sustain a claim of negligence, all of the following must be in place EXCEPT:
A. Duty
B. Dereliction of duty
C. Direct cause
D. Due process
4. A written violation of a patient’s right to privacy that may result in a charge of defamation of
character being filed against a health care provider is termed .
A. Libel
B. Slander
C. Assault
D. Nonfeasance
5. This means “let the master answer”.
A. Res ipsa loquitor
B. Respondeat superior
C. Parens patriae
D. Stare decisis
6. Which of the following is a form of intentional torts that have an implication to heath care setting?
A. A. Libel
B. Slander
C. Invasion of privacy
D. All of the above
7. This is the unintentional commission or omission of an act that a reasonably prudent person would
or would not do under the same or similar circumstances.
A. Battery
B. Libel
C. Negligence
D. Slander
8. It is the execution of an unlawful or improper act?
A. Malfeasance
B. Misfeasance
C. Nonfeasance
D. Slander
9. The fourth type of theory usually used in ethical debate. This theory believes that a divine being
who has set down a finite series rules that adherents claim can provide guidance to most?
A. Duty oriented
B. Consequence oriented
C. Divine theory
D. Virtue ethics
10. Aristotle’s traits of virtuous character include which of the following?
A. Choice must proceed from a firm character
B. Virtue is a disposition to choose the mean
C. Virtuous acts must be chosen for their own sakes.
D. All of these

LESSON 6 TITLE: Basic Principles of Health Care and the Nature of Rights in Ethical Discourse
1. A competent elderly tells you,” I want to go home.” You respond with, “We won’t let you go home;
you’re not capable of taking care of yourself.” You may have just created the elements for what tort?
ANSWER: False imprisonment, you are illegally confining a competent individual against his or her will
in a manner that violates the confined individual’s right to go home or to be free.
2. The patient tells you, “I don’t want the treatment.” You respond with, “Your doctor ordered the
treatment and told me to make sure you take it, even If I have to hold you down.” You may have just
created the elements of what tort?
ANSWER: forcing a patient to give treatment by holding him or his down is unlawful and this is an
example of Battery.

Basic Ethical Principles

Determine right and wrong in regard to:
- Autonomy
- Veracity
- Confidentiality
- Beneficence
- Nonmaleficence
- Justice
- Role fidelity

● Hierarchy of thinking in regard to biomedical ethics: proceed from general worldview, to universal
principles, to rules and codes, to decisions
UNIVERSAL PRINCIPLES
Autonomy
- Form of personal liberty
- Ability to decide
- Power to act on your decisions
- Respect for the individual autonomy of other
--- Self-determination often used synonymously with autonomy
– Informed consent- derived from basic principles of autonomy
• Legal exceptions: under therapeutic privilege and implied consent
– Paternalism: intentional limitation of autonomy of one person by another
– Health care professionals fiduciary relationship with patients
1. Veracity
- Binds both health practitioner and patient in an association of truth
- Harm to patient autonomy and potential loss of practitioner credibility makes lying to patients a
practice to be avoided
2. Beneficence
- Acts of mercy and charity
- Any action that benefits another
Hippocratic Oath: physician will “apply measures for the benefit of the sick”
3. Nonmalefiecnce
- One ought not to inflict evil or harm
*Beneficence
- One ought to prevent evil or harm
- One ought to remove evil or harm
- One ought to do or promote good
*Nonmaleficence
- Principle of double effect: secondary effects may be foreseen, but can never be intended outcomes.
E.g. administering morphine for pain, ethically prescribe but the analgesics suppresses respiration
- Under what circumstances can one act morally when some of the foreseeable effects of that action
are harmful?
• Principles of Double Effect (Guiding Elements)
– Course chosen must be good or at least morally neutral
– Good must not follow as a consequence of secondary harmful effects
– Harm must never be intended but merely tolerated as casually connected with good intended
– Good must outweigh harm
4. Confidentiality
- American Hospital Association’s The Patient Care Partnership: Understanding Expectations, Rights
and Responsibilities
- Outline of current state of practice with regard to individual’s right to privacy in health care
5. Justice
- Procedural justice or due process: disputes between individuals
- Distributive justice: distribution of scarce resources
- Compensatory justice: individuals seek compensation for a wrong that has been done
6. Role Fidelity
- Modern health care is the practice of a team
- Allied health over 100 individual professions
- Ethics of health care require practitioner practice faithfully within constraints of role
- Prescribed by scope of practice of state legislation

Rights
- Entitlements, interests, powers, claims, needs
- If one possesses a right, one need not feel gratitude to others for its possession
- In moral philosophy and political theory thought of as justified claims
- A right creates obligation in others to behave in a certain way
- Symbolic language of covenants, charters, manifestos, and conventions
- Expressions of hope for future of humanity
- Not meant to outline a reality grounded in law or claims that can be enforced

Right to Health Care?

- Many claim health care as a human right. Is it?
- And if it is, where would such a right come from, and who has obligation to provide it?
- Health care as a right difficult to define
- Is it a positive or recipient right?

Historical Background of Rights Reasoning

• Natural Rights
– Equated to the law of God such as Golden Rule
• Natural Liberties
– Universal moral rights exist prior to and independent of guarantees of social contract or
institutionalized government
– Negative rights: obligate others from interference
• Human Rights
– All humans equally separated from beasts of the field and are unique unto themselves
– Positive rights: basic needs we all share, recognize, and respect as a person’s just due
– Basic truths understood and known by human reason alone not dependent on outside dictates
• Traditions of Natural Law
– Humans possess rational nature as a gift from God
– Natural laws are not dependent on social contract
– Natural laws are unchangeable and universal
– Inability to effect natural rights does not distinguish them
– Natural laws discovered even without knowledge of God

Contractarian and Consequentialist Rights Theory

• John Stuart Mill
– Duties of perfect obligation: inherent within them assigned correlative rights
– Duties of imperfect obligation: do not give birth to any right
– Moral rights: backed up by force of law or public opinion
• Contractarian Theory
– Force or mechanism for selection of correct principles is agreement or bargain reached by initial
agents
– Moral agents come to initial situation and bargain to a choice
• Hobbesian Model
– Those living in the state of nature do not come to the table as equals
– Only law of self-preservation existed
– World where strong and ruthless armed with force and fraud are only ones allowed to come to
bargaining table
• John Rawls
– Original position: all individuals are free and equal
– Veil of ignorance: denies each agents’ knowledge of who is to receive rights to goods and services
– Seen in the fair opportunity rule

Fair Opportunity Rule

• Contractarians
– Individual rights grounded in principle of justice and collective choice
– Collective choice forms basis of morality
• Original Position
Posited concept of moral right to equal concern and respect
– Rights existed prior to collective choice procedure

CHECK FOR UNDERSTANDING

1. is the principle that deals with the need to tell the truth.
A. Beneficence
B. Veracity
C. Confidentiality
D. Role fidelity
2. The legal principle of a right to privacy is matched to the ethical principle of .
A. Confidentiality
B. Justice
C. Veracity
D. Nonmaleficence
3. The use of placebos is most problematic when you are considering the principle of .
A. Veracity
B. Beneficence
C. Role fidelity
D. Maleficence
4. The famous admonition “If you can’t do the patient good, at least avoid harm,” speaks of the two
important principles of beneficence and .
A. Confidentiality
B. Justice
C. Veracity
D. Non maleficence
5. “Nurses should practice nursing and allied health specialist should only practice within their
specialty areas” is an application of the basic principle of .
A. Veracity
B. Beneficence
C. Role fidelity
D. Maleficence
6. When one person has a right, others have obligations to either refrain from hindrance or provide
the required goods and services associated with the right. What type of obligation is this?
A. Imperfect obligation
B. Perfect obligation
C. Correlative obligation
D. Personal obligation
7. Perhaps the most famous moralized contractarian theory of rights that includes the concept of an
original position comes from the work of .
A. John Locke
B. John Stuart Mill
C. John Rawls
D. Thomas Aquinas
8. What rights are generally equated to the law of God?
A. Artificial Rights
B. Natural Rights
C. Legal Rights
D. Moral Rights
9. We have different Golden rule across religions, what religion has its golden rule which says “Hurt
not others which you would find hurtful?”
A. Buddhism
B. Brahmanism
C. Islam
D. Taoism
10. He is an English philosopher where in his model he assumes that the state of nature was a state of
social chaos, and that the origins of law, which are simultaneous with those of morality, are in social
contract.
A. John Rawls
B. John Locke
C. Thomas Aquinas
D. Thomas Hobbes

LESSON 7 TITLE: Basic Principles of Health Care and the Nature of Rights in Ethical
Discourse

Legal Rights
• Not only asserted as moral prerogatives but afforded governmental guarantees
• Created through constitutional guarantees, legislative statutes, judicial review, governmental
agencies
• Easier to put into place laws that protect negative rights
• Characteristics of a Legal Person
– Persons can be injured
– Persons can be thought to have interests
– Persons can be benefited
• Legal rights often used to reaffirm moral rights, do not necessarily coincide
Moral and Legal Rights
• Universal
• Moral rights provide equality among humans
• Moral rights not product of human creativity, but are inherent to our species
The Problem of Rights
• Multiplication of claims to personal rights
• Human imagination and creativity can create more claims to rights than we could possibly honor
CHECK FOR UNDERSTANDING
1. “Right to bear arms” are example under what kind of legal right?
A. Human rights
B. Personal right
C. Negative rights
D. Positive rights
2. Which of the following characteristics commonly attributed to legal person?
A. Person can be benefitted
B. Person can be injured
C. Person can be thought to have interest
D. All of the above
3. can be thought of as recipient or welfare rights as they require goods or service provided.
A. Positive rights
B. Negative rights
C. Human rights
D. Natural rights
4. A power, privilege, or immunity guaranteed under a constitution, statutes, or decisional law.
A. Legal Rights
B. Justice
C. Confidentiality
D. Natural rights
5. Right to a public education is under what type of legal rights?
A. Natural Rights
B. Positive Rights
C. Negative Rights
D. Human Rights

LESSON 8 TITLE: Confidentiality and the Management of Health Care Information

Confidentiality: A Principle with Qualifications

- Any breach of confidentiality is invasion of privacy
- Expectation of patient-provider relationship
Arrived at and defended using the four systematic approaches to ethical decision making
• Utilitarian
• Health care conducted under agreement of confidentiality
• Practitioners who breach trust in violation of agreed-on expectation
• Duty-oriented
• Privacy viewed as person’s right
• Confidentiality is professional’s duty
• Virtue ethics
• Patient confidentiality mainstay of health care practice
• Forms virtue from the “good practitioner”
• Emphasizes virtue of character and sense of honesty
• Protective privilege of confidentiality is limited where health and safety of others involved
• Harm principle: requires health care providers refrain from acts or omissions that would
foreseeably result in harm to others, especially in cases in which individuals vulnerable to
the risk

Invasion of Privacy Tort Actions

• Misappropriation: deals with unpermitted use of a person’s name or likeness for another’s benefit
or advantage
• Intrusion: involves intrusion upon another’s solitude or seclusion
• Public disclosure of private facts: involves publicity of objectionable nature of private information
• Presenting someone in a false light to the public: involves publication of information that leads to
the public regarding the plaintiff falsely.
Common Legal Reporting Requirements
• Child abuse
• Drug abuse
• Communicable disease
• Births and deaths
• Injuries with guns or knives
• Blood transfusion reactions
• Poison and industrial accidents
• Misadministration of radioactive materials
Modern Health Care and Confidentiality
• Patient record accessible to physicians and technical and administrative staff who generate and
handle patient data
• Access to patient information exacerbated by use of computerized information systems
• Prior to enactment of HIPAA and the Privacy Rule there was no unifying federal privacy act for
medical records
Health Insurance Portability and Accountability Act
• Encourage use of electronic transmission of health information
• Provide safeguards to protect security and confidentiality of the information
• Encourage use of electronic transmission of health information
• Provide safeguards to protect security and confidentiality of the information
• Protect and enhance rights of consumers by providing them access to their health information
and controlling inappropriate use of information
• Improve quality of health care in U.S. by restoring trust in health care system
• Improve efficiency and effectiveness of health care delivery by creating a national framework for
health privacy protection
• HIPAA rules affect virtually all health care records

DATA PRIVACY ACT- In 2012 the Philippines passed the Data Privacy Act 2012,
comprehensive and strict privacy legislation “to protect the fundamental human right of privacy, of
communication while ensuring free flow of information to promote innovation and growth.”
https://www.privacy.gov.ph/wp-content/files/attachments/ppt/DPO7_Health_IDP.pdf

Medical Record
• Property of hospital or clinic
• Patient has legal interest and right to information
• Record is confidential

Medical Record Maintenance

• Access limited to patient, authorized representatives, attending physician, hospital staff members
who have legitimate interest
• If correction is significant, someone designated in facility’s policy should review correction to
determine it meets policy requirements
• Health care practitioners should only make changes within scope of practice for their specialty
• Draw single line to cross out incorrect entry, enter correction, error initialed and dated.
• Mistakes should not be erased or unreadable
• If legal suit threatened, no changes in medical record without consulting risk management.

Human Subject Research

• Protocol that sets forth explicit objectives
• Formal procedures designed to reach objectives
• Researchers may conduct both invasive and noninvasive procedures
• Basic ethical principles in planning research protocol involving human subjects:
– Autonomy
– Beneficence
– Nonmaleficence
– Confidentiality
– Justice
• Human subject research generally requires:
– Risks to subjects minimized by using procedures consistent with sound research design that do
not unnecessarily expose subjects to risk
– Risks to subjects reasonable in relation to anticipated benefits
– Selection of subjects is equitable Informed consent sought and appropriately documented from
subject or subject’s legal representative
– Provision for monitoring data collected to ensure safety of subjects
– Provision for protection of privacy and maintenance of confidentiality of collected data.
Institutional Review Boards
• Ensure satisfactory compliance with appropriate research standards
• Review research protocols prior to implementation
• To protect rights and welfare of human subjects
● Research: systematic investigation designed to develop or contribute to generalizable
knowledge
● Human subjects: living individuals whom investigator conducting research obtains:
– Data through intervention or interaction with individual
– Identifiable private information

CHECK FOR UNDERSTANDING

1. Which of the following of privacy issues usually deals with the unpermitted use of person’s name
of likeness for another’s benefit or advantage?
A. Slander
B. Libel
C. Misappropriation
D. Fraud
2. The allowance of unessential or lay personnel to be present during a surgical procedure
examination in a clinical is an example of?
A. Slander
B. Libel
C. Intrusion
D. Misappropriation
3. This usually involves the publication of information that leads to the public regarding the plaintiff
falsely.
A. Public disclosure of facts
B. Intrusion
C. Misappropriation
D. Presenting someone in a false light to the public
4. Invasion of privacy is a breach of what health care principle?
A. Beneficence
B. Maleficence
C. Confidentiality
D. Veracity
5. A review of the appropriateness of care and the various types of patient care provided within an
institution.
A. Institutional Review Board
B. Utilization review
C. Privacy review
D. Third party payers
6. All but one is TRUE about a medical record?
A. Property of hospital or clinic
B. Patient has legal interest and right to information
C. Record is confidential
D. None of the above
7. With regards to medical record maintenance which of the following is NOT true?
A. Draw single line to cross out incorrect entry, enter correction, error initialed and dated
B. Mistakes should be erased or unreadable
C. If legal suit threatened, no changes in medical record without consulting risk management
D. None of the above
8. HIPAA has three self-declared major purposes which includes?
A. To protect and enhance the rights of consumers by providing them access to their health
information and controlling the inappropriate use of information.
B. Safeguards to protect the patient’s privacy will be part of the research protocol
C. Only those involved in the study will have access to the raw data
D. All of the above
9. Basic ethical principles in planning research protocol involving human subjects include?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. All the above
10. Which of the following is NOT considered a minimum standard set by institutional review
boards?
A. Research results should be presented in such a fashion as to protect the anonymity of the
patients.
B. Safeguards to protect the patient’s privacy will be part of the research protocol.
C. Any member of the public will have access to the raw data collected from the study.
D. The same level of obligation to maintain patient confidentiality in the practice of health care is
expected in the conduct of medical research.

LESSON 9 TITLE: Justice and the Allocation of Scarce Resources.

Health Care in The United States
• Principle of Justice
– Equated to obligation to be fair in distribution of benefits and risks
– Maintenance of this principle simple in abstract and complex in application
– Reform of health care delivery, in regard to equity and access to health care services, major
issues
• Formal Justice
– In distribution, equals must be treated equally, and unequals must be treated unequally
• Material Justice
– Principles that specify relevant characteristics or morally relevant criteria in regard to treatment
are material principles
• Common methods for distribution of goods and resources:
– To each person an equal share
– To each person according to need
– To each person according to merit
– To each person according to contribution
– To each person according to effort
– To each person according to social worth
• Fair Opportunity Rule
– No persons granted social benefits on basis of undeserved advantage
– No persons denied social benefits on basis of undeserved disadvantages

Micro- and Macro-Allocation of Health Care

Macro-allocation
– Province of Congress, state legislatures, insurance companies, private foundations, and health
organizations
• Micro-allocation
– More personal determination of who will receive scarce resources
• Two-Tier System
– Everyone guaranteed coverage for basic care and catastrophic health needs
• Cultural and social barriers bar the way for many citizens to receive health care
• Lifeboat Ethics
– Who shall be saved from drowning, and what will be the criteria for our selection?
• Triage
– Allocating scarce resources practiced and justified in crises of war or disaster

Micro-Allocation
• Medical Utility
– Which patient has best prognosis?
– Often difficult to assess
• Social Utility
– Which patient has greatest social worth?
– Invites problems of racism, ageism, sexism, bias against retarded and mentally ill
• First Come, First Served
Random selection treats all patients as equal

Theories of Justice
 Egalitarian
 Utilitarian
 Libertarian

Egalitarian Theories
 Emphasize equal access to goods and services
 Advocates of a right to health care
 Socialistic universal access health care systems
 Daniel’s Veiled Prudence
i. Prudent planner does not know her age
ii. Prudent planner ignorant of her conception of the good
iii. Prudent planner guided by a time neutral concern for her well-being over the lifespan
iv. Prudent planner has to plan for each stage of her life under assumption she will live through it
 Fair Innings Argument
i. Finite span of years considered reasonable lifetime
ii. Everyone equal chance to have a full set of fair innings, to reach appropriate life expectancy
iii. Injustice when one who has not had full opportunity to reach full allotment of innings

Utilitarian Theories
 Criteria so public utility is maximized
 Public utility: greatest good for greatest number
 Political planning and intervention methods of redistributing goods and wealth
 QALY: quality adjusted life years
– Measures cost-benefit of applying a medical procedure
i. Callahan Natural Life Span Argument
1. After a person has lived normal life span, medical care no longer oriented to resisting death
2. Medical care following natural life span limited to relief of suffering
3. Technologies capable of extending life beyond normal life span create no technological
imperative for its use

Libertarian Theories
 Emphasize personal rights to social and economic liberty
 Choice of allocation system freely chosen
 Free-market system operates on material principle of ability to pay

Health Care Crisis

– Society spends 17.4 percent of gross domestic product on health care
– $2.9 trillion or $9,255 per person
– Per capita medical costs increased 1,000 percent
– Aging population places great burden on stressed system
– Use of high technology in medicine

World Health Care Models

 Beverage Model
 Bismarck Model
 National Health Insurance
 Out of Pocket

◦Beverage Model
 Model originated in Great Britain
 Health care financed by government and taxed based rather than insurance based
 No medical bills; health care treatment public service
 Strong emphasis on primary care
 Costs controlled by rationing
 Long wait times for non-acute secondary and tertiary care
 Newest technologies not easily available
 Low costs per capita
 Government, as sole payer, controls what doctors can do and what they will charge

◦Bismarck Model
 Germany, France, Japan, Belgium, Switzerland
 Care providers and payer’s private entities
 Private not-for-profit health insurance (“sickness funds”) financed jointly by employees and
employers through payroll deductions
– Basically charities and cover everybody

◦National Health Insurance

 Canada, Australia, Taiwan, South Korea
 Health care provider’s private
 Payer is government-run insurance program all citizens pay into
 Insured residents entitled to same level of care
 No profit motive, no need to advertise, no expensive underwriting
 National system great leverage and market power to negotiate lower prices

Patient Protection and Affordable Care Act

 Law requires Americans to purchase health insurance
 Expands Medicaid rolls
 Establishes health-insurance exchanges to provide more competitive rates
 Provides subsidies to the poor and middle-class to assist them in purchasing a private plan
 Imposes billions in new taxes, mainly on the rich and health care industry
 Still most complicated, expensive, and inequitable health care system in developed nations
 Imposes billions in new taxes, mainly on the rich and health care industry
 Still most complicated, expensive, and inequitable health care system in developed nations
 National shortage of primary care physicians
 Disparity in reimbursement levels between Medicare and Medicaid
 Geography creates access maldistribution

The Quality Improvement Movement and Standard of Care

 Medical errors: top 10 causes of deaths
 Health care quality assessment top priority for health care providers
 Health care providers conform to specific standard of care to protect others.

CHECK FOR UNDERSTANDING

1. The process of allocating scarce resources has been commonly practiced and justified in the
crises of war or disaster?
A. Utilitarianism
B. Libertarianism
C. Triage
D. Social utility
2. The allocation of scarce resources to those with the best prognosis.
A. Distributive justice
B. Libertarianism
C. Medical utility
D. Social utility
3. When it comes to allocation of resources the most common neutral system is?
A. First come, first served
B. Social utility
C. Medical utility
D. Lifeboat
4. Which of the following is not included in common methods for distribution of good and resources?
A. To each person an equal share
B. To each person according to need
C. To each person according to merit
D. None of the above
5. This theory of justice emphasizes equal access to goods and services.
A. Libertarianism
B. Utilitarianism
C. Egalitarianism
D. None of the above
6. This is a national health care program that primarily serves indigent populations.
A. Medicare
B. Medicaid
C. Micro-allocation
D. Macro-allocation
7. It is one of the general system models where generally health care providers are private but the
payer is government run insurance program that all citizens pay into?
A. Bismarck Model
B. Beveridge Model
C. Out of pocket model
D. National Health Insurance Model
8. This major theory of justice use free-market system operates on material principle of ability to
pay?
A. Libertarian
B. Utilitarian
C. Egalitarian
D. Distributive
9. In Egalitarian theories, Daniel’s uses a concept of veiled prudence. Veiled prudence consists of
ignorance of four key elements, which are?
A. The prudent planner does not know her age.
B. The prudent planner is guided by a time neutral concern for her well-being over the lifespan.
C. The prudent planner has to plan for each stage of her life under the assumption that she will live
through.
D. All of the above
10.In QALYs which is also known as Quality Adjusted Life Years, what score is associated if you
are already dead?
A. 0
B. 1
C. 2
D. 3

LESSON 10 TITLE: Role Fidelity

Conflicts of Interest
• Joint-venturing
– Group of individuals join together performing a business venture
– Any commercial relationship between practitioner and a company, in which practitioner has
material interest that could form basis for a conflict of interest, spelled out in a disclosure statement
• Self-referral
– To self-refer to an establishment in which you do not provide service but have an economic
interest is at least suspect and perhaps unethical

Sexual Misconduct in Health Care Practice

• Sexual Relations
– Between practitioners and patients unethical
– Relationship between practitioner and patient always unequal
– Create emotional factors that interfere with therapeutic relationship and objective judgment
• When practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it is
time to end professional relationship

Scope of Practice
• Role Fidelity
– Requires we remain within scope of clear legitimate practice
– One does not cross line without willful intention
• Nurse-patient Relationship Models
– Bureaucratic model: emphasis on maintenance of social order at expense of individual patient’s
welfare
– Physician advocate model: goal is to enhance authority of physician

Impaired Colleagues
• Impaired colleagues place clients at risk
• Behavioral difficulties: absenteeism, illogical decision making, excessive errors
• Question is not whether practitioner has a duty to intervene, but the manner of the intervention
• Health care provider must be confronted
• Made to seek effective assistance
• Treat impaired colleague humanely

Codes of Ethics and Professional Conduct

• Codes of conduct and ethics include:
– Appropriate scope of practice
– Conflicts of interests
– Serving best interest of patients
– Obligations to promote patient autonomy and privacy
– Obligations beyond patients to others in society
– Ethics of research
– Informing on unethical or illegal behavior

• Common Problems with Professional Codes

– Vagueness as to duties and prohibitions and self-regulation and peer enforcement
– Incompleteness as to duties
– Excessive concern with promotion and prestige of profession and financial and business
interests

• Gatekeeping
– One looks out for the interests of the profession or of others in a similar practice
– Result of professional obligations and training
– Strong sense of collegiality with others in practice
– Disparaging: talking ill of

Gaming the System

• Practitioner attempting to get around the system
• Willing to lie in the process
• Often done on behalf of patient or at patient’s request
• Health care practitioners’ responsibility to be truthful, keep promises, be fair
• Lying undermines a person’s credibility
• If individual clinician found to be lying, can have harmful effect on entire health care profession
• Gaming can harm other patients

CHECK FOR UNDERSTANDING

1. The physician assistant who certifies who certifies that an elderly patient with bunions needs a
handicapped parking stickers, when in fact the severity of the problem does not meet the standard
for authorizing the sticker. What moral problem is involved in this situation?
A. Disparagement
B. Gaming the system
C. Gatekeeping
D. None of the above
2. The common problems associated with professional codes are as follow EXCEPT?
A. Incompleteness as to duties
B. Vagueness as to duties and prohibitions
C. Excessive concern with prestige of profession
D. None of the above
3. One looks out for the interest of the profession or of others in a similar practice is known as?
A. Disparagement
B. Gaming the system
C. Gatekeeping
D. Code of conduct
4. Code of conducts and ethics include the following EXCEPT?
A. Serving best interest of patients
B. Ethics of research
C. Incompleteness to duties
D. Appropriate scope of practice
5. What are the ways of a health care professional to avoid disparagement?
A. Offer professional courtesy to others
B. Avoid sexual and conflict of interest
C. Look after the welfare of the profession
D. All of the above
6. Which of the following statement about sexual misconduct is INCORRECT?
A. Between practitioners and patients unethical
B. Relationship between practitioner and patient always equal
C. When practitioner feels potential for misunderstanding or mutual feelings of romantic interest, it
is time to end professional relationship
D. None of the above
7. Sheryl is a respiratory therapy technician in a small town in Michigan. The town has a small
hospital and a small durable medical supply company. She is known locally as an entrepreneur
ball of fire and has managed to become both the head of the hospital respiratory care department
and the owner of the small durable medical supply company. What code of ethics and professional
conduct best describe the scenario?
A. Role fidelity
B. Conflict of interest
C. Moral duty
D. Duty to treat
8. What universal principle requires remaining within the scope of legitimate practice. Scope of
practice is clear, and one does not cross the line without willful intention?
A. Justice
B. Autonomy
C. Role Fidelity
D. Veracity
9. The nature substance abuse is such that even fine practitioners begin to experience behavioral
difficulties such as
EXCEPT.
A. Behaves naturally
B. Absenteeism
C. Illogical decision making
D. Excessive error
10. An example of conflict of interest where a group of individuals join together to perform a
business venture.
A. Self-referral
B. Business partners
C. Joint -venturing
D. Stark law

LESSON 11 TITLE: Role Fidelity

Health Care Provision in a Multicultural Society
• We are a nation of immigrants, a multicultural society, a universal nation, a pluralistic society
• We have competing ideas regarding basic issues such as the meaning of health and illness
• Most health care practitioners in the United States adhere to Western system of health care
delivery
• Health care providers often not only ethnocentric but also xenophobic
• Culture shock: communication barrier raised; problem patient or uncommunicative one
ANA Committee on Ethics
• Fundamental criteria for moral duty decisions:
– Patient at significant risk of harm, loss, or damage if practitioner does not assist
– Practitioner’s intervention or care directly relevant to preventing harm
– Practitioner’s care will probably prevent harm, loss, or damage to patient
– Benefit the patient will gain outweighs any harm practitioner might incur and does not present
more than a minimal risk to health care provider
• If practitioner answers yes to all four criteria, it is a moral duty to treat under principle of
beneficence
• If all criteria could not be answered with yes, the decision to treat would become a moral option
rather than a duty for the practitioner

Institutional Ethics Committee

• Interdisciplinary body of health care providers, community representatives, and nonmedical
professionals
• Address ethical questions within health care institution, especially on care of patients
• Committees play advisory role
• Often multidisciplinary group
• Physicians, nurses, social workers, philosophers, laypersons, lawyers, administrators, religious
leaders
• Ethical training increasing in health care programs

CHECK FOR UNDERSTANDING

1. An interdisciplinary body of health care providers, community representatives, and non-medical
professionals who address ethical questions within the health care institution.
A. American Nurses Association
B. Institutional Ethics Committee
C. Joint Commission
D. None of the above
2. An act or course of action that is required by one on the basis of moral position is termed _.?
A. Role fidelity
B. Moral duty
C. Moral option
D. Morality
3. A high-stress situation in which one finds oneself in another culture in which former behavior
patterns are ineffective and one fails to understand the basic cues of social intercourse is termed .
A. Culture shock
B. Ethnocentrism
C. Culture bias
D. Racism
4. The patient with heart condition who is restricted to be. Although he is told to remain in bed and
appears to understand, he is found several times a day standing and gazing out his window. The
patient, a devout Muslim who by faith is required to pray several times a day facing in a particular
direction, feels that the religious priority overcomes the requirement of bedrest. What should you
do if you are assigned to this patient?
A. Report the patient for being uncooperative
B. Restraint the patient
C. Respect the patient’s cultural activity
D. None of the above
5. It is the most devastating Ebola outbreak dates back in?
A. December 2013
B. March 2014
C. August 2015
D. None of the above

LESSON 12 TITLE: Reproductive Issues

The Abortion Issue
• Abortion statistics
– More than half of American women receiving abortions are in their 20s
– 17 percent of all U.S. abortions are teenagers
– 60 percent of women already have a child
– 37 percent have two or more children
– No racial or ethnic group makes up a majority of women having abortions
– 70 percent of women reported religious affiliation
– 40 percent of women with family incomes below federal poverty level
– 10 percent occur in second trimester
– 90 percent in first twelve weeks of pregnancy
– 60 percent occur in first eight weeks
• Abortion is a very common experience for women
• 2012: 1.31 million abortions in United States
• Reasons diverse and complex
• Experience of abortion real, immediate, personal
• Americans evenly divided between pro-choice/pro-life positions

• Pro-choice advocates favor intact dilation and evacuation

• Pro-life advocates use term partial birth abortion
• Fewer than a thousand third-trimester abortions performed each year

The Legal Debate

• 1973: In Roe v. Wade, Supreme Court, legalized a woman’s right to have an abortion
– Right not considered to be unrestricted
– Balanced the interests of the woman and the state
– Term person used only postnatally
– 28th week: allowed state to shift to protection of fetus
• 1976: Danforth v. Planned Parenthood of Central Missouri
– Statutory provision required a woman to receive her husband’s, or if a minor, her parent’s or
guardian’s, permission prior to having abortion
– Court held requirements were unconstitutional
• 1976: Hyde amendment restricted availability of Medicare funding for abortions
– Modified to allow funding in which mother’s life threatened by carrying fetus full term or in cases
of incest or rape
– It does primarily affect poor women
• Webster v. Reproductive Health Services
– Court held that a state could ban public employees and public health facilities from performing or
assisting in performing nontherapeutic abortions
• State legislatures in Northeast and West Coast have consistently supported abortion rights
• Legislatures in a number of states have passed restrictive laws designed to stop or slow process
• Main framework of Roe v. Wade still in place and is the law of the land

The Moral Issues

• Personhood
• Sanctity of life
• Quality of life
• Autonomy
• Mercy
• Freedom
• Social stability

The Two Positions

• Pro-life: anti-abortion, believes abortion is murder and should be stopped
• Pro-choice: believes decision to abort is one of personal liberty and should be legal

Sanctity of Life Argument

• Fetus is a live human
• Killing him or her is wrong
• Allow for a few exceptions
• Human life sacred on basis of divine mandate, unalienable natural or human rights, or common
collective decision
• Genetic code argument

The Facts of Fetal Development

• Conceptus: union of sperm and egg
• Zygote: full genetic code will determine sex, hair color, skin color, and other attributes
• Embryo: zygote settles into uterine wall
• 8 weeks: entity is a fetus
• Second trimester: fetus will have begun to move (quickening)
• 5th month: neurologically, fetus can feel pain
• 6th month: fetus period of potential viability
• Third trimester: fetus develops minimal consciousness
• Birth occurs after nine months
• Infant completely dependent on mother

Killing and Self-Defense

• If someone is about to kill you, and the only way to save yourself is to kill the other person first,
then killing is permissible
• Doctrine of double effect: distinguish intended effect of an action from other, unintended effects

“Human” or “Person”?
• Traits Central to Personhood
– Member of the moral community
– Consciousness of objects and events
– Ability to feel pain
– Reasoning
– Self-motivated activity
– Capacity to communicate
– Concept of the self

The Viability Argument

– Viability: characteristic of biological independence
– Some argue a fetus has standing only when it becomes viable outside the mother
– Some philosophers believe there is more to the abortion question than the issue of personhood

Method of Analogical Thought Experiments

• The Violinist Analogy
• The Rapidly Growing Child Analogy
• The Carpet-Seed Children Analogy
Women’s Liberty and the Priority of Life Plan
• Pro-choice: crucial a woman have control over her life plan in the way a man has control
• Pro-life: root of abortion problem is modern attitude toward sex
• Differing ideas concerning sexuality, one’s religious beliefs, or deeply held moral beliefs
• Pro-choice: crucial a woman have control over her life plan in the way a man has control
• Pro-life: root of abortion problem is modern attitude toward sex
• Differing ideas concerning sexuality, one’s religious beliefs, or deeply held moral beliefs

• Pro-life theorist:
• Will see the social problem as another manifestation of rampant immorality of modern age
• Considers element of autonomy in reproduction a matter of “convenience” than a life plan

Traditionalism vs. Modernism

• Pro-life Activists
– Tend to be more traditional and religious
– Sex should be reserved for marriage
• Pro-choice Activists
– Tend to be less traditional and religious
– More career oriented with higher incomes
– Sex is a natural expression of oneself

Abortion and the Freedom of Religion

• Pro-life Theorists
– Reject the idea their views on abortion are the result of their religious views
– They are result of basic moral reasoning
– Freedom of religion is not absolute
• Pro-choice Theorists
– Reflect one’s most deeply held beliefs
– Even if views are not religious in the partisan sense, they are equally profound
– Best solution: tolerance

CHECK FOR UNDERSTANDING

1. The position that abortion is murder and must be stopped is known as the position..
A. Sanctity of life
B. Viability
C. Pro-life
D. None of the above
2. This is a widely accepted exception to the “thou shalt not kill” proscription.
A. Self defense
B. Abortion
C. Mercy Killing
D. All of the above .
3. This term is when the fetus begun to move and the mother will be able to sense the movement
at a point?
A. Conception
B. Quickening
C. `Viability
D. Conceptus
4. Which of the following is NOT included in the list of traits central to personhood?
A. Reasoning
B. The ability to manage stress
C. The ability to feel pain
D. A concept of the self
5. Judith Thomson uses the method of analogical thought of experiment because she believes
there is more to the abortion question than issue of personhood. One of her analogy talks about
faulty contraception which is?
A. Viability argument
B. The Violinist Analogy
C. The Rapidly Growing Analogy
D. The Carpet-Seed Analogy
6. They are known as the conservative traditionalist?
A. Pro-life activist
B. Pro-life theorist
C. Pro-choice activist
D. Pro-choice theorist
7. In the 1973 case _, the Supreme Court of the United States, relying on the constitutional
right of privacy, legalized a woman’s right to have an abortion 1983
A. Doe v. Bolton
B. Planned Parenthood. Detroit
C. Roe v. Wade
D. Harris v. McRae
8. In this case of about abortion, Supreme Court examined a statutory provision that a woman
required to receive her husband’s permission prior having an abortion.
A. 1976 Danforth v.Planned Parenthood of Central Missouri case
B. Planned Parenthood. Detroit
C. Roe v. Wade
D. Harris v. McRae
9. This is the union of sperm and the ovum in the stage of human embryo development?
A. Intercourse
B. Implantation
C. Embryo
D. Conception
10. The position that the decision to abort is one of personal liberty and thus should be legal is
known as the position.
A. Pro-choice
B. Pro-life
C. Viability
D. Sanctity of life

LESSON 13 TITLE: Reproductive Issues

Traditionalism
Possible answers:
1. They are more traditional and religious.
2. They believe that sex should be reserved for marriage.
3. They are called conservative traditionalist.
Modernism
Possible answers:
1. They are less religious, more career oriented with higher incomes.
2. They believe that sex is a natural expression of oneself.
3. They are also known as liberal modernist.

MAIN LESSON
The Environmental Perspective
• See humans as members of a biotic community
• Duty to maintain a balance of numbers with other members of that community
• Maintain and perhaps encourage use of abortion as a tool to control world population
• Aggressive attitude toward family planning

The Family Planning Perspective

• Asks why we should favor accidental babies over planned babies
• People should have the right to choose at what point they will have their children
• Pro-life perspective: family planning example of decadent culture of permissiveness

In Vitro Fertilization
• Eggs removed from a woman and fertilized in a laboratory dish (by husband or another man)
• Embryos implanted in a woman (donor or other woman), where egg brought to term
• Extra, or spare, embryos
• Implantation process may fail and be repeated
• Freezing of embryos
• Rating them for quality
• Discarding those that hold genetic defects
• Thawing them and disposing of them
– What happens to excess embryos can be a moral dilemma and controversial
• Women could postpone pregnancy without risking infertility or diseases of pregnancy
• Identifying genetic abnormalities
• Embryonic tissue in medical research
– Embryo: mitochondria, cytoplasm, DNA of mother and father

In Vitro Fertilization or IVF is a complex series of procedures used to treat fertility or genetic
problems and assist with the conception of a child.
IVF is a type of assisted reproductive technology used for infertility treatment and gestational
surrogacy, in which a fertilized egg is implanted into a surrogate’s uterus, and the resulting child is
genetically unrelated to the surrogate. Some countries banned or otherwise regulate the
availability of IVF treatment, giving rise to fertility tourism. Restrictions on availability of IVF include
costs and age to carry a healthy pregnancy to term. IVF is mostly attempted if less invasive or
expensive options have failed or are unlikely to work. IVF is a choice for couples who are not able
to conceive without assistance.
(https://www.assignmentpoint.com/science/medical/in-vitro-fertilization.html)

Surrogacy

• When a woman agrees to carry a baby to term and give it up to another set of parents to raise
• Sometimes done for money, sometimes as a favor
– Pregnancy a deeply personal experience that should never be undergone for the sake of others
– Very reason surrogacy supreme gift to another
• Kantians: surrogacy problematic since birth mother is being used as incubator and not regarded
as a rational actor
• Utilitarians: faced with very complicated utility calculations
• Well-accepted practice in spite of misgivings of some people

CHECK FOR UNDERSTANDING

1. The analogy titled “The Carpet-Seed Children Analogy” which attempts to deal with the issue of
failed contraception is a defense of abortion by?
A. Mary Anne Warren
B. Michael Tooley
C. Judith Thomson
D. Lydia Saad
2. When a woman agrees to carry a baby to term and give up to another parent is known as?
A. Surrogacy
B. Adoption
C. In vivo fertilization
D. Artificial Insemination
3. The most common ethical problems associated with the process of in vitro fertilization comes
from what is to be done with the unneeded _.
A. Conceptus
B. Embryos
C. Egg
D. Sperm
4. In 1979, China introduced the to reduce the rate of their population growth.
A. Only boy child policy
B. Contraceptives policy
C. One child policy
D. No child policy
5. This is a procedure which eggs are removed from a woman and fertilized in a laboratory dish?
A. Surrogacy
B. In vivo fertilization
C. Artificial Insemination
D. In vitro fertilization
6. Laws that single out the medical practices of doctors who provide abortions and impose on them
requirements that are different and more burdensome than those imposed on other medical
practices are called laws.
A. Trap
B. Stark
C. Pro-life
D. Pro-choice
7. Her birth received enormous press attention as the world was alerted to her birth. She was
called the first “test tube baby.”
A. Leslie Brown
B. Louise Brown
C. Karen Quinlan
D. Nancy Cruzan
8. It is the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can
survive outside the uterus.
A. Expulsion
B. Abortion
C. In vitro fertilization
D. Surrogacy
9. He is the communist revolution that encouraged the population to multiply in China to increase
available manpower.
A. Lao Tzu
B. Wo Bin
C. Mao Zedong
D. Kim Jong Ill
10. What year did Congress enacted the Hyde amendment?
A. 1976
B. 1967
C. 1986
D. 1968

LESSON 14 TITLE: THE HUMAN ORGANISM

Differentiate in Vitro Fertilization to surrogacy.
Answer: In Vitro Fertilization (IVF) is a procedure in which eggs are removed from a woman and
fertilized in a laboratory dish (by either the husband or another man). The embryos are then
implanted in a woman (the donor or some other woman) where the egg may be brought to term
while Surrogacy occurs when a woman agrees to carry a baby to term and give it up to another set
of parents to raise.

Biological and Biographical Life

• Biological Life
– Living things
– Cardiopulmonary function
• Biographical Life
– Human life captured in weddings, memories, relationships
– Separates human life from other life forms
– Makes us uniquely human

Brain Death
What does "brain death" mean?
- Brain death is a legal definition of death. It is the complete stopping of all brain function and
cannot be reversed. It means that, because of extreme and serious trauma or injury to the brain,
the body's blood supply to the brain is blocked, and the brain dies. Brain death is death. It is
permanent.
- The diagnosis of brain death is defined as "death based on the absence of all neurologic
function." Families who have had a loved one declared brain dead may have questions about
what the term really means. https://www.kidney.org/atoz/content/braindeath
- With the modern technology of respiratory and cardiac support, in certain cases of severe trauma
we can keep the remainder of the body’s cells alive for days and months with no brain activity
being present.

Harvard medical School Brain Death Test

- Unreceptivity and unresponsiveness
- No movements or breathing
- No reflexes
- Flat E.E.G of confirmatory value

Persistent Vegetative States (PVS)

The vegetative state is a chronic condition that preserves the ability to maintain blood pressure
(BP), respiration, and cardiac function, but not cognitive function. Hypothalamic and medullary
brain stem functions remain intact to support cardiorespiratory and autonomic functions and are
sufficient for survival if medical and nursing care is adequate. The cortex is severely damaged
(eliminating cognitive function), but the reticular activating system (RAS) remains functional
(making wakefulness possible). Midbrain or pontine reflexes may or may not be present. Patients
have no awareness of self and interact with the environment only via reflexes. Seizure activity may
be present but not be clinically evident. Traditionally, a vegetative state that lasts > 1 month is
considered to be a persistent vegetative state. However, a diagnosis of persistent vegetative state
does not imply permanent disability because in very rare cases (eg, after traumatic brain injury),
patients can improve, reaching a minimally conscious state or a higher level of consciousness.
https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-
consciousness/vegetative-state-and
minimally-conscious-state.

KEYPOINTS
• No recognizable cognitive function
• Characterized by permanent eyes-open state of unconsciousness
• Patient is not comatose
• Patient is awake but unaware
• Irreversible loss of all neocortical function
• Brain stem functions remain
• Patients can breathe on their own
• Elicitable reflexes, spontaneous respirations, and reactions to external stimuli
• Recovery rather remote

CHECK FOR UNDERSTANDING

1. When we speak of life in the sense of relationships, dreams, and expectations for the future, we
are speaking of.
A. Biographical life
B. Biological life
C. Ordinary life
D. Extraordinary life
2. In which of the following cases did the New Jersey Supreme court rule that the state has no
right to order respiratory support to be continued?
A. Nancy Beth Cruzan
B. Baby Doe
C. Karen Ann Quinlan
D. None of the above
Rationale:
3. Criteria for brain death given by Harvard Medical School are which of the following?
A. No movements or breathing
B. Unresponsiveness
C. Flat EEG of confirmatory value
D. All of the above
4. In certain cases of brain trauma, we can keep the remainder of the body’s cells alive for days
and months with no brain activity present. This case is considered as?
A. Persistent Vegetative State
B. Brain Death
C. Bedridden
D. Brain Activity
5. This is characterized by a permanent eyes state of consciousness with no recognizable
cognitive function:
A. Persistent Vegetative State
B. Brain Death
C. Bedridden
D. Brain Activity

LESSON 15 TITLE: THE HUMAN ORGANISM

Ordinary and Extraordinary Care
Every person with decisional capacity has the right to refuse any treatment, regardless of the
nature of the treatment or consequences of the refusal. The surrogate decision-making has the
power to act on this right for the patient, as long as there is reason to believe that the surrogate is
making decisions based on the patient’s wishes, values, or interests. That said, some people and
groups believe that some refusals of treatment are acceptable and not others. They argue that it is
morally worse to refuse “ordinary treatment” rather than “extraordinary treatment.” This was based
on the idea that people have a general obligation to act to sustain their own lives. A certain degree
of pain and suffering is normal. To refuse to do the basic minimum to sustain one’s life is morally
wrong because it undermines life itself, much like suicide. Lately, insurance providers have used
the ordinary/extraordinary distinction to determine which treatments they need to cover and which
do not constitute “basic care.” The key to both of these arguments is the focus on categorizing
types of treatment. The error (on their own terms) comes when it is not acknowledged that what is
ordinary for one patient may be extraordinary for another. Legally no distinction between treatment
in categories is recognized with regard to the right to refuse treatment. However, some see a
moral difference and refusal of ordinary treatment may be a sign that a surrogate is not acting in
good faith. Ordinary and extraordinary treatments are generally categorized as follows:

Ordinary Treatment
1. Low risk of harm.
2. Simple, relatively low tech.
3. Routine.
4. Good chance for benefit to the patient.
5. Relatively inexpensive.
6. Available to most people who need it.
7. Causes little pain or distress.

ExtraordinaryTreatment
1. High Risk
2. Complex, relatively high tech.
3. Innovative, experimental, unusual.
4. Relatively small chance for benefit to the patient.
5. Relatively expensive.
6. Available to few (may involve distributive justice issues).
7. Usually a source of pain or distress.
Any treatment is extraordinary if the burdens outweigh the benefits or it offers no hope of benefit
for the patient. (Purtilo, R. Ethical Dimensions in the Health Professions (Saunders, 1999) p220.)
But who defines benefit and burden? And what meets the criteria of hope?
http://www.pages.drexel.edu/~cp28/ordextr.htm

Personhood
• One who could be said to have interests
• One who has cognitive awareness
• One who is capable of relationships
• One who has a sense of futurity

Advanced Directives
• 1990 Patient Self-Determination Act (PSDA)
– Federal law regarding advanced directives
– To make people aware of their rights
• Joint Commission
– Developed standards for the documentation of patients’ wishes regarding advanced-directives
• No uniformity in laws on living wills and surrogate decision makers
• Many authorities recommend use of durable power of attorney over a living will.
Living will is one type of advance directive. It is a written, legal document. It describes the
treatments you would want if you were terminally ill or permanently unconscious. These could be
medical treatments or treatments that will help you live longer. A living will doesn’t let you select
someone to make decisions for you.
A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA
states that you have chosen to make health care decisions for you. It becomes active any time you
are unconscious or unable to make medical decisions (and may be called Medical Power of
Attorney, or MPOA). A DPA is generally more useful than a living will. But a DPA may not be a
good choice if you don’t have another person you trust to make these decisions for you.

Supreme Court
– Upheld concept that competent individuals could refuse life-sustaining treatment
– Made no legal distinction between tube feeding and other life-sustaining measures

CHECK FOR UNDERSTANDING

1. In December 1989, this case became the first right-to-die cases to be heard by the Supreme
Court in the United States.
A. Baby doe case
B. Nancy Cruzan case
C. Karen Anne Quinlan case
D. None of the above
Rationale:
2. Philosophers such as Joseph Fletcher and Joel Feinberg have attempted to define
characteristics that a being must possess in order to be considered e bearer of rights. Among the
suggested criteria are as follow EXCEPT?
A. One who has cognitive awareness
B. One who could be said to have interests
C. One who has a sense of futurity
D. One who is incapable of relationships
3. Procedure, medicine or treatment given to a patient offered no reasonable hope of benefit is an
example of care?
A. Extraordinary
B. Advanced
C. Ordinary
D. Exceptional
4. This is a federal law regarding advance directives that tell patients upon admission their rights
under the state of law?
A. Living will statement
B. Patient Self-Determination Act (PSDA)
C. Durable power of attorney
D. None of the above
5. A 50-year old woman is dying of cancer. She has only few days to live. She has severe anemia
due to the cancer. Even though blood transfusion is the usual treatment for severe anemia, the
decision is made not to give. What care does this case involve?
A. Advanced care
B. Ordinary care
C. Extraordinary care
D. None of the above

LESSON 16 TITLE: THE HUMAN ORGANISM

Proxy Decision-making Standards
- Courts have not made their decisions on basis of personhood criteria
- Courts created standards for allowance of decisions by proxy
- Best-interest Standard
- Takes into account tangible factors as harms and benefits, physical and fiscal risks
- Substituted-judgmentStandard
- Decision about treatment or nontreatment must remain that of the patient
- Based on principle of autonomy

Informed Nonconsent
- Patients who understand the nature of their conditions and the consequences of refusing care

COURT RULING
• Acuity of patient is irrelevant to the allowance of treatment refusal
• Patient’s own perceived view of her quality of life and treatment requirements necessary to
preserve it are of paramount importance
• There is no meaningful legal distinction between mechanical life support and nasogastric feeding;
both are invasive
• Distinctions between withholding and withdrawing care are legally irrelevant Do Not Resuscitate
(DNR): A do-not-resuscitate (DNR) order placed in a person’s medical record by a doctor informs
the medical staff that cardiopulmonary resuscitation (CPR) should not be attempted. Because CPR
is not attempted, other resuscitative measures that follow it (such as electric shocks to the heart
and artificial respirations by insertion of a breathing tube) will also be avoided. This order has been
useful in preventing unnecessary and unwanted invasive treatment at the end of life. The success
rate of CPR near the end of life is extremely low. (See also Overview of Legal and Ethical Issues in
Health Care.)
Doctors should discuss with seriously ill patients the possibility of cardiopulmonary arrest (when
the heart stops and breathing ceases) in light of their immediate medical condition, describe CPR
procedures and likely outcomes, and ask patients about treatment preferences. If a person is
incapable of making a decision about CPR, an authorized surrogate may make the decision. A
DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted.
Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that
may prolong life can still be provided. Depending on the person's condition, these other treatments
are usually more likely to be successful than CPR. Treatment that keeps the person free of pain
and comfortable (called palliative care) should always be given.
https://www.msdmanuals.com/home/fundamentals/legal-and-ethical-issues/do-not-resuscitate-dnr-
orders

Languages of DNR
- Code
- No code
- Slow code
- Chemical code
Do Not Resuscitate (DNR) Guidelines
1. DNR order should be documented in the written medical record.
2. DNR orders should specify the exact nature of the treatments to be withheld.
3. Patients, when they are able, should participate in DNR decision. Their involvement and wishes
should be documented in the medical record.
4. Decisions to withhold CPR should be discussed with the health care team.
5. DNR status should be reviewed on a regular basis.

CHECK FOR UNDERSTANDING

1. Amira, a 40 years old patient in coma has a DNR order placed in his medical chart to avoid the
use of CPR. DNR means?
A. Do Not Regurgitate
B. Do Not Revive
C. Do Not Resuscitate
D. Do Not Retaliate
2. Which of the following are included in the DNR Guidelines?
A. DNR status should be reviewed on a regular basis.
B. DNR orders should be documented in the written medical record.
C. Decisions to withhold CPR should be discussed with the health care team
D. All of the above
3. __standard maintains that the decision about treatment or nontreatment must remain that of the
patient, based on the principle of autonomy.
A. Parens patriae
B. Substituted-judgement
C. Best-interest
D. All of the above
4. The case of become the landmark decision regarding the right to informed nonconsent
A. Karen Ann Quinlan case
B. Nancy Cruzan case
C. Elizabeth Bouvia case
D. Baby Doe case
5. This refers to the practice in a hospital or other medical center to purposely respond slowly or
incompletely to a patient in cardiac arrest, particularly in situations for which CPR is of no medical
benefit.
A. No code
B. Chemical code
C. Code
D. Slow code

LESSON 17 TITLE: THE HUMAN ORGANISM

Baby Doe
• Baby Doe Regulations
– Consider withholding of medical care for handicapped infants, reglect
• Exceptions
– When infant chronically and irreversibly comatose
– When treatment would only prolong dying
– When treatment would be futile, or inhumane
• Translated into the language of personhood:
– Infant who has no present or future potential for self-awareness or relationships can be said to
have no interests at all
– Incomprehensible to provide life-extending care
Organ Donation
• Advances in technique and immunosuppressive drugs have made it possible to transplant:
– Hearts
– Lungs
– Kidneys
– Livers
– Bone marrow
– Skin
– Corneas
– Pancreases
• Survival and success rate progressively improving
• Shortage of supply
• Uniform Anatomical Gift Act
• Purely voluntary decision
• Organs may be donated by those close to individual
• Need to obtain family consent in time of grief and stress major barrier to organ procurement
• Volunteerism and public education have not provided adequate supplies of donated organs
– See Table 9-1: Options for Increasing the Supply of Salvageable Organs

Euthanasia
Euthanasia refers to deliberately ending someone’s life, usually to relieve suffering. Doctors
sometimes perform euthanasia when it’s requested by people who have a terminal illness and are
in a lot of pain. It’s a complex process and involves weighing many factors. Local laws, someone’s
physical and mental health, and their personal beliefs and wishes all play a role.
Are there different types?
There are several types of euthanasia. What’s chosen depends on a variety of factors, including
someone’s outlook and level of consciousness.
Assisted suicide vs. euthanasia
Assisted suicide is sometimes called physician-assisted suicide (PAS). PAS means a doctor
knowingly helps someone end their life. This person is likely experiencing persistent and unending
suffering. They may have also received a terminally ill diagnosis. Their doctor will determine the
most effective, painless method. In many Trusted Source cases, doctors will provide people with a
drug they can take to end their life. A lethal dose of opioids, for example, may be prescribed for
this. In the end, it’s up to the person to decide whether they take the drug. With euthanasia, a
doctor is allowed to end the person’s life by painless means. For example, an injection of a lethal
drug may be used.

Active vs. passive

When most people think of euthanasia, they think of a doctor directly ending someone’s life. This is
known as active euthanasia. Purposely giving someone a lethal dose of a sedative is considered
active euthanasia.
Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments
so that a person passes more quickly. A doctor may also prescribe increasingly high doses of
pain-killing medication. Overtime, the doses may become toxic.
This makes the distinction between passive euthanasia and palliative care blurry. Palliative care
focuses on keeping people as comfortable as possible at the end of their life.
For example, a palliative care doctor might allow someone approaching death to stop taking a
medication that causes unpleasant side effects. In other cases, they might allow someone to take
a much higher dose of a pain medication to treat severe pain. This is often a standard part of good
palliative care. Many don’t consider it euthanasia.
Voluntary vs. nonvoluntary
If someone makes a conscious decision to seek help with ending their life, it’s considered
voluntary euthanasia. The person must give their full consent and demonstrate that they fully
understand what will happen.
Nonvoluntary euthanasia involves someone else making the decision to end someone’s life. A
close family member usually makes the decision. This is generally done when someone is
completely unconscious or permanently incapacitated. It usually involves passive euthanasia, such
as withdrawing life support from someone who’s showing no signs of brain activity.
https://www.healthline.com/health/what-is-euthanasia#types (visit this page to understand facts
about euthanasia)

Legal and Social Standing of Euthanasia

• 2016: Oregon and four other states allow physician-aid-in dying (PAD)
• No clear consensus for legalizing euthanasia

Key points

• Passive Euthanasia
• Doing nothing to preserve life

• Active Euthanasia
• Requires actions that speed process of dying

• InvoluntaryEuthanasia
• Ignores individual’s autonomous rights
• Could bring about death of unwilling victim
• A person has committed suicide when:
• That person brings about his or her own death
• Others do not coerce him or her to do the action
• Death caused by conditions arranged by person for purpose of bringing about his or her death

World Status of Euthanasia

• Netherlands: first modern industrialized nation to fully sanction physician assisted suicide
• German-speaking nations: law allows assisted suicide as long as drug is taken without any help
• Switzerland: allows physician assisted suicide as long as there are no “self-seeking motives”
• Belgium: second Western nation to legalize physician-assisted suicide; policies less stringent
Netherlands
• United States: doctors allowed to prescribe lethal doses of drugs to terminally ill patients to “aid in
dying” in five states; active euthanasia is illegal

CHECK FOR UNDERSTANDING

1. The Baby doe regulations consider the withholding of medical care for these handicapped
infants to be neglect. The regulations provided three exceptions which are?
A. When the infant is chronically and irreversibly comatose
B. When the treatment would futile; or inhumane.
C. When treatment would only prolong dying.
D. All of the above
2. This Act was passed in the US in 1968 and has since revise in 1987 and in 2006. The act sets a
regulatory framework for the donation of organs, tissues, and other human body parts in the US?
A. Uniform Anatomical Gift Act of 2006
B. Patient Self-determination Act
C. Consumers Act
D. None of the above
3. With regards to Options for Increasing the Supply of Salvageable Organ, this option would
require all competent adults to decide and record whether they wish to become organ donors at
their death.
A. Presumed consent
B. Mandated choice
C. Xenografting
D. All of the above
4. Failing to revive a patient who has signed a DNR order is an example of what type of
euthanasia?
A. Active euthanasia
B. Involuntary euthanasia
C. Passive euthanasia
D. All of the above
5. It is the first modern industrialized nation to fully sanction physician-assisted suicide.
A. Belgium
B. Germany
C. Netherlands
D. United States

LESSON 18 TITLE: THE HUMAN ORGANISM

1. Baby doe regulation is regarding the treatment of handicapped children, if there is available
treatment for the condition then we provide it for them. Enumerate the three exception for this
regulation?
ANSWERS:
- When infant chronically and irreversibly comatose
- When treatment would only prolong dying
- When treatment would be futile, or inhumane
2. With advance technology with the help of immunosuppressive drugs it is already possible to
transplant organs. Give 4 examples of organs that can be transplanted?
Heart, kidney, lungs and corneas
3. Differentiate voluntary and non-voluntary euthanasia.
Voluntary euthanasia is when someone makes a conscious decision to seek help with ending
their life while
Non-voluntary euthanasia involves someone else making the decision to end someone’s life,
usually the decision comes with your close family member.

MAIN LESSON
Mercy Killing
• Health care practitioner deliberately hastens death of a patient
• Practice prohibited under homicide laws
• ―Consent and humanitarian motive‖ is never a defense under the law for murder

Arguments for and Against Euthanasia

• Arguments for:
– Concern and compassion for those painfully and/or terminally ill
– Duty-oriented: extension of personal autonomy—to live our life according to our own vision,
unrestricted by views of others
• Arguments Against:
– Religious grounds: our lives are not ours but gifts from God; to take our life is to destroy what
belongs to God
– How does one decide euthanasia is appropriate for another?

Controversy around euthanasia

- There are many arguments both for and against euthanasia and PAS. Most of these arguments
fall into four main categories:
Morality and religion
Some people believe euthanasia is murder and find it unacceptable for moral reasons. Many also
argue that the ability to decide your own death weakens the sanctity of life. In addition, many
churches, religious groups, and faith organizations argue against euthanasia for similar reasons.
Physician judgement
PAS is only legal if someone is mentally capable of making the choice. However, determining
someone’s mental capabilities isn’t very straightforward. One studyTrusted Source found that
doctors aren’t always capable of recognizing when someone is fit to make the decision.
Ethics
Some doctors and opponents of PAS are concerned about the ethical complications doctors could
face. For more than 2,500 years, doctors have taken the Hippocratic oath. This oath encourages
doctors to care for and never harm those under their care. Some argue that the Hippocratic oath
supports PAS since it ends suffering and brings no more harm. On the other hand, some debate it
results in harm to the person and their loved ones, who must watch their loved one suffer.
Personal choice
―Death with dignity‖ is a movement that encourages legislatures to allow people to decide how
they want to die. Some people simply don’t want to go through a long dying process, often out of
concern of the burden it puts on their loved ones. https://www.healthline.com/health/what-is-
euthanasia#types

The Hospice Alternative

• Hospice Programs
– Provide palliative care, abatement of pain, and an environment that encourages dignity
– Do not cure or treat intensively
– Ceased to be a place and have become a concept
– Philosophy: dying is a natural part of life

CHECK FOR UNDERSTANDING

1. This care is given for people living with a serious illness to relieve pain and alleviate their
suffering, example is patient with terminal cancer?
A. Rehabilatative care
B. Primary care
C. Secondary care
D. Palliative care
2. These programs are set up to provide palliative care, abatement of pain and an environment
that encourages dignity,
but they do not cure or treat intensively.
A. Palliative programs
B. Hospice programs
C. Rehabilitation programs
D. None of the above
3. The best known hospice in Great Britain, founded by Dr. Cicely Saunders in 1967?
A. St. Luke’s
B. St. Christopher’s
C. St. Agustin’s
D. All of the above
4. He is a noted ethicist and a theologian, In the situation of euthanasia he quoted that ―It is
harder morally to justify letting someone die a slow and ugly death, dehumanized, than it is to
justify helping him to escape from such misery.‖
A. Dr. Cicely Saunders
B. Joel Feinberg
C. Christopher White
D. Joseph Fletcher
5. Euthanasia is synonymously known as which means putting a person to death painlessly or
allowing to die, as withholding extreme medical measures a person is suffering from an incurable
disease or condition?
A. Mercy killing
B. Suicide
C. Homicide
D. Killing me softly
LESSON 19 TITLE: HEALTH CARE AND THE NEAR FUTURE
Genomics and Medical Progress
Human Genome Project
Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the
U.S. Department of Energy (DOE) and the National Institutes of Health. During the early years of
the HGP, the Wellcome Trust (U.K.) became a major partner; additional contributions came from
Japan, France, Germany, China, and others. Project goals were to
 identify all the approximately 20,500 genes in human DNA,
 determine the sequences of the 3 billion chemical base pairs that make up human DNA,
 store this information in databases,
 improve tools for data analysis,
 transfer related technologies to the private sector, and
 address the ethical, legal, and social issues (ELSI) that may arise from the project
https://web.ornl.gov/sci/techresources/Human_Genome/index.shtml

Human Genome Project

– List of chemical letters that compose map of human genome
– May change nature of health care itself
– Missing is overarching vision that provides the way forward beyond initial steps

Huntington’s Disease
• Affects men and women equally across all ethnic and racial lines
• 30,000 people in United States
• Devastating disease, without a cure
• Affects patient’s ability to think, talk, and move
• Develops between a person’s 30s and 50s
• Huntington gene has been found
• 20 percent of birth defects caused by genetic or hereditary factors
• Should we just let genetic disease continue if we have power to stop it or at least lessen its
impact?

Human Genome Project

• While human genome project was pure research, we moved forward into application
– What are we to do with this knowledge?
– Is humankind in danger of overreaching its proper boundaries?
– Can mankind be trusted to use (or not use) the knowledge in question?
• Genetic information is exceptional compared to other medical information about a patient as
genetic conditions are family problems
– Allows physician to diagnose a future ailment
– Individualize therapy at level never before possible
Genetics as Social Policy
• Eugenics
– Manipulating the genes of offspring through breeding or genetic alteration
– the selection of desired heritable characteristics in order to improve future generations, typically
in reference to humans. The term eugenics was coined in 1883 by British explorer and natural
scientist Francis Galton, who, influenced by Charles Darwin’s theory of natural selection,
advocated a system that would allow “the more suitable races or strains of blood a better chance
of prevailing speedily over the lesssuitable.”https://www.britannica.com/science/eugenics-genetics
• Negative Eugenics
– Ability to screen and prenatally test for genetic disease to eliminate genetic diseases
– defined as prohibiting marriage and breeding between “defective stock”
• Positive Eugenics
– Not only breeding but genetic intervention
– Attempts to improve gene pool by increasing the numbers of those with positive attributes
– defined as promoting the proliferation of “good stock”
• Best Course of Action
– Use genetic testing to help individuals rather than to alter genetic makeup of humanity

CHECK FOR UNDERSTANDING

1. Which of the following provides a complete list of a chemical letters that compose the map of a
human genome?
A. Eugenics project
B. Stem cell research
C. Regenerative medicine
D. Human genome project
2. Which of the following is an example of a genetic disease?
A. Huntington’s Disease
B. Cystic fibrosis
C. Down syndrome
D. All of the above
3. Whose psychologist quoted that “For almost every behavioral trait so far investigated, from
reaction time to religiosity, an important fraction of the variation among people turns out to be
associated with genetic variation.”
A. Thomas Bouchard
B. Dan Abnett
C. Dr. Fautus
D. None of the above
4. The study of methods for controlling the characteristics of future human populations through
selective breeding?
A. Human enhancement
B. Cryogenics
C. Eugenics
D. Genetic therapy
5. As discussed in this chapter, ___, The Republic, refers to the practice of infanticide for diseased
or disabled newborns.
A. Faustus’
B. Plato’s
C. Socrates’s
D. Bauchard’s

LESSON 20 TITLE: HEALTH CARE AND THE NEAR FUTURE

Genetic Engineering
What is genetic engineering?
 Genetic engineering, sometimes called genetic modification, is the process of altering the DNA?
in an organism’s genome?.
 This may mean changing one base pair? (A-T or C-G), deleting a whole region of DNA, or
introducing an additional copy of a gene?.
 It may also mean extracting DNA from another organism’s genome and combining it with the
DNA of that individual.
 Genetic engineering is used by scientists to enhance or modify the characteristics of an
individual organism.
 Genetic engineering can be applied to any organism, from a virus? to a sheep.
 For example, genetic engineering can be used to produce plants that have a higher nutritional
value or can tolerate exposure to herbicides.

How does genetic engineering work?

To help explain the process of genetic engineering we have taken the example of insulin, a protein?
that helps regulate the sugar levels in our blood.
 Normally insulin? is produced in the pancreas?, but in people with type 1 diabetes? there is a
problem with insulin production.
 People with diabetes therefore have to inject insulin to control their blood sugar levels.
 Genetic engineering has been used to produce a type of insulin, very similar to our own, from
yeast and bacteria? like E. coli?.
 This genetically modified insulin, ‘Humulin’ was licensed for human use in 1982.
The genetic engineering process
1. A small piece of circular DNA called a plasmid? is extracted from the bacteria or yeast cell.
2. A small section is then cut out of the circular plasmid by restriction enzymes, ‘molecular
scissors’.
3. The gene for human insulin is inserted into the gap in the plasmid. This plasmid is now
genetically modified.
4. The genetically modified plasmid is introduced into a new bacteria or yeast cell.
5. This cell then divides rapidly and starts making insulin.
6. To create large amounts of the cells, the genetically modified bacteria or yeast are grown in
large fermentation vessels that contain all the nutrients they need. The more the cells divide, the
more insulin is produced.
7. When fermentation is complete, the mixture is filtered to
https://www.yourgenome.org/facts/what-is-genetic-engineering (visit this page to learn more facts
about genetic engineering)
• Scientists are genetically altering organisms for various purposes
– Can we rely on scientists to take the necessary precautions to keep the organisms they create
harmless to human beings?
Genetic Testing
Genetic testing is a type of medical test that identifies changes in chromosomes, genes, or
proteins. The results of a genetic test can confirm or rule out a suspected genetic condition or help
determine a person’s chance of developing or passing on a genetic disorder. More than 1,000
genetic tests are currently in use, and more are being developed.

Several methods can be used for genetic testing:

 Molecular genetic tests (or gene tests) study single genes or short lengths of DNA to identify
variations or mutations that lead to a genetic disorder.
 Chromosomal genetic tests analyze whole chromosomes or long lengths of DNA to see if there
are large genetic changes, such as an extra copy of a chromosome, that cause a genetic condition.
 Biochemical genetic tests study the amount or activity level of proteins; abnormalities in either
can indicate changes to the DNA that result in a genetic disorder.
Genetic testing is voluntary. Because testing has benefits as well as limitations and risks, the
decision about whether to be tested is a personal and complex one. A geneticist or genetic
counselor can help by providing information about the pros and cons of the test and discussing the
social and emotional aspects of testing.
https://ghr.nlm.nih.gov/primer/testing/genetictesting (visit this page to learn more about genetic
testing)
• Gene testing for the following reasons:
– Conformational diagnosis for symptomatic individual
– Presymptomatic testing for estimating risk of developing disease
– Presymptomatic testing for predicting disease
– Prenatal diagnosis screening
• Gene testing for the following reasons:
– Newborn screening
– Preimplantation genetic diagnosis
– Carrier screening
– Forensic screening
– Paternal testing
• Assumption
– Existence is a good thing
– For some it may not be
– Testing would be preventing injury
– Can existence be an injury?
– Should policy aim at the majority, and exceptions to the rule be regarded as exceptional?
• 2008: Genetic Information Nondiscrimination Act (GINA)
– Protects individuals from genetic discrimination by health insurers and employers
https://ghr.nlm.nih.gov/primer/testing/discrimination (visit this page to learn more about genetic
discrimination)

The Role of Parents

• Virtue ethics: to make many decisions for their children, including decision of life and death (or
nonexistence) prior to conception and birth (assuming one is pro-abortion)

CHECK FOR UNDERSTANDING

1. The practice of altering DNA by splicing parts of one into another?
A. Recessive gene
B. Recombinant DNA
C. Genetic carriers
D. Genetic predisposition
2. Genetic testing is generally performed for the following reason, EXCEPT?
A. Maternal testing
B. Newborn screening
C. Carrier screening
D. Prenatal diagnosis screening
3. In 2008, this act was passed to protect individuals from genetic discrimination by health insurers
and employers.
A. HIPAA
B. EMTALA
C. GINA
D. BAIPA
4. A genetically determined susceptibility to certain health problems is called?
A. Recessive gene
B. Recombinant gene
C. Genetic carriers
D. Genetic predisposition
5. This is a disease that deforms red blood cells into thin, elongated sickle-shaped forms and
causes anemia, cough, and muscle cramps.
A. Sickle cell disease
B. Pernicious anemia
C. Down syndrome
D. Huntington disease

LESSON 21 TITLE: HEALTH CARE AND THE NEAR FUTURE

The Politics of Screening Genetic Testing
Genetic screening is really a term that's used to help us identify a smaller group of people from a
large population. And this smaller group of people really actually might have a higher risk of either
having a disease, developing that disease, or potentially having children who may have that
disease as well. So I want to differentiate genetic screening from the term "genetic testing".
Genetic testing is focused on an individual; genetic screening is really focused on a whole
population of people, trying to identify those specifically who are [at] increased risk to develop it or
to have children with a condition in question or the condition being screened for.
https://www.genome.gov/genetics-glossary/Genetic-Screening
• Genetic screening requires:
– Wisdom
– Sensitivity
– Good science
– Confidentiality
Recombinant DNA
• Scientists recombine genetic material from one organism to another for various reasons
• Not always the case people trained in the sciences are conscious of their ethical duties
• Benefits from genetic engineering too great to ignore
Genetic Pharmacy
• Pharmacogenomics
– Study of genetic variations that influence individual response to drugs
– Combines traditional pharmaceutical sciences with understanding of common DNA variations in
human genome
– One of the most productive and promising applications of genetic engineering
• Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively
new field combines pharmacology (the science of drugs) and genomics (the study of genes and
their functions) to develop effective, safe medications and doses that will be tailored to a person’s
genetic makeup.
• Many drugs that are currently available are “one size fits all,” but they don't work the same way
for everyone. It can be difficult to predict who will benefit from a medication, who will not respond
at all, and who will experience negative side effects (called adverse drug reactions). Adverse drug
reactions are a significant cause of hospitalizations and deaths in the United States. With the
knowledge gained from the Human Genome Project, researchers are learning how inherited
differences in genes affect the body’s response to medications. These genetic differences will be
used to predict whether a medication will be effective for a particular person and to help prevent
adverse drug reactions. Conditions that affect a person’s response to certain drugs include
clopidogrel resistance, warfarin sensitivity, warfarin resistance, malignant hyperthermia, Stevens-
Johnson syndrome/toxic epidermal necrolysis, and thiopurine S-methyltransferase deficiency.
• The field of pharmacogenomics is still in its infancy. Its use is currently quite limited, but new
approaches are under study in clinical trials. In the future, pharmacogenomics will allow the
development of tailored drugs to treat a wide range of health problems, including cardiovascular
disease, Alzheimer disease, cancer, HIV/AIDS, and asthma.
https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics

CHECK FOR UNDERSTANDING

1. This is the study of genetic variations that influence individual response to drugs?
A. Pharmacology
B. Pharmacist
C. Pharmacogenomics
D. Gene therapy
2. A variant form of a given gene, which may determine a trait such as having type O or type A
Blood.
A. Eugenics
B. Heterozygous
C. Genetic testing
D. Allele
3. This is one of the most productive and promising applications of genetic engineering.
A. Gene therapy
B. Genetic pharmacy
C. Genetic testing
D. All of the above
4. In recombinant DNA technology, what is the common used bacterium??
A. E. coli
B. Salmonella
C. Lactobacilli
D. Streptococcus
5. Genetic screening requires which of the following?
A. Sensitivity
B. Wisdom
C. Good science
D. All of the above

LESSON 22 TITLE: HEALTH CARE AND THE NEAR FUTURE

Gene Therapy
• Copies of normal gene injected into cell with defective or nonpresent genes
• DNA of cell induced to incorporate new gene so that cell may function properly
• When cell reproduces, it passes along the new gene rather than the original
The Genetic Causes of Behavior
• Genetic modification of behavior could pose risks
• Behavior polygenic and environmental
• Scientists investigating genetic basis of criminal behavior
• Some have suggested all behavior is mediated through genes
Cloning
Clones are organisms that are exact genetic copies. Every single bit of their DNA is identical.
Clones can happen naturally—identical twins are just one of many examples. Or they can be made
in the lab. Below, find out how natural identical twins are similar to and different from clones made
through modern cloning technologies.
How is cloning done?
Many people first heard of cloning when Dolly the Sheep showed up on the scene in 1997.
Artificial cloning technologies have been around for much longer than Dolly, though.

There are two ways to make an exact genetic copy of an organism in a lab: artificial embryo
twinning and somatic cell nuclear transfer.

1. Artificial Embryo Twinning

Artificial embryo twinning is a relatively low-tech way to make clones. As the name suggests, this
technique mimics the natural process that creates identical twins. In nature, twins form very early
in development when the embryo splits in two. Twinning happens in the first days after egg and
sperm join, while the embryo is made of just a small number of unspecialized cells. Each half of
the embryo continues dividing on its own, ultimately developing into separate, complete individuals.
Since they developed from the same fertilized egg, the resulting individuals are genetically
identical. Artificial embryo twinning uses the same approach, but it is carried out in a Petri dish
instead of inside the mother. A very early embryo is separated into individual cells, which are
allowed to divide and develop for a short time in the Petri dish. The embryos are then placed into a
surrogate mother, where they finish developing. Again, since all the embryos came from the same
fertilized egg, they are genetically identical.
2. Somatic Cell Nuclear Transfer
Somatic cell nuclear transfer (SCNT), also called nuclear transfer, uses a different approach than
artificial embryo twinning, but it produces the same result: an exact genetic copy, or clone, of an
individual. This was the method used to create Dolly the Sheep.
What does SCNT mean? Let's take it apart:
Somatic cell: A somatic cell is any cell in the body other than sperm and egg, the two types of
reproductive cells. Reproductive cells are also called germ cells. In mammals, every somatic cell
has two complete sets of chromosomes, whereas the germ cells have only one complete set.
Nuclear: The nucleus is a compartment that holds the cell's DNA. The DNA is divided into
packages called chromosomes, and it contains all the information needed to form an organism. It's
small differences in our DNA that make each of us unique.
Transfer: Moving an object from one place to another. To make Dolly, researchers isolated a
somatic cell from an adult female sheep. Next they removed the nucleus and all of its DNA from
an egg cell. Then they transferred the nucleus from the somatic cell to the egg cell. After a
couple of chemical tweaks, the egg cell, with its new nucleus, was behaving just like a freshly
fertilized egg. It developed into an embryo, which was implanted into a surrogate mother and
carried to term. (The transfer step is most often done using an electrical current to fuse the
membranes of the egg and the somatic cell.)
The lamb, Dolly, was an exact genetic replica of the adult female sheep that donated the somatic
cell. She was the first ever mammal to be cloned from an adult somatic cell.
https://learn.genetics.utah.edu/content/cloning/whatiscloning/
• Cloning of a Human Baby
– President’s Council on Bioethics
• Is in clear opposition
• Process would violate principles of the ethics of human research
• Dangerous and unsafe
• High percentage of failures
• Radically new form of human procreation
• Likely we will master genes to enable us to clone distinct body parts for transplantation
Alteration of agricultural products and animals for human benefit key part of our future

CHECK FOR UNDERSTANDING

1. When a disease is the result of a combination of genes, it is called?
A. Allele
B. Heterozygous
C. Polygenic
D. Monogenic
2. Who write the book in 2013 which entitled to Creation: How science is reinventing life itself?
A. Peter Goodfellow
B. Francis Crick
C. Bryan Appleyard
D. Adam Rutherford
3. The taking of a somatic cell from an adult animal, inserting it into an egg, and growing an
identical twin is an example of?
A. Cloning
B. Stem cell
C. Xenografting
D. All of the above
4. This is the treatment of genetic diseases by the administration of genes to correct an absent or
defective gene?
A. Genetic therapy
B. Genetic engineering
C. Genetic pharmacy
D. Genetic testing
5. The President’s Council on Bioethics holds that cloning-to-produce-children would be radically
new form of human procreation that leads to concern such as which of the following?
A. Troubled family relations
B. Prospect of a new eugenics
C. Concerns regarding manufacture
D. All of the above

LESSON 23 TITLE: HEALTH CARE AND THE NEAR FUTURE

Stem Cell Research
• Dilemma in regard to research the word embryo
• Stem cell line: family of constantly dividing cells, product of a single embryo
• Human embryonic stem cells: building blocks of life
• Human life begins with embryo, grows into fetus, then infant, then child, then adult
• Does use of human embryos as raw materials for biotechnology undermine value of all human
life?
• Benefits such great magnitude that required destruction of human embryos in the process is
permissible

Human Enhancement
• Is human enhancement, beyond that needed to restore health, acceptable therapy?
– Modifications to appearance
– Neurological enhancements
• Posthumanists
– Believe evolution is far from over
– “Cyborg” existence is not to be resisted
– Do not question ethics of contemporary uses of technology
– Technopian vision of a pain-free, unlimited, eternal humanity
• Advancements currently underway will:
– Change the quality of our lives
– Extend our lives
– Make the lives of our children healthier and longer

CHECK FOR UNDERSTANDING

1. These are immature cells that function as blank slate capable of becoming any cell in the body?
A. heterozygous
B. Recessive
C. Stem cells
D. All of the above
2. ___medicine is focused on growing specialized tissues for spinal cord injuries, diabetes, cancer,
multiple sclerosis, Parkinson’s disease, and many other currently unthought-of applications
A. Specialized
B. Regenerative
C. Human enhancement
D. None of the above
3. A speculative theory that seeks to re-conceive what is human.
A. Eugenics
B. Posthumanism
C. Human enhancement
D. Stem cell
4. An endocrinologist prescribed Human Growth Hormone to young boy who is 4 feet tall and he
grew 5 ft. and 7 inches by the age of 16. This situation is an example of?
A. Stem cell
B. Eugenics
C. Human engineering
D. Human enhancement
5. A carrier is a person who carries a defective gene that, when combined in reproduction with a
similar one from another person, may yield a genetic defect.
A. Recessive
B. Heterozygous
C. Genetic
D. Diseased