Posted: September 20th, 2022
Creating an annotated bibliography calls for the application of a variety of intellectual skills: concise exposition, succinct analysis, and informed library research.
No right is held more sacred, or is more carefully
guarded, by the common law, than the right of
every individual to the possession and control of
his own person, free from all restraint or
interference of others, unless by clear and
unquestioned authority of law.
—Union Pac. Ry. Co. v. Botsford
• Describe various historical events that have had
an impact on the resolution of ethical dilemmas.
• Describe common ethical dilemmas and the
various ethical issues that have in many
instances divided many segments of the
population. Topics include:
– Artificial insemination
• Topics include:
– Organ donations
– Research, experimentation, and clinical
– Human genetics
– Stem cell research
• Ethical dilemmas arise in situations where a
choice must be made between unpleasant
• Occur when a choice involves giving up
something good and suffering some bad.
– Should I choose life knowing an unborn child
will be born with severe disabilities?
58,000–68,000 BC: Neanderthal burial sites
(evidence of belief in an afterlife)
1932–1972: Tuskegee Study of Syphilis
1946: Military Tribunal for War Crimes
1949: International Code of Medical Ethics
1954: Guidelines on Human Experimentation
First kidney transplant
1960s: Cardiopulmonary resuscitation
1964: WHO guidelines for biomedical research
1968: Harvard Ad Hoc Committee on Brain Death
1970: Patient as a Person
1971: Kennedy Institute of Ethics established
1972: Informed consent (Canterbury v. Spence)
1973: Women’s right to abortion (Roe v. Wade)
1974: National Research Act
1975: First successful cloning of frogs
1976: Substitute judgment (Karen Ann Quinlan)
First living will legislation enacted
1978: Commission for the Study of Ethical
Problems in Medicine
1980: Hemlock Society formed to advocate for
1983: First durable power of attorney legislation
Compassion and Choices
1987: Unethical experiments on children
1990: Patient Self-Determination Act
Cruzan could have feeding tube removed
Kevorkian assists terminally ill patients in
Timothy Quill and prescription for death
Derek Humphry’s book Final Exit
Radiation experiments on unknowing
1993: Patient’s wishes honored
1994: Oregon’s Death with Dignity Act
Michigan makes physician-assisted suicide
Cloning of Dolly
Fourteenth Amendment and the terminally ill
1997: Physician-assisted suicide
Kevorkian charged with murder
Supreme Ct. rules states may enact
assisted suicide laws
1998: Oregon voters reaffirm Death with Dignity
Kevorkian administers lethal injection
Michigan voters ban physician-assisted
1999: Kevorkian convicted of second-degree
Oregon has 23 assisted-suicide deaths
2000: Seven myths about end-of life care
2001: President’s Council on Bioethics created
Oregon Assisted Suicided Act challenged
District Court judge upholds Oregon Death
with Dignity Act
Oregon assisted suicides: 129 since 1991
2002: Attorney General appeals District Ct. ruling
2003: Human gnome system fully sequence
Oregon assisted suicide cases: 42
2004: Death with Dignity Act upheld
2005: Hospital allowed to remove life support
2006: Court upholds Death with Dignity Act
Court blocks Bush attempt to punish doctors
Morning after pill
2009: Right to know end-of-life options
2010: California legislation to build organ registry
2013: Info and referral service for kidney donors
2018: Seven states have death with dignity acts
One state death with dignity by court order
The termination of pregnancy by the removal or
expulsion from the uterus of a fetus or embryo
before it is viable.
• Rights of the woman
• Rights of the fetus
• Rights of the spouse
• Rights of the state
– Protecting life
• When does life begin?
• Who decides?
• Who protects the unborn fetus?
• What are the rights of the child or woman who
has been raped?
• What are the rights of the spouse?
• Should the principles of autonomy and right to
• Should an abortion be considered murder?
– Is preventing a birth that might have otherwise
occurred a form of killing?
• What are the religious implications?
• Is an abortion for mere convenience morally
• Should a child or woman who has been raped
have a right to abortion?
• What role should education play in the woman’s
decision to undergo an abortion?
• What alternatives should the woman be
educated about (e.g., the choice of adoption)
before undergoing an abortion?
• At what age should the decision to abort be that
of the mother?
• Should the feelings of guilt that may accompany
an abortion and how those feelings may haunt
the mother through the years be explained?
• Should the feelings that might occur after giving
birth be explained to the victim of a rape (e.g.,
anger and resentment)?
• When does control over one’s body begin, and
when does it end?
U.S. Supreme Court Decisions
Woman’s Right to Privacy
Roe v. Wade (1973)
• Right to abortion
• Recognition of state role in protecting the unborn
– First trimester: Abortion decision between
woman and physician.
– Second trimester: State may reasonably
regulate abortion procedure.
– Third trimester: State may prohibit all
abortions except those deemed
protect maternal life or health.
• Abortion committee review
• Abortion counseling
• Undue burden rule
– Denial of financial assistance for elective
– Funding not required for therapeutic
– Funding bans unconstitutional in California.
– Funding discrimination prohibited in Arizona.
– Refusal to fund abortion counseling not
• Interest insufficient
– Poe v. Gerstein (1975)
– Florida’s Therapeutic Abortion Act
– Husband’s consent not necessary for abortion
• Husband’s required consent unconstitutional
– Doe v. Zimmerman (1975)
– Written consent of husband for abortion not
• Competent persons under 18 years
• Incompetent persons
• Parental notification permitted
• Emancipated minor
• Parental notification not required
• The Fifth U.S. Circuit Court of Appeals
determined that a Texas law requiring a
pregnant mother to undergo an ultrasound prior
abortion is constitutional. Although a pregnant
woman cannot be compelled to view the
ultrasound image, the physician is required to
describe what the image shows.
States May Protect Fetus
Colautti v. Franklin (1979)
• States may seek to protect a fetus that a
physician has determined could survive outside
Abortion Rights Narrowed: Webster v.
Reproductive Health Services (1989)
• Missouri statute upheld:
– Public employees and public facilities may not
be used in performing or assisting in abortions
unnecessary to save the mother’s life.
– Physicians should conduct viability tests
before performing an abortion.
Partial Birth Abortion: Women’s Med.
Prof. Corp. v. Voinovich (1998)
• Court denied certiorari for first partial birth case
to reach federal appellate courts.
• 6th Circuit Court of Appeals held statute banning
any use of D&X procedure unconstitutionally
Partial Birth Abortion Ban Struck Down:
Stenberg v. Carhart (2000)
• Supreme Court struck down Nebraska ban on
“partial birth abortion.”
• Supreme Court found it an unconstitutional
violation of Roe v. Wade.
Partial Birth Abortion Ban
• National Abortion Fed’n v. Gonzages
– Partial-Birth Abortion Ban Act was found
unconstitutional because it lacked any
exception to preserve the health of the
mother, where such exception was
Texas Restrictions on Women’s Rights
Violated U.S. Constitution
• Supreme Court reviewed Texas Ambulatory
Surgery Center requirements and found two
provisions violated the Constitution:
– A physician must have admitting privileges at
a hospital that is located no further than 30
miles from where the abortion is performed.
– Minimum standards for an abortion facility
must be equivalent to the minimum
standards adopted under for ambulatory
• 24-hour waiting period not burdensome.
• Abortions after 20 weeks prohibited.
– Exception if the mother’s life is in jeopardy.
– No exceptions for rape or incest.
– Physicians who perform illegal abortions can
face a $10,000 fine and up to 3 years in
• The obligation of society is to define the liberties
of all and not to mandate one’s own moral code.
• The courthouse is not the proper forum to
address abortion issues that have no legal
• Conflicting beliefs.
• Matters of philosophy, ethics, theology.
• Sterilization: Termination of the ability to produce
– Elective: Voluntary sterilization.
– Therapeutic: Performed to preserve life or
– Eugenic: Involuntary sterilization.
• Described in statutes
• Mentally deficient
The improper performance of sterilization can
result in lawsuits based on such theories as
wrongful birth, wrongful life, and wrongful
A claim that but for a breach of duty by the
defendant(s) (e.g., improper sterilization), the child
would not have been born.
Wrongful life claims are initiated by the parent(s) or
child based on harm suffered as a result of being
• A claim by parents of unexpected child based on
allegation that conception resulted from a
– Negligent sterilization procedure
– Defective contraceptive device
• Injection of seminal fluid into a woman to induce
• Homologous artificial insemination
– Semen of spouse used to impregnate
• Heterologous artificial insemination
– Semen from donor other than husband
• Method of reproduction whereby a woman
agrees to give birth to a child for another party.
• Surrogate may be
– Child’s genetic mother
– Gestational carrier
• Legal right to enter a surrogacy contract
• Parental rights of the commissioning couple
• Long-term effects of surrogacy contracts
• Psychological impact on child
• Federal regulations require:
– Protocols regarding an organization’s organ
– Specific notification duties
– Requirements informing families of potential
– Sensitivity in dealing with families
– Educating hospital staff on organ donation
– Timely donation and transplantation
• Uniform Anatomical Gift Act adopted in 50
• Provisions for making available, acceptance,
and use of anatomic gifts.
• Who lives? Who dies? Who decides?
• Failure to obtain consent.
• Altruism vs. sale of organs.
and Clinical Trials (1 of 2)
• Ethical principles
– Respect for person
• Hippocratic Oath: Physicians act to benefit
and Clinical Trials (2 of 2)
• Right to try experimental drugs
• Office of Research Integrity
• Food and Drug Administration
• Institutional review board
• Informed consent
• Experimental subject’s Bill of Rights
• Patient responsibilities
• The Cures Act
• Each person to be treated equally.
• How should each person be treated?
– According to need?
– According to value to society (societal
– According to merit?
Nuremberg Code and
Declaration of Helsinki
• International code of ethics that governs human
• Result of Nazi medical atrocities.
• Requires human subjects be fully informed.
• The federal government controls experiments
– Medical devices
– Medical procedures
• Organization must provide for:
– Education in ethical decision-making
– Nurse participation in ethical decision-making
– Ongoing monitoring of approved protocols
• Federal regulations require a hospital-based
institutional review board (IRB).
• IRB functions:
– Review proposed research studies.
– Approve protocols for research.
– Conduct research oversight.
• Organization must:
– Disclose risks, benefits, and treatment
– Determine competency of patient consent.
– Obtain written consent from patient.
• Organization must:
– Disclose treatment costs.
– Educate staff on
• Potential side effects of treatments.
• Implementation of protocols.
• Monitoring of protocols.
• The study of inheritance as it occurs in human
beings. It includes:
– Stem cell research
– Clinical genetics
• Genetic disease markers
– Molecular genetics
Nondiscrimination Act (1 of 2)
• Law prohibits discrimination on basis of genetic
information with respect to the availability of
health insurance and employment.
• Prohibits group health plans and insurers from
denying coverage to a healthy individual based
on genetic predisposition to develop a specific
Nondiscrimination Act (2 of 2)
• Prohibits employers from using genetic
information when making hiring, firing, job
placement, or promotion decisions.
• A genetic marker is a gene or DNA sequence
that has a known location on a chromosome and
can be associated with a particular gene or trait.
• Genetic markers can identify certain diseases.
• Use of embryonic stem cells to create organs
and various body tissues.
• Highly controversial issue generally involving
• Fears as to how far scientists might go in their
attempts to create.
• Deadliest epidemic in human history.
• First case appeared in literature in 1981.
• More than 21 million people have died from
• Is caused by human immunodeficiency virus
• HIV is highly contagious bloodborne virus.
• Destroys body’s capacity to ward off bacteria.
• Body fluids
– Vaginal secretions
– Breast milk
• Blood transfusions
• AIDS and Healthcare workers
Confidentiality: Disclosure of
Physician’s HIV Status
A physician cut his hand with a scalpel while he
was assisting another physician. Because of the
uncertainty that blood had been transferred from
Doe’s hand wound to the patient through an open
surgical incision, he agreed to have a blood test for
HIV. His blood tested positive for HIV and he
withdrew himself from participation in further
• Discuss the ethical and legal issues.
• Physician’s right to privacy versus patient’s right
– Advocates the greatest good for the greatest
– A person who has moral integrity and a strict
regard for doing the right thing
Failure to notify the patients at risk could result
in the spread of the HIV virus to other
noninfected individuals through sexual contact
and through exposure to other body fluids. Doe’s
name was not revealed to the patients, only the
fact that a resident physician who participated in
their care had tested HIV-positive. “No principle
is more deeply embedded in the law than that
expressed in the maxim Salus populi suprema
lex . . . (the welfare of the people is the supreme
• Provide educational materials for patients and
• Universal protocols.
• Strictly adhere to handwashing protocols.
• Safely handle all body fluids.
– Adhere to OSHA requirements.
1. Discuss under what circumstances ethical
2. Discuss the controversy over the Supreme
Court decision in Roe v. Wade.
3. What ethical principles surround the abortion
issue? Discuss these principles.
4. Do you agree that individual states should be
able to impose reasonable restrictions or
waiting periods on women seeking abortions?
Who should determine what is reasonable?
5. Should a married woman be allowed to abort
without her husband’s consent?
6. Discuss the arguments for and against partial
7. Why is the medical issue of abortion an
example of legislating morality?
8. What is artificial insemination? What questions
should be asked when considering artificial
9. Discuss the importance of organ donations.
10.Describe the ethical considerations that should
be addressed before conducting research on
11.Why is it important that written consent be
obtained from each patient who participates in
a clinical trial?
12.What is sterilization, as discussed in this
chapter? Do you agree that eugenic
sterilization should be allowed? Explain your
13.Describe the distinctions among wrongful birth,
wrongful life, and wrongful conception.
14.Discuss the moral dilemmas of these concepts.
15.Describe the controversy over surrogacy.
16.Discuss why there is controversy over genetic
markers and stem cell research.
17.What is AIDS, and how is it spread?
18.Discuss the controversy that can occur when
considering a patient’s right to know whether a
caregiver has AIDS and the caregiver’s right to
privacy and confidentiality.
Learning Objectives (1 of 2)
Learning Objectives (2 of 2)
Noteworthy Historical Events (1 of 11)
Noteworthy Historical Events (2 of 11)
Noteworthy Historical Events (4 of 11)
Noteworthy Historical Events (5 of 11)
Noteworthy Historical Events (6 of 11)
Noteworthy Historical Events (7 of 11)
Noteworthy Historical Events (8 of 11)
Noteworthy Historical Events (9 of 11)
Noteworthy Historical Events (10 of 11)
Noteworthy Historical Events (11 of 11)
Abortion: Ethical and Legal Issues (1 of 6)
Abortion: Ethical and Legal Issues (2 of 6)
Abortion: Ethical and Legal Issues (3 of 6)
Abortion: Ethical and Legal Issues (4 of 6)
Abortion: Ethical and Legal Issues (5 of 6)
Abortion: Ethical and Legal Issues (6 of 6)
Abortion Restrictions Struck Down
Abortion: Funding Issues
Abortion: Spousal Consent
Abortion: Parental Consent
Abortion: Informed Consent
State Abortion Statutes: South Carolina
Abortion: Law and Morality
Artificial Insemination (1 of 2)
Artificial Insemination (2 of 2)
Surrogacy: Ethical and Legal Issues
Organ Donations (1 of 2)
Organ Donations (2 of 2)
Conducting Clinical Trials
Institutional Review Board
Informed Consent (1 of 2)
Informed Consent (2 of 2)
Stem Cell Research
Spread of AIDS
Confidentiality: Ethical Issues
Confidentiality: Legal Decision
Review Questions (1 of 5)
Review Questions (2 of 5)
Review Questions (3 of 5)
Review Questions (4 of 5)
Review Questions (5 of 5)
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