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HCE Lesson 9 - Bioethics and Its Application in Various Health Care Situations
Theoretical foundation of nursing (TFN1)
Riverside College
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Bioethics and Its Application in Various Health Care Situations - Nurses should be knowledgeable about the rapidly changing field of biological, reproductive and genetic breakthroughs so to be able to engage in informed discussions with the patient. - Ethics involves determining what is good, right and fair. Ethical issues arise every day in healthcare and everyone has a role to play in ensuring the ethical delivery of care. Health care givers, particularly midwives, perinatal and neonatal nurses, face ethical issues possibly because of their interactions with patients and clients in the reproductive age groups. - Nursing is a process that involves judgment and action with the aim of maintaining, promoting and restoring balance in human system. The need for judgment and action brought about the moral questions of right or wrong of duty. The end purpose of nursing is the welfare of other human beings.
Sexuality and Human Reproduction 1. Issues On Contraception, Its Morality And Ethico -Moral Responsibility Of Nurses 2. Morality Of Abortion And Other Problem Related To Destruction Of Life 3. Issues On Artificial Reproduction And Its Ethico -Moral Responsibility Of Nurses
Sexuality - the quality or state of being sexual: ➢ the condition of having sex ➢ sexual activity ➢ expression of sexual receptivity or interest especially when excessive - According to definition of Merriam Webster: ➢ Sexuality may be understood or misunderstood, esteemed or degraded, treated respectfully or abused. ➢ The word sex denotes whether a person is male or female or sex difference. But sexuality is related to sexual behaviour, gender consciousness, and sexual nature. ➢ Sexuality: The characteristic quality of the male and female reproductive elements. ➢ Knowing we are made in the image and likeness of God is the basis for our RESPECT of ourselves and others. Positive attitude toward sexuality begins with positive attitudes towards ourselves and others.
Two Views of Sex - Traditional ➢ Sex is only for procreation.
➢ The traditional view says that sex is only for procreation and that it should only be for a man and a woman, sex outside marriage is wrong. Sex should be considered as an expression of love and commitment. ➢ Example: A married woman named Anna has an impotent husband, and Anna also has sex with her workmate Mark in her office. According to the traditional view, this is wrong. Anna is married and should only be having sex with her husband, Francis and also since her husband is impotent, then Anna should not have sex anymore. They can't make a baby so that means they shouldn't have sex anymore. That's the traditional view.
- Liberal ➢ Sex is like any other act. ➢ The liberal view says that sex is like any other act. There are some things that need to be checked before a sexual encounter can be considered moral. Is it honest? Are both parties aware of what the other person wants? Is it consensual? Is it non- exploitive? If those are present, then having sex is moral. ➢ Sexual liberty has to do with being willing to respect the different sexual behaviors of people. ➢ Sexually liberal people respect other people's sexual choices while being free to make their own. This includes the choice of wanting a partner that shares same sexual values or one who places same significance on sexual compatibility in a relationship, high or low. ➢ Example: the liberal point of view says that Anna should check if it's honest (does mark know she has a husband? does her husband know she is having sex with mark?), is it consensual? (Both of them agree to it. Is it okay with her husband?) Is it not exploitive? (Check if Anna is the boss of Mark and somehow Mark is feeling forced to have sex with her because she is his boss). So if those three factors are checked, then the liberal view says that Anna and Mark's sexual encounter is morally okay.
- Mixed ➢ Now, then we also have a mixed point of view. A mix between traditional and liberal. This point of view basically rejects the sex is bad tradition and emphasizes honestly respect, and commitment. It also has a balance between privacy and social
responsibility. This view recognizes commitment as a core value of sexual maturity.
Human Reproduction - Humans reproduce sexually by the uniting of the female and male sex cells. Although the reproductive systems of the male and female are different, they are structured to function together to achieve internal fertilization. - According to Encyclopedia: ➢ Human reproduction is essential for the continuance of the human species. ➢ In order for us to understand more of the biology of human sexuality, we should remember the anatomical parts and related functions of our reproductive system which we have learned in our Anatomy and physiology subject ➢ The male and female reproductive organs work together to produce offspring. ➢ It is not reproduction that ultimately has value, but rather control over reproduction: "control over whether one reproduces or not is central to personal identity, to dignity, and to the meaning of one's life"
Reproduction - Process by which living beings transmit their genes and give birth to a new generation of living beings. ➢ The female reproductive organs contribute to sustaining the growth of embryos and fetuses. ➢ Both sexes have reproductive organs called genitals or genitalia designed for the purpose of intercourse and conception. - The male and female reproductive organs work together to produce offspring. - The responsibility of sex demands a lifetime commitment Sexuality and Human Reproduction 1. Issues On Contraception, Its Morality And Ethico -Moral Responsibility Of Nurses 2. Morality Of Abortion And Other Problem Related To Destruction Of Life 3. Issues On Artificial Reproduction And Its Ethico -Moral Responsibility Of Nurses Issues on Contraception, Its Morality and Ethico -Moral Responsibility of Nurses - "birth control" "fertility control“ - The deliberate use of artificial methods and other techniques to prevent pregnancy as a consequence of sexual intercourse. - How does a woman get pregnant? A woman will get pregnant if a man's sperm reaches one of her egg cells. Contraception prevents
this from happening. It keeps the sperm and the egg apart, it stops egg production, and it stops the combined sperm and fertilized egg from attaching to the lining of the womb (This type of contraceptive is sometimes called as your 'Plan B' or 'Morning-After-Pill').
- Although preventing pregnancy is the main purpose of contraception, some types of contraception can also protect a person's sexual health from STDs.
- Contraception, is by the nature of its very word- “against life.” A person wills that a life not exist, or come into existence. It separates the procreative and unitive meanings of the conjugal act; it destroys the union of life and love, the very essence of our existence and created being.
- The use of contraception is completely different morally and practically from that of Natural family Planning (NFP).
- Cultures and religions support various values that influence individual’s decisions. Contraception
- Contraception occurs by either preventing the fertilization of an ovum (egg) by the sperm cell, or the prevention of implantation of the embryo (fertilized egg) into the lining of the uterus.
- Not all couples who have sexual intercourse want to have a baby. They might choose to use methods of contraception (birth control).
- Use effective birth control correctly and consistently. Birth control failure rates are directly related to the degree of human error possible with each method.
Different Types of Contraception - Male and Female Condoms - Contraceptive Diaphragm/CAP ➢ Inserted in the vagina before sex. Best used with a spermicide (or a gel that kills sperms). Have to stay in the vagina of a woman for 6 hours or more after coitus. - COMBINED PILL ➢ "The pill". It contains artificial female hormones estrogen and progesterone. Stops the release of egg. - CONTRACEPTIVE IMPLANT ➢ Placed under your skin by a doctor or a nurse. Lasts for 3 yrs. Releases progesterone into your blood stream to prevent pregnancy - CONTRACEPTIVE INJECTION ➢ (Depo-Provera, Sayana Press, Noristerat) Releases progesterone into your blood stream to prevent pregnancy. 13 weeks/3 months. - INTRAUTERINE DEVICE (IUD) ➢ T-shaped plastic and copper device that's put into your womb by doctor or
- PRO - That's a religious idea. Humans interfere with the natural order all the time example is when doctors cure illnesses. Some results are good some are bad. So look at the consequences of contraception to decide whether it is good or bad.
CONTRACEPTION IS ANTI-LIFE
- ANTIS - "life is a good thing"; those who use contraception are anti-life because they intend to prevent a new life from coming into being. BAD INTENTION. It is always morally wrong to do something with a bad intention.
- PRO - Human rights come in here. The right to decide.
CONTRACEPTION IS A FORM OF ABORTION
- ANTIS - some contraception prevent the implantation of a fertilised egg, thus this equals to abortion. Abortion is wrong then these forms of contraception are wrong.
Ethico-Moral Responsibility of Nurses in Contraception - Primary Concern ➢ Welfare of the patient and respecting the autonomy of the patient. - Secondary Concern ➢ Make sure the patient gets all the information and advice that they need to be able to choose wisely. - Patient needs to know: reliability of the method, ease of use of the method, potential side effects, and health risks. Help the patient weigh the advantages and disadvantages. Usually the doctor does this but if the patient will ask you, you also have to know. - What if I have my own personal views about contraception? What if I don't agree with it? You have two options, you can inform the patient about your views (that you don't agree with it) and advise them to ask someone else, or you can disregard your views and just give the patient the UNBIASED information that he or she is asking for. It is unethical for a practitioner to give medical advice influenced by a non- medical factor without disclosing this to the patient. - Health care practitioners should respect also the confidentiality of a patient. The problem here is when teenagers ask for contraceptive help and make it clear that they do not want their parents to know about it. What to do? Encourage the minors to inform their parents and explore the reasons the patient does not want to do so.
Morality of Abortion and Other Problem Related to Destruction of Life - Abortion ➢ Traditionally defined as the expulsion or removal of a nonviable fetus. - The most controversial ethico-moral issues we must consider is the issue on abortion. - That is, a fetus that cannot live outside the uterus at that time. The definition is relative because the viability of a fetus depends on where and when the expulsion occurs. - Some describe this as a conflict between innocent life and selfishness, while others view it as a conflict between a person’s right and ability to control her body and the surrender of that control to others. - The health habits of the mother during pregnancy can have a dramatic effect on the health of the child. Is the mother obligated to alter her behavior to maximize the health of her fetus? For example, should she not smoke, not drink alcoholic beverages, obtain prenatal care, and maintain emotional calm? If she does not, should the health care profession or the society intervene for the sake of the fetus? - In biology, the term fetus is applied at the beginning of the ninth week of pregnancy, well into the second trimester. This name change, however, is not of moral significance, and even expulsions early in the first trimester are still referred to as abortions. There is debate as to when the human conceptus (fertilized egg) is to be considered a fetus in a moral sense and not merely in a biological sense. Only after we have determined the moral status of the fetus will we be able to say whether the expulsion of the conceptus, the embryo, or the biological fetus is ethically significant. - Based on 2008 data, WHO estimates that there are approximately 22 million unsafe abortions annually, resulting in 47 000 deaths and 5 million complications resulting in hospital admission. Nearly all unsafe abortions (98%) occurred in low- and middle- income countries. One of the factors driving unsafe abortion is the lack of safe abortion services, even where they are legal.
Two Principal Moral Considerations - Moral Status of the Fetus ➢ Is the fetus a person? At what stage in its development does it becomes a person? Conception? 1st trimester? Birth? ➢ The central issue is whether the fetus is a person or not. ➢ The term ‘fetus’ is generally used after the first eight weeks of human development following conception. Believers in the Bible as God’s word
support absolute respect for the human fetus, while most contemporary secular philosophers hold that a human fetus has no right to life and is not a person. This chapter explores these two positions and argues that the human fetus is a person.
- Rights of the Pregnant Woman ➢ Does the pregnant woman have the right to decide if she is going to carry the baby to term or not?
Ensuring comprehensive legal grounds for abortion - When there is a threat to the woman’s life. ➢ Almost all countries (95%) allow abortion to be performed to save the life of the pregnant woman. This is consistent with the human right to life, which requires protection by law, including when pregnancy is life- threatening or the pregnant woman’s life is otherwise endangered. Even where protecting a woman’s life is the only allowable reason for abortion, it is essential that there are trained providers of abortion services, that services are available and known, and that treatment for complications of unsafe abortion is widely available. Saving a woman’s life might be necessary at any point in the pregnancy and, when required, abortion should be undertaken as promptly as possible to minimize risks to a woman’s health. - When there is a threat to the woman’s health. ➢ Sixty-seven per cent of countries allow women to seek abortion to preserve their physical health and 64% to preserve their mental health. Since all countries that are members of WHO accept its constitutional description of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, this is implied in the interpretation of laws that allow abortion to protect women’s health. - When pregnancy is the result of rape or incest. ➢ The protection of women from cruel, inhuman and degrading treatment requires that those who have become pregnant as the result of coerced or forced sexual acts can lawfully access safe abortion services. Others require forensic evidence of sexual penetration or a police investigation to confirm that
intercourse was involuntary or exploitative. Either situation can lead women to resort to clandestine, unsafe services to terminate their pregnancy.
- When there is fetal impairment. ➢ Several countries specify the kinds of impairment, such as those considered to be incompatible with life or independent life, while others provide lists of impairments. In some countries, no reference is made in the law to fetal impairment; rather, health protection or social reasons are interpreted to include distress of the pregnant woman caused by the diagnosis of fetal impairment. Prenatal tests and other medical diagnostic services cannot legally be refused because the woman may decide to terminate her pregnancy. A woman is entitled to know the status of her pregnancy and to act on this information.
- For economic and social reasons. ➢ In countries that permit abortion for economic and social reasons, the legal grounds are interpreted by reference to whether continued pregnancy would affect the actual or foreseeable circumstances of the woman, including her achievement of the highest attainable standard of health.
- On request. ➢ Allowing abortion on request has emerged as countries have recognized that women seek abortions on one – and often more than one – of the above grounds, and they accept all of these as legitimate, without requiring a specific reason. This legal ground recognizes the conditions for a woman’s free choice and that the ultimate decision on whether to continue or terminate her pregnancy belongs to the woman alone.
Guiding Principles For Health Care Workers In Abortion - Provide Information ➢ It is a necessary component of any medical care and should always be provided to individuals considering abortion. At a minimum, this should include (6): the available options for abortion methods and pain management; what will be done before, during and after the procedure, including any tests that may be performed; what they are likely to experience (e. pain and
➢ Endometriosis - tissues similar to the lining of the uterus grows in other places in the body outside the womb. Symptoms: abdominal pain, heavy periods, infertility.
MORAL ISSUE ON Artificial Insemination - Human procreation dissociated from sexual partners ➢ The naturally devised means of transmitting life is no other than the marital act. Now, by AI, the said act is deliberately excluded from procreation and replaced with a medical means, that is, the insertion of a thin and soft catheter containing sperm into the wife’s reproductive tract – a procedure enormously contrary to nature. - Not therapeutic; does not cure infertility or reserve infertility - Women alone can chose to have a child even without a husband or a boyfriend. All they need is a sperm donor. In a situation like this, it is said to create a paradox on the right to reproduction since it is supposed to be a couple decision. People question the welfare of the child in this situation also. The child has the right to have a mother AND a father. Should the identity of the sperm donor be revealed? What information will be given to the child in the future? - If the sperm donor dies, they usually have a sperm bank for this, those who want to donate their sperm can go there. Usually if you donate a sperm then you can get paid. Not sure how much it is. So if the sperm donor dies, is it still ethical to use his sperm that is in the bank. Sperm donor must leave a written consent for the use of his sperm after his death. Some counter this the child will lose his inheritance rights. - The use of a donor in Artificial Insemination introduces a new genetic material to the family, which is foreign to the couple. There is a great chance that, in this same sperm bank, will be used to multiple inseminations, therefore those children will be half-brothers. What if those kids get married not knowing about that? - What are the criteria for choosing a donor? What will be his relation to the unborn child? Should the husband or partner give a formal consent that the woman will be inseminated with donor semen?
Types of Artificial Insemination - Homologous ➢ Artificial Insemination Homologous ➢ Husband’s sperm is used ➢ It generally involves masturbation on the part of the man
- Heterologous ➢ Artificial Insemination Donor ➢ A donor’s sperm is used ➢ It seems to involve adultery, since the woman and the donor are having a sort of intercourse without being married to one another.
Ethico-Moral Responsibility of Nurse in Artificial Insemination - Informed consent ➢ The physician or advanced practice nurse is responsible for informing the client about the procedure and obtaining consent by providing a detailed description of the procedure or treatment, its potential risks and benefits, and alternative methods available. - Assesses the couple's emotional status relative to infertility. - Counsels and informs about the side effects of the procedure. ➢ S/E: Nausea, vomiting, ovarian enlargement, occurance of ovarian cysts - Describes the legal ramifications of the procedure. ➢ The laws on the subject frequently provide that the children of the insemination can be told the identity of the donor when they reach age 18. - Assists in interviewing donors for the program. ➢ Thorough medical histories must be taken of all candidates for anonymous semen donation. All potential donors must also be screened for infectious or inheritable diseases which could adversely affect the recipient or the resultant child. Frozen semen should be used for artificial insemination because it enables the donor to be tested for communicable disease agents and diseases at the time of donation, and again after an interval before the original semen is used, thus increasing the likelihood that the semen is free of blood-borne pathogens.
In-Virto Fertilization (IVF) - Process of fertilization where an egg is combined with sperm outside the body. - Infertility and to prevent genetic problems and assist with the conception of a child; advanced age of a woman; damaged of blocked fallopian tubes. Antibody problem that harms eggs and sperms. Genetic disease of mother and father. Mature eggs are collected from ovaries and fertilized by sperm in a lab.
In the Philippines, this is usually 200,000 to 400,000 pesos.
One of the main problems in IVF are about the left over embryos. For the clinic to store the frozen embryos, the couple have to pay a fee. There are couples who do not know what to do about the left over embryos that they just stop paying. For ethical and legal reasons, most clinics are reluctant to throw away the embryos without the consent of the couple.
Homologous IVF ➢ Involves the gametes from both spouses; no third party is involved.
Heterologous IVF ➢ Involves the gametes of a donor (a third party supplies necessary gametes).
Surrogate Motherhood - Practice in which a woman (the surrogate mother) bears a child for a couple unable to produce children in the usual way, usually because the wife is infertile or otherwise unable to undergo pregnancy. - Surrogacy is one of the most controversial methods of parenthood and infertility treatment in which a surrogate carries a fetus for another woman. - Surrogacy is an arrangement where a surrogate mother bears and delivers a child for another couple or person. - Surrogate ➢ A woman who becomes pregnant, carries, and delivers a child on behalf of another couple. - FULL surrogacy ➢ gestating woman has NO genetic link to the child - PARTIAL surrogacy ➢ Gestating woman has a genetic link by providing the oocyte. - In practice, the surrogate mother has her health care expenses covered and is paid a fee.
Compensated Surrogacy - Also variously called "Commercial surrogacy", "paid surrogacy", "wombs for rent", "outsourced pregnancies" or "baby farms" - It refers to a form of surrogate pregnancy in which a gestational carrier is paid to carry a child to maturity in her womb and is usually resorted to by well off infertile couples who can afford the cost involved. - This procedure is legal in several countries including in India where due to excellent medical infrastructure, high international demand and ready availability of poor surrogates it is reaching industry proportions.
Surrogate Motherhood - The rights of the children produced. ➢ Both parties involved should have voluntarily accepted certain restrictions on their autonomy. They cannot change their minds after the start of pregnancy or if they had already implanted the embryo. In cases of divorce, the agreement still stands and the commissioning parents will still be the parents. It is only in the case that the commissioning parents die before the birth of the child will the surrogate have a chance to keep the child or give it up for adoption. There are a lot of cases, that when the time has come for the surrogate mom to give birth, she wants to keep the baby. ➢ Does the child have the right to know who his or her biological parents are? Especially if this child is only through PARTIAL surrogacy. What if it's the sperm that was donated, and then implanted to the surrogate mother's uterus? Does this child have the right to know who his or her half-siblings are? The other children who the donated sperm was used on. - The ethical and practical ramifications of the further commodification of women's bodies. ➢ The surrogate mother is expected to behave as a responsible woman (adopt a healthy lifestyle, etc) and to confirm with the agreement of the commissioning parents to testing and prenatal screening. It is included here a possibility of terminating the pregnancy in case there is a severe malformation on the fetus. ➢ Using a woman's body as some kind of "womb-renting". It takes away the specialness of pregnancy. - The exploitation of poor and low income women desperate for money. ➢ There are several arguments that are surrounding this area in surrogacy. Those who are opposed to surrogacy say that paying someone to carry a baby for you is an insult to human dignity, it is an instrumentalization of the human body, potential exploitation of vulnerable women and inappropriate inducement/coercion of women. ➢ Most of those who agree to be surrogate mothers are in desperate need of money especially here in the Philippines, there are a number of women who have also agreed to this. - The moral and ethical consequences of transforming a normal biological function of a woman's body into a commercial transaction.
HCE Lesson 9 - Bioethics and Its Application in Various Health Care Situations
Course: Theoretical foundation of nursing (TFN1)
University: Riverside College
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