Question

 

Choose an ethical issue listed below associated with the practice of nursing. You will identify pros and cons that, when analyzed, will allow you form a defensible position related to the issue. Principles from identified codes of ethics should be examined about the issue and position. Your original discussion response and those of your peers must be in APA format.

You will address the following:

Define the scope of the ethical issue.

Examine the scope of the issue as it relates to nursing and principles identified in codes of ethics.

Identify at least two positions taken on this issue by scholarly experts in the ethics discipline.

Explore the future of the issue as it relates to nursing practice.

Possible topics to choose from:

                In vitro fertilization

                Surrogate mothers

                Donor eggs for profit

                Selecting sex of offspring

                Uses for extra embryos from in vitro fertilization

                Condom distribution in high schools

                Elective abortion

                Use of monies to fund abortion for the indigent

                Abortion without parental consent for adolescents

                Transplantation of fetal tissue

                Mandatory HIV testing for all pregnant women

                Child abuse charges for knowingly exposing fetus to harmful substances such as tobacco, alcohol, drugs and

environmental teratogens

Answer 1

Nursing Ethical Issue in Patient Care:

Ethically speaking, ‘what should be done’ in an individual, patient-care situation is at the heart of many practice dilemmas nurses face on a regular basis. Consider, for example, the nurse who has received a discharge order for a homeless patient hospitalized for pneumonia. The nurse knows the patient needs further care that will not likely be delivered ‘at home.’ The nurse also knows the bottom financial line is that the patient has ‘used up’ the days allotted for the medical condition and discharge is imminent. This example illustrates the dilemma related to the ethical issue of the distribution of scant resources that occurs frequently within health care arenas. The ethical principle of justice guides the fair and equal treatment of all people; yet, the nurse wrestles with the consequences of limited organizational and societal financial resources.

Vitro Fertilization:

Clinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but raise ethical and other concerns regarding respect for donors as individuals (e.g., adequacy of informed consent), potential harms, justice (e.g., concerns about possible eugenics – by encouraging and facilitating selection and marketing of facts for offspring), and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies’ medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors’ prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors’ personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial.

Looking at Komal’s case, we might wonder that there are no reliable means to predict whether the use of ARTs will be successful and how many attempts will be necessary. The complexity of these procedures thus makes it difficult for women to evaluate whether a specific ART treatment that is offered to them is really necessary or appropriate. This is particularly the case early into their treatment. Priti is a 45 year old working woman. She was inconsolable during the interview. She has not been able to conceive for a long time. According to medical reports, her husband's vas deferens is blocked. The doctors suggested an IVF for her with donor sperm and donor eggs, since she does not have “quality eggs” because she is too “aged” to produce good ones. Three IVF treatment cycles have failed. While talking, she was in tears and said

surrogate mother:

If ever a woman should decide to become a surrogate, a word of caution, do not go into this endeavor blindly. All of the ramifications should be taken into consideration.

What groups of people mostly consent to becoming a surrogate? Statistically, mostly educated women with 13 or more years of education. It was not primarily a money factor that led them to make the decision. Mostly these women are employed and are not undergoing financial difficulties. They are predominately Catholic or Protestants.

The women want the intending family to enjoy the special love of a child and the wholesome gratification of their own child(ren). The surrogate is empathetically driven to share what they have, and relieve some of the social stigma of not being able to produce a child.

Some stresses associated with being a surrogate are: insemination (over several months), pain, unpleasant side effects, depression, sleep disturbance, guilt difficulty remaining unattached, intrusive or aloof couples, relinquishing, etc. It takes a special person to become a surrogate. If you cannot adhere to the demands no matter how much a person may wish to help out

you are a surrogate mother; you are having second thoughts and have decided not to give your baby away because you have genetic ties. The genetic ties involve the surrogate furnishing the egg to be fertilized with the sperm from the infertile couple. The infertile couple is pressuring the surrogate to give the child up because the surrogate agreed to. The infertile couple has the law on their side because a contract was signed.

____Have the class count off in 3’s (surrogate and infertile couple)

____5-10 minute skits

____5 minutes over all prep time

Donor eggs for Profit:

Clinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but raise ethical and other concerns regarding respect for donors as individuals (e.g., adequacy of informed consent), potential harms, justice (e.g., concerns about possible eugenics – by encouraging and facilitating selection and marketing of facts for offspring), and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies’ medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors’ prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors’ personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial.

Select sex of offspring:

Since last fifty years, consideration of ethics in research has become an important issue. Most of the discoveries which have caused major and significant improvement in medical sciences were a result of fully authorized research without consideration of ethical issues. Ethics should be cornerstone of every research and specified rules were regulated for protection of humans in biochemical and behavioral researches. Genetic research has largely improved since past two decades, but ethical issues in this research field are of a great importance in appliance of these researches in diagnosis and treatment of genetic disorders. Ethical issues are always considered in sex selection and preference and prenatal genetic diagnostic techniques rearranging spermatozoa are always considered. In fact selecting the gender of a child before birth is controversial, because as it is pointed out in human rights, racial preference is strongly prohibited, so can be gender preference considered an approved decision, as it is in favor of a gender over another, while diminishing the opposite sex's value in society. Sex selection and gender preference is considered a sexual discrimination and prejudice, and one of its unwanted effects is gender imbalance. In some Asian countries this imbalance is in favor of male gender, and this issue is seldom seen in western European and North American countries. Sex selection is often discussed seriously and always a question arises that whether use of modern technologies in fertility for selecting the gender of future child is ethical or not? Those who believe in this issue, usually consider this issue as disobedience of God, and therefore interfering in natural process of reproduction.

Extra Embryos

By the time she was in her 40s, Andrea Cinnamond was afraid she'd never be a mother. Then came the day in 2005 her daughter was born through in vitro fertilization, followed two years later by twin sons. Today, Kaitlin, Jack, and Aidan bounce around like Ping-Pong balls through their Boston, Massachusetts, home.

Cinnamond, now 49, and her husband are grateful for their healthy children and the medical science that helped create them. Yet she's haunted by the three embryos that were left over.

Like many women struggling with infertility, Cinnamond was delighted when a laboratory took sperm and egg and provided five chances for a second child after Kaitlin's birth. In many ways, infertility is a numbers game -- more embryos created means more tries for success. She was asked in the beginning about the matter of surplus embryos, but how could she think about those she might not want when her thoughts were consumed by the children she longed for Profit:

When the time came to decide about the extras, she says, "I thought I was going to be calm and casual." And she was, until the first bill arrived to keep the embryos frozen. "I was petrified," she says. "There was no practical reason to keep them. I just wasn't ready to make the decision not to keep them." She paid the $600, hoping that her thoughts would crystallize as time passed. This year, she's paying the bill again.

Michelle DeCrane of Austin, Texas, has also been paying for embryo storage for two years. She has a 2-year-old daughter -- and six frozen embryos. "I would love to have another baby, if I were younger -- I'm 40 -- and if money was not an object." She finds herself trapped in a mental loop; while she doesn't have the same mind-blowing love for the embryos as she has for her daughter, neither does she consider them anonymous laboratory tissue. And there's another wrinkle: One of the six embryos is biologically hers and her husband's;

Distrubtion condoms in High school:

The ethical frameworks that relates to the ethical dilemma of distributing contraceptives to minors are the common good approach and the rights approach. The Common Good approach considers all people as part of one community. We share “certain general conditions that are… equally to everyone’s advantage (Velasquez).” In order for the community to thrive, certain conditions need to be sustained and protected so that the welfare of all people in the community are stable. These certain conditions can include: affordable health care, a just legal system, and having good schools. In terms of the ethical issue, the public schools’ intentions are pure and good. They believe that educating their students and also providing the protection such as condoms, if they did decide to have sex is always available for them. They also believe that minors’ have the right to consent to their own medical and health care situations without necessarily the consent of the parent.

The Rights approach are rights that are morally “justified by moral standards that most people acknowledge, but which are not necessarily codified in law (Velasquez).” Some rights are be both positive and negative that are based on solely because we are humans. A negative right requires inaction while a positive right requires action. For example, we do not have the right to murder someone but we do have the right to life. In terms of the ethical issue, parents have the right to protect and make decisions for their child who is legally capable of doing so. Parents also have the right to direct the upbringing of their child. They have a right to decline contraceptives if they do not morally believe that that is the right decision for their child.

Nurses have opinions about abortion, but because they are health professionals and their opinions are sought as such, they are obligated to understand why they hold certain views. Nurses need to be clear about why they believe as they do, and they must arrive at a point of view in a rational and logical manner. To assist nurses in this task, the ethical issues surrounding abortion are enumerated and clarified. To do this, some of the philosophic and historic approaches to abortion and how a position can be logically argued are examined. At the outset some emotion-laden terms are defined. Abortion is defined as the expulsion of a fetus from the uterus before 28 weeks' gestation, the arbitrarily established time of viability. This discussion is concerned only with induced abortion. Since the beginning of recorded history women have chosen to have abortions. Early Jews and Christians forbade abortion on practical and religious grounds. A human life was viewed as valuable, and there was also the practical consideration of the addition of another person to the population, i.e., more brute strength to do the necessary physical work, defend against enemies, and ensure the continuation of the people. These kinds of pragmatic reasons favoring or opposing abortion have little to do with the Western concept of abortion in genaeral and what is going on in the U.S. today in particular. Discussion of the ethics of abortion must rest on 1 or more of several foundations: whether or not the fetus is a human being; the rights of the pregnant woman as opposed to those of the fetus, and circumstances of horror and hardship that might surround a pregnancy. Viability is relative. Because viability is not a specific descriptive entity, value judgments become part of the determination, both of viability and the actions that might be taken based on that determination. The fetus does not become a full human being at viability. That occurs only at conception or birth, depending on one's view of ensoulment. The fetus is owed some moral obligations because of its greatly increased potentiality. After a certain point it deserves legal and moral protection. A woman would have the right to be relieved of carrying the fetus, but she would not have the right to the death of the fetus. A significant moral difference exists in these 2 concepts, and it is this issue that forms the basis of the debate concerning the conflict between maternal and fetal rights. When the rights of the fetus and those of the pregnant woman come into direct conflict the rights of the fetus are always subordinated to those of the women. The 3rd ethical foundation of the abortion debate, that of circumstances of horror and hardship surrounding the pregnancy, is really a combination of the first two. A fetus that is known to suffer from disease or deformity has as many or as few rights vis-a-vis the pregnant woman as does a perfectly healthy fetus. The assignment and hierarchy of fetal rights is not dependent upon the circumstances of conception. The next concern is whether the state can enter the private social spheres to regulate the personal activities of individuals. The Supreme court has never made a statement regarding the moral permissibility of abortion. The Court simply has prevented individual states from interfering with a woman's action based on her personal convictions. This is an important difference, and no step should be taken to abrogate this fundamental civil right.

Currently, the amendment prohibits the use of federal funds for abortions except when the pregnancy results from rape or incest, or when it endangers the ... When Medicaid coverage for abortion care is inaccessible or denied, low-income women must scramble to find other resources to cover the cost of the procedure.

fetal tissue transplantation;

Recent research using fetal tissue transplants has expanded possible treatment options for several traumatic and degenerative neurologic disorders. However, the expectations of therapeutic benefit to be gained from these methods have been challenged by an equivalent degree of controversy. Fundamental viewpoints regarding abortion, physical autonomy and the principle of harm have been raised against continuing research and the use of fetal tissue transplants. In this article, we first attempt to elucidate the practice, potential and limitations of such techniques. The critical, yet unresolved issues of supply and sources of fetal tissue are also discussed. In light of these concepts, we examine certain pertinent obligations and ethical concerns that may clarify the nurses' role in dealing with cases involving the use of fetal tissue transplants.