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by: Paola Araque


Paola Araque
GPA 3.29
Medical Ethics
Stuart Rachels

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About this Document

These notes include the lecture and a summary of the assigned reading for that week
Medical Ethics
Stuart Rachels
Class Notes
medical ethics
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This 5 page Class Notes was uploaded by Paola Araque on Sunday February 14, 2016. The Class Notes belongs to PHL 223 at University of Alabama - Tuscaloosa taught by Stuart Rachels in Summer 2015. Since its upload, it has received 38 views. For similar materials see Medical Ethics in PHIL-Philosophy at University of Alabama - Tuscaloosa.


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Date Created: 02/14/16
Medical Ethics Notes Week 4 Lecture 0 What Causes Death 0 Active Euthanasia gt someone other than the patient 0 Passive Euthanasia gt the disease or some natural process 0 Permanent Sedation gt supposedly the disease as well I alleviates the pain ultimately the disease kills the patient not the medicine Physician Assisted Suicide PAS the patient I the doctor does NOT do the killing I assisting in suicide is illegal in 45 states I insurance policies may vary 0 The Netherlands 0 Active Euthanasia is legal if I a voluntary request is made by a competent patient It has to be multiple requests the patient can t go back and forth between the decision and the decision cannot be made out of pressure the patients suffering is intolerable all analgesics have been tried the patient is fully informed a second opinion from another doctor is needed to agree with the patient undergoing active euthanasia 90 of Dutch citizens support the law PVS patients cannot be killed because they are not competent to make the decision about ending their life Patient does not need to be dying Almost all the patients that end their lives are terminally ill 0 The Case of Elizabeth Bouvia a disabled person requested help in dying in the end she changed her mind about having the feeding tube and allowed nurses to continue feeding her 0 she was unable to use her arms or legs 0 killing yourself when you are so disabled is not easy 0 doctors are aware of drugs that can cause a lot of harm to a patient if too much is given but they don t really know HOW to kill a patient 0 Suicide 0 3X more common than homicide and about 38000 suicides occur in the US each year I about 13000 murders occur each year only 4 of attempts at suicide succeed men are 4x more likely to commit suicide than women why men are more likely to use a gun vs a woman who may use medications I hence most suicides being gun related 0 when guns are used it is twice as likely used for suicide than a homicide many people who attemptcommit suicide have temporary problems and it s just a decision made in a spur of the moment In the 1950s 50 of England s suicides were oven related When they switched to natural gas the percentage went down A LOT and it never went back up the most popular place to commit suicide is the Golden Gate Bridge I 1600 suicides in the last 80 years 76 million dollars are being invested for a stainless steel safety net at the Golden Gate Bridge the most depressed people commit suicide during recovery if more than one doctor can make the call that you are a harm yourself you can be involuntarily institutionalized Physician Assisted Suicide 0 Jack Kevorkian helped over 100 people die in the 90s I took place in Mlchigan and what he did was not illegal at the time I he was arrested and put on trial even though he was not breaking the law his medical license was taken away known as the mercy trials he wanted to represent hiimself in court and fired his lawyer 1999 convicted of 2nd degree murder manslaughter responsible for death but you didn t want it after triggering the lethal dose himself under the law he was guity of 1st degree murder died in 2011 I took patients to public park where they could commit suicide and then took their bodies to the morgue O Kevorkian I did not always know his patients well I was a pathologist not a pain specialist or an oncologist someone who deals with patients undergoing cancer treatment 0 Pathologists look at autopsys and cell tissue 0 they also deal with corpses and never see live patients I Kevorkian usually didn t have access to medical records and talk to specialists but the medical community wouldn t work with Kevorkian I But maybe what he did was better than letting these patients suffer Timothy Quill o knew Diana for 8 years 0 had access to medical records 0 had access to the advice of specialists including pain specialists unlike Kevorkian o Quill like Kevorkian was charge with murder but the grand jury didn t indict him 0 Physician Assisted Suicide The Law 0 In Quill vs Vacco 1997 the Supreme Court said States can ban PAS if they want 0 In 1994 the Oregon Death with Dignity Act passed 51 to 49 and it made PAS suicide legal in the state of Oregon In 2006 the Supreme Court upheld Oregon s law 63 Washington state legalized PAS in 2008 Vermont did the same in 2013 0 To qualify for PAS the patients must 0 be clearly competent patient can express their values 0 be dying according to the law the patient must be within 6 months of deat and another doctor can concur o wait 15 days after initial request In 2014 105 people died resulting from PAS Mostly cancer patients kill themselves because they are aware of how weak they are In 2012 1 case out of 425 were physician assissted suicide deaths What are the patient s reasons 0 loss of autonomy control 91 Patient has no control of hisher body and they are VERY sick Patient wants to take control of their own death unable to enjoy things 87 loss of dignity 71 pain 28 Readings 0 Reproductive Technology 0 Infertility I the inability to get pregnant after one year of unprotected sex I a couple can become infertile if ovulation does not occur the fallopian tubes are blocked the embryo is abnormal or implantation is unsuccessful o In Vitro Fertilization I the uniting of sperm and egg in a laboratory dish instead of inside of woman s body I doctors create the embryo that can then be transferred inside of the woman s uterus I Process of IVF o Ovarian stimulation superovulation the woman takes ovulation stimulants fertility drugs to prompt her ovaries to produce several eggs at once instead ofjust one per month IVF procedures call for multiple eggs because some of them can be defective and not every embryo will successfully implant or develop properly once transferred into the uterus 0 Egg Retrieval once the eggs are ready they are extracted from the egg sacs of the ovaries which requires a 30 minute surgery The eggs are suctioned out by a small needle 0 Inseminationfertilization the eggs are then inspected and the ones that are of highest quality are mixed with sperm insemination and within a few hours the sperm will penetrate the eggs fertilization o Embryo culture afterwards the embryos are left to grow in a culture medium After 10 days the fertility experts can look for genetic diseases by using preim plantation genetic diagnosis PGD o Embryo transfer embryos are delivered to the uterus usually painless To increase the chances of pregnancy two or more embryos are transferred at once Gamete Intrafallopian Transfer GIFT I same as IVF but eggs and sperm are transferred together to a fallopian tube to fertilize instead of in a petri dish Zygote Intrafallopian Transfer ZIFT I like IVF but the embryo is transferred to a fallopian tube instead of the uterus Couples can also rely on donors if not using their own spermeggs IVF is very expensive and one attempt can cost 12400 Side effects of IVF for mother I stress inconvenience bleeding infection damaged tissue I chance of birth complication abdominal pain memory loss mood swings and headaches I risk of ovarian hyperstimulation syndrome swollen and painful ovaries Side effects of IVF for child I chances of prenatal or postnatal death are higher I premature birth is likely 0 increase of cerebral palsy blindness heart defects infection respiratory distress syndrome I birth defects and low birth weight I to reduce these chances the nurses can abort certain fetuses in the utero Woman can freeze her eggs for future use Storage can last up to 4 years Surrogacy I woman who gestates a fetus for others I makes a contract with them to carry the pregnancy and then gives up the baby at birth to let the couple legally adopt it I Traditional Surrogacy sperm from the couple or a donor used to artificially seminate the surrogate Gestational Surrogacy surrogate receives a transferred embryo created through IVF suing the sperm and egg of others Surrogate has no genetic connection to the baby 0 Cloning the asexual production of a genetically identical entity from an existing one I Twinning done through in vitro fertilization scientists are able to produce an embryo and when it consists of two to four identical cells they separate them and let them grow into discrete but genetically identical organisms Reproductive Cloning creation of a genetic duplicate of an adult animal or human Therapeutic or Research Cloning cloning for other purposes Dolly the sheep in 1996 o Somatic Cell Nuclear Transfer SCNT DNA packed nucleus is extracted from an egg cell The eggs nucleus is replaced with a donor nucleus of an ordinary body cell from the adult individual to be cloned the reconfigured cell is stimulated with chemicals or electricity to start cell division and growth to the embryo stage the cloned embryo is transferred to a host uterus for development and birth 0 No human has been successfully cloned and none is likely to be cloned anytime soon 0 IVF The Simple Case 0 7 Objections to the simple case IVF is unnatural IVF is risky for the offspring IVF separates the procreative and the conjugal aspects of marriage and so damages the marital relationship IVF is illicit because it involves masturbation Adoption is a better solution to the problem of childlessness IVF is an expensive luxury and the resources would be better spent elsewhere IVF allows increased male control over reproduction and hence threatens the status of women in the community


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