bioethics 2

Stem Cells & Cloning 3/23/05

Mr. JOHN MICHAEL O. LORENA, RN MAN


Objectives:

1. Define the domains of ethics2. Explain basic ethical principles3. Formulate ideas and stand on

various bioethical issues


Course Description

• Deals with the ethics and moral decision making in relation to advances in the life and health sciences.

• It includes issues and principles on death, animal welfare, beneficence, maleficence, respect for persons, resource allocation and biotechnology


Basics of BIOETHICS


Course OutlineDates Chapters Topics

April 12-16 1-2 EthicsHippocratic Oath

April 19-23 3-4 Death, Abortion and Animal Welfare

Benefitting and Avoiding Harm

April 26-April 30 5-6 Respect for PersonsAvoiding Killing

May3-7 7-8 Death & DyingSocial Ethics

May 10-14 9-10 Human Control of LifeResolving Conflicts among Principles

May 17-21 11 Virtues in BioethicsFinal Exam


1. Basics of Bioethics by Veatch, 2nd Edition

2. Other books (Ethics)

Required Book:


Classroom Management1. No opening of book during lecture sessions

1. Must have notebook (Major requirement)2. Punctuality

1. Locking of doors2. Readmission slips/ Medical certificate

3. Examination1. Quizzes

1. No Make-up quizzes2. Graded Recitation3. Examination booklet

1. Blue ink2. Crossing out scheme

4. No using of cellular phone during lecture hours1. Penalty

5. Grading System


Basics of BIOETHICS


What is…………….


Phencyclidine

Case 1


Personal reflection…….


ETHICS

• Greek word “ethicos or ethos” (custom or character)

• Philosophical science that deals with the morality of human conduct

• Philosophical discipline that provides the principles on the morality of human acts

• Provides theories and principles of right or wrong and good or bad actions

• The ‘should’ of human behavior • The study of morals


Types of ethics

1. Bioethics or Clinical ethics 1. Ethics applied to human life or health

1. Abortion or euthanasia2. Nursing ethics

1. Refers to ethical issues that occur in the nursing practice

1. Patient confidentiality; being patient advocate

3. Management or business ethics


Morality• Latin word “mos or moris”• Means custom• Actualizes the theories and principles

(provided by Ethics)• Relates to people’s behavior• Other term is “Applied ethics”• Function:

– Apply these theories and principles


1. I do not talk with my seatmates during fire drill because that is one of the rules.

2. I do not say bad words because if I do, mommy will get mad at me.

3. I pay taxes because it is the right thing to do.

4. For a cookie, I will pick up my toys. 5. I do not eat in class because my

teacher does not like it. 6. I pay taxes because it is the law.

What specific stages of Moral Development are the following examples?


Moral Development Stages

PRECONVENTIONAL / PREMORAL LEVEL (Egocentric focus)Stage 1 (Punishment Avoidance - Obedience) right

and wrong is determined by what is punishedStage 2 (Instrumental-Relativist) right and wrong is

determined by what is rewarded; own needs a priorityCONVENTIONAL LEVEL (Societal focus)

Stage 3 (Good Boy/Girl) right and wrong is determined by close others’ approval or disapproval; pleases others

Stage 4 (Law and Order Orientation) right and wrong is determined by society’s rules and laws, which should be obeyed rigidly; rules as inflexible, unchangeable


POSTCONVENTIONAL LEVEL (universal focus)• Stage 5 ( Social Contract Legalistic

Orientation ) – – right and wrong is determined not only by

social rules but also higher moral principles like equality, justice or due process

• Stage 6 (Universal-Ethical Principle Orientation) – – right and wrong is determined by abstract

ethical principles that emphasize justice and equity; decisions are based on conscience rather than social laws


BIOETHICS

• Daniel Callahan together with Willard Gaylin, 1969 (Hastings Center)

• Van Rensselaer Potter, 1970 (popularized)– Oncologist

• Bio (life)• Ethos (ethics/custom)


"Biology combined with diverse humanistic knowledge forging a science that sets a

system of medical and environmental priorities for

acceptable survival.“Global Bioethics (1988)

Bioethics

-------- 1911 - 2001 --------

Van Rensselaer Potter


BIOETHICS• Discipline that deals with morality of human

conduct• Multidisciplinary (law, philosophy, religion,

medicine)• Branch of ethics

– that deals with the life sciences and their impact in society

– Analyzes moral values in the context of biomedical sciences

• Deals with the life sciences, namely, medicine, health care, genetics, biology and research


Bioethical Issues and Concerns

1. Ends and purposes of life sciences, quality of life, death and pain sufferings

2. Reproduction: genetic engineering, cloning, in-vitro fertilization, sperm banking

3. Organ harvesting and transplantation4. Advanced biomedical technology

1. Stem cell2. Gene therapy


Individual Homework….

• Submit a picture/clipping of a recent bioethical issue that has a relevance on your life as a student nurse and make a reaction (30 sentences).

• Submission is tomorrow• Short bond paper


• Given that case 1, the people involved are faced with some difficult and controversial ethical choices….

• Thus, we need to study the map of ETHICAL TERRAIN (overview of the ethical issues at stake)


Levels of Moral Discourse

METAETHICS

Normative Ethics

Rules and Rights (Codes of Ethics)

Cases (Casuistry)


Casuistry

• Rely on paradigms cases (similar)• Similar cases should be treated

similarly• New case is similar in all relevant

respects– May consult a colleague or refer to a

hospital ethics committee


Rules & Rights• Tell us what is legal and ethical

– If considered ethical –Seen as grounded in our moral systemGroups of rules or rights-claims are called CODE of ETHICS

Therefore, can consult the Codes of Ethics a particular discipline

Rule-like maxim (Nurse)Right-claims (Patient)


Rules & Rights• When organization gather together collection of

rules or right-claims • – they produce a CODE of ETHICS

• Can also be in a form of OATHS or Directives• When made up of rights-claims

– Bill of Rights• Physicians may consult the Code of Ethics of the their

Medical Association• Controversies

1. Legalism (no exceptions)2. Antinomianism (every case is unique)3. Situationalism (must be evaluated)4. Rules of practice


Rules & Rights continuum

Antinomianism Situationalism Rules of Practice Legalism

No Rules apply Rules apply rigidly


Normative ethics1. Norms of behavior/character are discussed2. Norms of good moral character are

articulated1. It involves (3) questions

1. What principles make actions morally right? (ACTION)

2. What kinds of consequences are good or valuable? (VALUE)

3. What kinds of character traits are morally praiseworthy? (VIRTUE)


Normative ethicsA. Action Theory (Questions of ethical

principle)A. Principles of Beneficence and

NonmaleficenceB. Value Theory (Intrinsic goods)

A. ValueA. Money (Instrumental)B. Happiness, beauty, knowledge and health

(Valuable)


Normative EthicsC. Virtue Theory (Good character)

A. Morally praiseworthy character traits (VIRTUE)

A. Compassion (Professional VIRTUE)A. Hippocratic Oath

B. Benevolence (Willingness to do good) = (Secular VIRTUE)A. Japanese, Greek

C. Faithfulness (Religious VIRTUE)A. Christian, Muslim, etc.


Metaethics• Deals with the most basic questions

of ethics– What is the meaning?– How it can be justified?– Which one is correct?


Metaethics• Source?

– Religious• Approved by God

– Secular• Natural law or Contract (hypothetical)

– Relativists• Culture or personal preference

• Is it ethical?– Divine Law or church tradition– Secular

• Empirical experience by Kant• Experience of sympathy by Hume


Hippocratic Oath


Hippocrates


I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgment, I will keep this Oath and this contract: To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them.I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.In purity and according to divine law will I carry out my life and my art.I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.

Hippocratic Oath


I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation. TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient. I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life. WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.

Hippocratic Oath (Modern)


Why Bioethics?


Current Bioethical Issues1. Check the local news paper2. Stem cells (state, national,

international)3. Genetically Engineered Organisms4. Knowing your genes5. In vetro fertilization – choosing your

child's genes and characteristics6. Global warming7. Chemicals exposures – human health8. Environmental health


"A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." -

Aldo Leopold, 1949, A Sand County Almanac

The First Bioethicist

---------- 1887 - 1948 ----------

Aldo Leopold


“An ethic, ecologically, is a limitation on freedom of action in the struggle for

existence”Aldo Leopold

Limits on Freedom


“The Commons”

The Tragedy of the CommonsBy Garrett Hardin, Science, 1968


Technical Solutions

“It is our considered professional judgment that

this dilemma has no technical solution.”

The Tragedy of the CommonsBy Garrett Hardin, Science, 1968


Problems – Solutions?

Lead and kids Fetal alcohol syndrome Nuclear disarmament Bioterrorism Ocean Fisheries Persistent chemicals The Commons


"Biology combined with diverse humanistic knowledge forging a

science that sets a system of medical and environmental

priorities for acceptable survival.“Global Bioethics (1988)

Bioethics

-------- 1911 - 2001 --------

Van Rensselaer Potter


1860’s - Scientific method in medicine, Gregor Mendel1928 - Penicillin discovered – widely used WWII1920’s - Lead in gasoline, lead in paint1931 - 30 states had sterilization laws on books1932 - Tuskegee syphilis study initiated 1947 - Nuremberg - The Doctors Trial1952 - First open heart surgery & Chlorpromazine1953 - Structure of DNA – Watson & Crick

Ethics and Science


60’s - Thalidomide, mercury, chronic hemodialysis, amniocentesis, informed consent, IRB’s

70’s - Hastings Center founded, bioethics defined, Tuskegee noticed, Belmont Report (3 principles), Genentech Inc. founded, awareness of FAS, sensitivity of developing CNS

80’s - Recombinant microorganism could be patented, lead is harmful to developing brain

90’s - molecular biology, sequencing of human genome (other species), Jurassic Park

00’s - US stem cell research restricted03 - Human cloned?

Ethics and Science


Question??Who were the most influential people

of the past century?

James Watson (L) and Francis Crick (R), and the model they built of the structure of DNA (and Rosalind Franklin).


ELSI

Ethical Legal / Regulatory Social Implications or Issues What is unsaid or missing? Science Values Politics


Topics

Why this is topic important DNA to RNA to Proteins Stem Cells Cloning – Therapeutic and Human


Stem Cell History1998 - Researchers first extract stem cells from human

embryos 1999 - First Successful human transplant of insulin-

making cells from cadavers2001 - President Bush restricts federal funding for

embryonic stem-cell research2002 - Juvenile Diabetes Research Foundation

International creates $20 million fund-raising effort to support stem-cell research

2003?? - California ok stem cell research 2004 - Harvard researchers grow stem cells from embryos

using private funding2004 - Ballot measure for $3 Billion bond for stem cells


Importance Disease

• Diabetes, Spinal cord injury, Parkinson’s disease, heart disease

Genetic based Disease• Cystic fibrosis,

Huntington’s


DNA – T-A C-G

Thymine (T) Adenine (A)Cytosine (C) Guanine (G)

Over 3 billion base pairs, 30,000 genesHumans are over 99.9% identical


Central Dogma of Molecular Biology

DNA

RNA

Protein

Transcription

Translation


RNA Transcription Protein Translation

DNA RNA Protein

Gene Expression


Human Variability in DNA

• SNPs (single nucleotide polymorphisms)• Many examples directly cause disease

– Huntington’s, Cystic Fibrosis, Muscular Dystrophy, etc.

• The ‘environment’ also plays a big role


...AUC AUC UUU GGU...

...Ile Ile Phe Gly...

...AUC AU- --U GGU...

...Ile Il e Gly...

Normal

CF

Common Cystic Fibrosis Mutation


Parents to Children

Mother & Father both CarriersChildren?

1 – Not a carrier (25%)2 – Carrier (50%)1 – With CF (25%)


Gene Environment Interactions

• PKU and consumption of phenylalanine• Malaria and Sickle Cell gene• HIV infection and CCR5 receptor variant• Alcohol intolerance and aldehyde

dehydrogenase• Beryllium disease (exposure to beryllium)


Sexual Reproduction

The Association of Reproductive Health Professionals


Stem Cell Differentiation

Princeton University


Stem Cell Cultivation

University of Wisconsin-Madison


Embryonic Stem Cells (ESCs)

August 9, 2001 - President Bush restricted federal funding of human embryonic stem cell research to 70 lines thought to be in existence

Only 11 now available and useable

Many researchers calling for change

Science and Politics of ESCs research


Blastocyst Diagram

Princeton University


Human Clones?

Are there human clones?Yes – Identical Twins

(Time 2.19.01)


Cloning Defined

• What is cloning?• Asexual reproduction

• Examples?• Bacteria, fungus• Plants – cutting – potato• Farm animals


Asexual Reproduction

The Association of Reproductive Health Professionals


Cloning Dolly

1997 - 2003(Roslin Institute http://www.roslin.ac.uk/library/)


Cloning A Sheep

(Roslin Institute http://www.roslin.ac.uk/library/)


Human Stem Cell Production


Removing Nucleus

Removing the maternal nucleus before nuclear transfer



Nuclear transfer

Nuclear transfer embryo about to be activated



Coning for use in Stem Cells

Cloning techniques for creating stem cells

Therapeutic cloning

Reproductive cloning


IVF – In Vitro Fertilization

Available since 1986 About 100,000 IVF kids in U.S. Often creates extra embryos U.S. - About 400,000 frozen

embryos (unregulated) England – 52,000 (regulated by

government)


End of Lecture/Discussion

Questions or Comments?

bioethics 2

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