Ethics Midterm 2

justice as fairness

John Rawls that proposes a structure for society based on equal distribution of resources and opportunities for all individuals. 

Libertarian Justice 

individual liberty, self-ownership, and free-market principles, views healthcare as a commodity to be bought and sold rather than a right

“sick around the world”

comparison of the US healthcare system with those of other wealthy nations, highlighting (universal access, cost, quality, and equity)

Eugenics

a controversial social movement aimed at improving the genetic quality of the human population through selective breeding and sterilization.

what year was the term eugenics formed?

1883

what year did Indiana pass the first sterilization law?

1907

when was the US eugenics record office established?

1910

eugenic immigration controls in the US began in?

1924

US Supreme Court authorizes forced sterilization in ?

1927

German passes sterilization law in ?

1933

When did the nuremberg code sets rules for human experimentation?

1947

Sir Francis Galton

pioneers the mathematical treatment of heredity, “eugenics” is derived from green, meaning “good in birth” or “noble in heredity”

Forced Sterilization

breaching principle of informed consent and a persons right to bodily autonomy and reproductive freedom 

Eugenic Marriage Laws

marriage between white people and non white people was a felony

Loving VS Virginia

declared state laws prohibiting interracial marriage, was based on a couple Richard and mildred.

Eugenic Immigration Controls

limited number of immigrants able to enter country, act motivated eugenics

Buck VS Bell

Virginias law allowing for involuntary sterilization of people deemed “feebleminded” , led to sterilization of 60,000 people in the US

Nuremberg Code 

Put an end to American eugenics movement, sterilization can still be used in other states.

Nash Family Case 

Molly Nash and Fancy Anemia (progressive bone marrow, her parents decided to use preimplantation genetic diagnosis (screen child for FA and made sure second child was match to first), the son was a donor match 

Heritability

involves the tension between the individuals right to privacy and ethical duty to warn relatives about shared genetic risks 

Genetic Determinisim 

the idea that genes determine a physical or behavioral phenotype (discrimination/undermines moral responsibility) 

Gattaca

genetics and genetic engineering, cautionary tale about the societal dangers of genetic determinism, discrimination, and eugeneics 

public health

understand the causes of disease and disability in population

General ethical considerations in Public

-producing benefits

-avoiding and preventing harms

-maximal balance of benefits over harms and other costs

-benefits and burdens fairly insuring public participation

-respecting autonomous choices and actions

-promises and commitments

-acting transparantly

-maintaining trust 

Public Health and Human Rights

public health problems are human rights problems/ human rights problems are public health problems 

Public Health Interventions 

-Health Education (least coercive)

-Incentives, Subsidies and taxes (can be coercive) 

-Regulative Measures (most coercive) 

Ethics and Communicable Disease 

balancing public health goals with individual rights, particularly regarding issues like liberty, privacy, and autonomy

Jacobson VS Massachusetts

establishes police power to enforce public health laws (Supreme Court case that affirmed the authority of states to enact and enforce mandatory vaccination laws to protect public healthy even if it infringes individual liberty)

vaccination

treatment with a vaccine to produce immunity to a particular infectious disease or pathogen

Quarantine

period or place of isolation in which people or anima that may have been exposed to infectious disease are placed 

Disease Survellance 

the continuous, systematic collection, analysis, and interpretation of health-related data to detect, prevent, and respond to public health threats

Emergency Preparedness (General Ethical Issues)

resource allocation (e.g., balancing limited supplies with patient needs) and fairness in distributing benefits and burdens

Duty to Treat during Epidemics

physicians were expected during epidemics to continue their provision of care to patients without the regard to the risk their own health 

Changing Physician Roles in Public Health Emergencies

Rationing and Prioritization

rationing: government-controlled distribution of scarce goods or services, often during crises, to prevent shortages and price spikes

prioritization: process of ranking tasks, resources, or people to decide what is most important and deserves allocation

Emanual and Wertheimer on healthcare rationing

-life cycle principle

-investment refinement

-public order principle 

Life cycle principle 

prioritizes younger people who have not yet lived a complete life, everyone should have an equal opportunity to live through all stages of life 

Prognosis

likelihood of patient recovering or living for a significant period after the invention, Aims to allocate resources where they are most likely to result in a postive outcome

Public Order Principle

term does not appear to be a formal principle within the “complete lives” system. It likely relates to the “instrumental value” principle, which addresses the need to maintain essential societial function

Investment Refinement

primarily focuses on prioritizing patient welfare and public health outcomes over financial gain

stem cells 

unspecialized cells that have the ability to self-renew and differentiate into specialized cells 

Embryonic stem cells vs. Adult stem cells 

Embryonic: pluripotent(can develop into any cell type), found in early embryos, scope of differentiation (more versatile)

Adult: multi-potent (can only develop into a limited number of cell types), various tissues throughout the body (bone marrow and repair and maintenance), scope of differentiation (more specialized).

Pluripotent

can become any cell type in the body 

multipotent 

can only become a limited number of cell types (usually related to tissue of organ) 

Unipotent 

cell can only differentiate into one specific cell type but can self-renew 

Totipotent

most powerful type of stem cell, ability to develop into all cell types in the body, as well as the placenta 

regnerative medicine 

uses stem cells to repair or replace damaged tissues and organs

Basic Research in Stem Cells

-provide oversight over all issues and related to derivation and cell lines

-review and approve the scientific merit of research 

-review compliance of all in-house hEs cell research with all relevant regulations 

-maintain registries of hES cell research conducted at the institution 

-facilitate education of investigators involved in hES cell research 

Ethical issues with sources of Stem cell 

revolve around human embryonic stem cells, requires destruction of embryo, concern of informed consent for all donors (umbilical cord blood), potential commercialization and unequal access to therapies

informed consent,explotation, commercialization (fairness), cell tourism (unproven and unregulated stem cell treatments

existing stem cell lines

populations of stem cells that can be cultured indefinitely in a laboratory setting derived from embryonic cells, adult cells, and induced pluripotent cells

List of Ethical issues with sources of stem cells

-existing stem cell lines

-adult stem cells 

-embryos leftover from IVF 

-embryos created by IVF for research 

-embryos created by cloning/SCNT 

adult stem cells

avoids destruction of embryo debate and safety and efficacy, deals with informed consent, and the risks of unproven therapies. concerns with potential harm from interventions 

Embryos leftover from IVF

can be kept frozen in storage, donated to another couple for scientific research or disposed of 

Embryos created by IVF for research

embryos leftover from infertility treatments, voluntarily donated by patients for scientific purposes. (used to create embryonic stem cell lines or embryo models) (destruction of embryo, created with intent to destroy)  

Embryos created by cloning/SCNT

developed using somatic cell nuclear transfer (SCNT) where the nucleus from a body cell is transferred into an egg cell that has had its nucleus removed. Used for reproductive cloning to create genetically identical organism or therapeutic cloning to harvest stem cells for research and potential disease treatments 

“nothing is lost” priniple 

argument that suggests it is permissible to use discarded embryos for research because the embryos would be destroyed anyway 

Somatic cell nuclear transfer (SCNT) 

used in regenerative medicine and therapeutic cloning to create patient specific embryonic stem cells that are genetically identical to the donor 

reproductive cloning

process of producing a genetically identical copy of a multicellular organisms involves Somatic cell nuclear transfer. goal to create a new organism (to generate an animal that has the same nuclear DNA as a previous organism)

therapeutic cloning 

process that uses somatic cell nuclear transfer to create a cloned embryo for the purpose of extracting embryonic stem cells that are genetically identical to a patient. goal is to grow tissues and organs for medical treatment with potential to avoid immune rejection  (production of human embryos for research)

Moral Status of Embryo

a central debate with views ranging from full moral status equal to a person to no moral status at all with many positions in between. A view is that moral value increases with biological development 

NAS Guidelines for Human Embryonic

prohibit the derivation of new hESC lines after 14 days of development or after the primitive streak has formed cloning a human creating human-animal chimeras, and selling hESCs

stem cell research 

study that focuses on understanding, isolating, and utilizing stem cells to treat disease and improve human health 

Embryonic Stem Cell Research

studying the unique properties of embryonic stem cells, can develop into any cell type, to understand human development, diseases, and to develop new medical treatments 

Oversight (ESCRO) committee Oocyte Procurement

-provide oversight over all issues related to derivation and use of hES cell lines 

-review and approve the scientific merit of research protocols 

-review compliance of all in house hES cell research with all relevant regulations and guidelines 

-maintain registries of hES cell research conducted at the institution and hES cell lines derived or imported by institutional investigators 

-facilitate education of investigators involved in hES cell research 

Hwang Scanda

scientific misconduct and ethical breaches by South Korean Hwang Woodsuk. Claimed to have created the first human embryonic stem cells through cloning. Centered on faked research, involved unethical sourcing of human eggs from his students and the black market, as well as subsequent charges of embezzlement and bioethics law violation

Chimera/Cybrids

biological entities that mix genetic material from different species, but are created differentialy

chimera

organism with cells from two or more distinct genetic sources (animal with some human cells)

Cybrid

cell or embryo with nuclear DNA from one source and mitochondrial DNA from another. Fusing a nucleus from one cell into a cell with no nucleus

Glover on Genetic Engineering

Jonathon Glover explored the ethics of genetic engineering, particularly concerning the distinction between therapeutic (fixing defects) and enhancement (improving traits) applications. “Medical” versus “non-medical” boundary is hard to defend, as both involve promoting a flourishing life.Also discusses parental choice where suggesting that parents can make genetic choices to improve a childs chances but with respect to childs autonomy.(the benefits of genetic engineering has to be weighed against the potential risk of disaster) 

Positive genetic engineering

aims to increase desirable traits and is often associated with disease prevention and enhancement

negative genetic engineering

focuses on decreasing or eliminating undesirable traits, such as genetic diseases or harmful mutations

Not Playing God (theological objection) 

Humans should to interfere with the natural order or the process of creation because these are part of GOds plan

Not playing God (secular objection)

metaphor

argues humans are expanding their sphere of control and decision making into complex areas where they lack the necessary knowledge, capacity, or wisdom to manage the consequences

Genetic Supermarket View

describes a scenario where parents could choose genetic traits for their children through reproductive genetic technologies

Problems with Supermarket View

collective action problems, widespread individual choices lead to negative societal outcomes like reduced genetic diversity, social inequality, and the potential for a “designer baby” market that could stigmatize those who don’t conform to certain standards

GE and Values- “what kind of people should their be?”

given the rise of genetic and psychological modification technologies. Focus on fundamental values. Ethical implications of technology. Negative/Positive distinction. 

3 “Rs” of animal research

Replacement, Reduction, and Refinement

Medical Assistance in Dyingarguments for and against

center on patient autonomy and relief of suffering, allowing a terminally ill person to have control over their death with dignity 

Sick Violinist Thought Experiment Future Like Ours argument

distinct counter argument against abortion that was not directly addressed in the provided search results concerning the violinists scenario. 

Oocyte Procurement

process of harvesting a women’s eggs from ovaries for assisted reproduction like IVF or research