The healthcare system is impacted by numerous legal and ethical issues that have elicited mixed reactions in the medical and political arenas. Providers of healthcare and caregivers face several challenges, including maternal versus fetal rights, end-of-life issues, stem cell research and genetic screening, and the challenge of privacy and confidentiality. These issues involve ethical dilemmas that emerge from the need to make a decision involving unpleasant alternatives. It is important to respect the autonomy of patients while at the same time observe the law.
Struggles with End-of-life Issues
End-of life (EOL) issues present struggles for healthcare professionals and families of patients because of the ethical dilemmas encountered. Decision making is critical because of medical advancements that have the potential to extend life or reshape conditions during death. Moral issues such as autonomous decision making, costs of care, and care regulation in futile treatments are difficult to tackle (Thomas et al., 2018). Patients’ right to autonomously choose their end-of-life treatment should be respected regardless of the limitations that present ethical dilemmas. Therefore, healthcare givers should perform their duties in a way that respects patient autonomy and that prevents harm. During EOL care, factors such as poor communication, shared decision making, and compromised patient autonomy might give rise to ethical dilemmas (Thomas et al., 2018). Nurses deal with these situations by providing the best and most dignified care to patients and their families.
Dealing with end-of-life issues is challenging because family members are sometimes unable to decide when to commence or conclude treatments. In other cases, religious and cultural beliefs contradict recommended care protocols, and families find it difficult to make appropriate choices (Thomas et al., 2018). Patients might also make decisions and become distressed, especially in cases where the outcomes go against their expectations. Struggles emerge whenever a clear course of action is unavailable. For example, it could be difficult to determine who should make the critical decisions if the patient is fully incapacitated (Thomas et al., 2018). It is important for nurses to acquire the necessary knowledge and skills needed in order for them to have these difficult conversations with patients and their families.
Allowing a Patient to Die and Physician-Assisted Suicide
Allowing a patient to die mainly involves respecting their autonomous choice to die in order to avoid suffering by respecting their wish to decline treatment. In contrast, physician-assisted suicide refers to the act of a physician being actively involved in the death of a patient, mainly by providing the means through which the individual kills themselves (Sumner, 2017). One of the main differences between the two is that allowing a patient to die usually involves withholding care while assisted suicide involves interventions such as injections or the administration of pills (Sumner, 2017). Rejecting life-sustaining care is usually a patient’s right, especially in areas where euthanasia is illegal.
There is a difference between a physician allowing a terminally ill person to die from declining treatment and the same physician administering a lethal injection. In one case, the cause of death is the illness, owing to the withdrawal of end-of-life care (Sumner, 2017). In the other case, the death is caused by the medication that is prescribed by a physician. In the US, advance care planning and do-not-resuscitate orders are commonly used by terminally ill patients as the standards of care in the course of treatment. For example, it is common practice in the United States to allow a patient with a terminal illness to decline pointless treatment, mechanical ventilation, or cardiopulmonary resuscitation and die (Sumner, 2017). Many physicians choose to protect patients from the burden of unwanted medical interventions and allow them to die rather than administering an injection to alleviate suffering.
A Patient’s Right to Know versus a Caregiver’s Right to Privacy
The issue of a caregiver’s disclosure of HIV/AIDS status versus their need for confidentiality is a controversial issue. On one hand, a physician has the right to have their medical information kept private (Wilkinson et al., 2020). Both federal and state laws offer protection to nurses against discrimination. On the other hand, a patient has the right to be free from an identified risk of infection, even from a caregiver with HIV/AIDS (Wilkinson et al., 2020). The controversy surrounding this issue is complex and controversial because of the lack of applicable court precedents and relevant data regarding the degree of HIV transmission risk from caregivers to patients. In states such as Massachusetts, caregivers with HIV/AIDS are allowed to practice, though under strict conditions. Their standards of patient protection are designed to ensure that caregivers with AIDS do not expose patients to the risk of infection.
The doctrine of utilitarianism promotes the idea of the greatest good for the greatest number. In that regard, a caregiver would be required to inform patients about their HIV status (Wilkinson et al., 2020). However, they do not divulge that information because their privacy is legally protected. Failure to notify patients of the risk of infection could have legal implications in case an individual is infected and consequently transmits the disease to other people unknowingly. In many states, caregivers with AIDS are allowed to practice under strict conditions (Wilkinson et al., 2020). However, failure to disclose HIV status could be viewed as insensitive to patients’ needs. It is unfair for a patient to blindly accept treatment without the knowledge of impending risks.
Wrongful Birth, Wrongful Life, and Wrongful Conception
Wrongful birth refers to the claims for damages made by the parents of a child born with a deformity or disability. The claims could be made against a physician or a reproductive facility for their failure to inform them in a timely manner about the likelihood of giving birth to a child with a genetic disorder (Pozgar, 2020). The costs of raising a deformed child are relatively high, and the parents could not be in a financial position to provide adequate care. This negligence denies the parents an opportunity to make the decision whether to have the child or not. Similarly, wrongful life refers to claims made by a child or parents against a physician for harm suffered because of being born (Pozgar, 2020). The claims are made because the physician should have warned the parents about the dangers of giving birth to a genetically defective child. A physician’s negligence denies the parents the opportunity to avoid the birth. In contrast, wrongful conception refers to claims for damages against a physician or a reproductive facility for reasons such as negligent contraceptive advice or unsuccessful sterilization procedures that lead to an unwanted baby (Pozgar, 2020). These concepts present moral dilemmas because of the controversial nature of abortion. The aforementioned situations can be avoided, but pro-life physicians find it unethical to divulge information that could lead to an abortion (Pozgar, 2020). Some states have passed legislation that bars such claims in order to protect doctors who are against abortion. However, others allow them because parents have the constitutional right to decide whether to keep or abort a child.
Partial Birth Abortion
Partial birth abortion is conducted for several reasons. First, it is done to save a pregnant woman in case their health or life is in danger (Ziegler, 2020). It is considered more ethical to remove a fetus and save the mother than save the fetus and lose the mother. Second, partial birth abortion is conducted in cases where physicians discover serious fetal abnormalities (Ziegler, 2020). Research has shown that certain abnormalities are noticeable in late pregnancy, necessitating the removal of the fetus through abortion. An example of such an abnormality is a condition known as hydrocephalus, which is characterized by the accumulation of water in the brain’s ventricles, leading to pressure build up. This condition can only be detected in the second trimester of pregnancy (Ziegler, 2020). The condition poses several health risks to the mother in case the fetus develops fully and she delivers vaginally. Proponents of the procedure argue that it is a safe way of terminating the pregnancy, saving the mother, and preserving the cervix for future pregnancies.
Opponents of partial birth abortion argue that the procedure is unethical because there are alternative methods of saving the fetus. For example, could drain the excess fluid from the developing fetus in order to ensure safe delivery rather than extracting it. In addition, they could induce labor and remove the fetus by caesarian section (Ziegler, 2020). Another reason for the opposition of partial birth abortion is the baby’s right to life after conception. They argue that disabled babies should be allowed to live out their lives, rather than being prematurely extracted. Man abortions are conduced based on diagnosis of incurable conditions and not because a mother’s health is at risk (Ziegler, 2020). Other reasons include the violation of medical ethics, the danger of harm to the mother, and possible cruelty to the child.
Genetic Markers and Stem Cell Research
Genetic screening and stem cell research are controversial issues, both in the medical and political arenas. On one hand, opponents of genetic screening argue that genetic markers could lead to the discrimination of individuals who are considered to possess inferior genes (Chapman, 2020). Moreover, making reproductive decisions based on a child’s genetics is unethical and should be discouraged. Genetic screening could help physicians to determine an individual’s predisposition to certain diseases. However, this issue is controversial because the procedure could also be used to select for desirable human traits (Chapman, 2020). Current research has also shown that genetic testing does no reveal much about the likelihood of an individual developing certain diseases. The majority of chronic diseases are caused by factors that include personal lifestyle, the environment, exposure to microorganisms, and an individual’s metabolism.
On the other hand, stem cell research is controversial because it involves the obliteration of human embryos. Adult stem cell, induced pluripotent stem cells, and amniotic stem cells are not controversial because they do not involve the destruction of embryos (Chapman, 2020). In the United States, the issue of when life begins is controversial, and a section believes that it begins at conception. Opponents argue that an embryo has the same moral status as a human being, and its rights should be respected (Chapman, 2020). Therefore, the derivation of stem cells from blastocysts is equivalent to murder. Opponents of stem cell research advocate for the use of alternative methods that include somatic cell nuclear transfer, induced pluripotent stem cells, single-cell blastomere biopsy, and the use of umbilical cord blood.
References
Chapman, A. R. (2020). The ethical challenges of the stem cell revolution. Cambridge Scholars Publishing.
Pozgar, G. D. (2020). Legal and ethical issues for health professionals: Legal and ethical issues for health professionals, 5th ed. Jones & Bartlett Learning, LLC.
Sumner, L. W. (2017). Physician-assisted death: What everyone needs to know. Oxford University Press.
Thomas, K., Lobo, B., & Deering, K. (Eds.). (2018). Advance care planning in end of life care, 2nd ed. Oxford University Press.
Wilkinson, D., Herring, J., & Savulescu, J. (2020). Medical ethics and law: A curriculum for the 21st century, 3rd ed. Elsevier Limited.
Ziegler, M. (2020). Abortion and the law in America: Roe v. Wade to the present. Cambridge University Press.