HB12 BMT2 UNIT A Obj.1.00 Exploring Bioethics Module 1

1. HB12 BMT2 UNIT A Obj.1.00 Exploring Bioethics Module 1

2. 1.01 Bioethics concepts What is Bioethics you ask? Well, Ethics seeks to determine what a person should do or the best course of action, and provides reasons why. It helps people know how to behave, treat other people and the type of communities to live in. (Similar to _______?) Bioethics is a subfield that explores ethical questions related to the life sciences. Bioethical analysis helps us to make decisions about policies and how to use new biomedical knowledge and innovations.

3. Bioethical VS Scientific questions • Scientists seek to describe and understand phenomena in the world. They want to describe what “is”. • Ethicists seek to determine what people “should” do or the best course of action. • What are the physical risks of using steroids? s/e • Should athletes be allowed to use steroids? s/e • How can we modify a mouse for……… ? s/e • Should we modify a mouse for………? s/e

4. Why learn about Bioethics? Or, why is it important? • Is it ok to take steroids to enhance sports performance? How are they different from a high protein diet or vitamins? How should I decide on ways to enhance my natural abilities that are permissible? (Carl’s case) • Should I take a genetic test to determine if I carry a gene for an illness I can do nothing about or prevent? If I find out I carry it, should I tell my siblings or my spouse? What do I do with the results?

5. STEROIDS • 2 Major types: • Anabolic- builds up muscle mass (Testosterone) • Catabolic- breaks down muscle & reduces inflammation (Cortisone & Prednisone). Used widely in medicine for asthma, arthritis & skin conditions. • Synthetic substances- similar to male sex hormone Testosterone. Anabolic Androgenic Steroids are what body builders use. “Androgenic” increase “male characteristics” such as muscles.

6. STEROIDS CONT’D. • Anabolic steroids may be prescribed by a doctor for someone who does not make enough Testosterone on their own. • However, Anabolic Steroids (without an Rx), is ILLEGAL in the US. (Well know athlete?) • Anabolic steroids on the street cost about $10 each pill, or a liquid (10ml) for $150.

7. STEROIDS CONT’D. • Side effects can be very serious. It stunts (reduces) growth in adolescents. • Men can grow breasts, women can grow excessive hair all over their bodies/deepen voice, • Men can have shrunken testicles and decreased sperm counts. • Can increase acne and cause baldness. • Weakens Immune system • Affects mood- can be extremely happy/depressed/delusions and “Roid Rages”, violent & angry outbursts. Suicidal ideation.

8. Advances in the life sciences are giving humans new capacities, such as new medicines, procedures, ability to manipulate or alter plants and animal DNA (and human DNA) that bring many benefits to millions of people. • However, what are the potential effects or harm that can be inflicted? How will we know? • Should vaccines be mandatory even if the parent objects? Why/why not? • What is the fairest way to distribute organs to the thousands of people they could help? What could alleviate this problem? What is being done? • This is known as “public decision” policies.

9. So, why teach about Bioethics? • Advances the understanding of science • Prepares us to make informed, thoughtful choices • Promote respectful dialogue among people with diverse views • Emphasize critical thinking skills • Learn ethical reasoning skills

10. Concepts and skills in Bioethics • Four key questions to ask when faced with an ethical choice: (LEARN THESE!!) • 1. What is the ethical question? • 2. What are the relevant facts? • 3. Who or what could be affected by the way the question gets resolved? • 4. What are the relevant ethical considerations? • Three considerations to confront in the decision: (LEARN THESE!!) • 1. Respect for persons/people • 2. Minimize harm/maximize benefits • 3. Fairness

11. Other ethical considerations?? • Weighing ethical considerations….. • What would be some things to consider and weigh in on? • Any Current issues come to mind?? • Building and assessing strong/weak justifications: • Why? Why do you hold that view? Why do you feel this way? • Is there ever a right or wrong answer? Why?

12. Euthanasia VS Physician Assisted SuicideWhat’s the difference? • Physician-assisted suicide entails making lethal means available to the patient to be used at a time of the patient's own choosing. • By contrast, voluntary active euthanasia entails the physician taking an active role in carrying out the patient's request, and usually involves intravenous delivery of a lethal substance.

13. Grief (ɡrēf/) noun • deep sorrow, especially that caused by someone's death. • "she was overcome with grief" • synonyms: sorrow, misery, sadness, anguish, pain, distress, heartache, heartbreak, agony,  torment, affliction, suffering, woe, desolation, dejection, despair; mourning,  mournfulness, bereavement, lamentation;  • literarydolor, dole • "he was overcome with grief" • informal • trouble or annoyance. • "we were too tired to cause any grief" • synonyms: trouble, annoyance, bother, irritation, vexation, harassment; informalaggravation, hassle • "the police gave me a lot of grief"

14. “How To Die In Oregon” • This documentary explores real life responses to Oregon's "Death with Dignity Act“, the first law in the U.S. to allow physicians to prescribe lethal doses of drugs to the terminally ill. • A middle-aged woman with terminal liver cancer, prepares to take her own life, while another cancer patient decides to suffer through his illness even though death is just as certain for him. Others grapple with choosing their own course of action, and one man decides to hold a "death party.“ • *Assignment

15. How many states have death with dignity? • As of February 20, 2017, California, Colorado, District of Columbia, Oregon, Vermont, and Washington have Death with Dignity statutes. • In Montana, physician-assisted dying is legal by State Supreme Court ruling.

16. Identifying types of questions • Ethical, Scientific, Legal, Personal Preferences • Why is it important to know the difference in the type of questions? • Would each type affect what the outcome would be? • How?

17. 1.02 Module 2 Balancing Individual and Community Claims Establishing State Vaccination Policies

18. What are the four key questions to always ask yourself? • What are relevant ethical considerations?

19. Exploring VaccinesSetting vaccine policies • Under what circumstances, if any, should a state grant exemptions to its school vaccination policy? • What would be some reasons for an exemption? • What’s the difference between exemption and opting out? • Should the state be able to threaten legal action and/or fines to get parents to comply with the state’s vaccination policy? • Gathering relevant facts…………… read article 2.2

20. Master 2.1 • Get kids vaccinated, or else…………..(ARTICLE) • The Washington Post, Nov. 14, 2007 • Get Kids Vaccinated or Else, Parents Told • Should Public Health over ride a parent or an individual person to refuse vaccines? • What about health care workers being forced to get Hepatitis vaccines and Flu/Pneumonia vaccines? • Employer not paying sick days if they are out due to illness and did not receive vaccines…………

21. Community Immunity • What is it? • How can the community be affected? • Site some recent examples. • RISK vs BENEFIT-------------------------- • Do you know anyone that has ever had a childhood disease, such as; • Smallpox, Measles, Mumps, Polio, Pertussis • Rubella (German Measles), Diptheria, Varicella • Have you ever even heard of these diseases?

22. Exemptions, Opting out, Non Immune Status • Some reasons for: • Exception? • Opting out? • Non-Immune status?

23. Community Immunity cont’d. • Master 2.2-2.7 • Activity from • “Re-emerging Infectious Diseases” BMT1 • Community Immunity Simulation • Class or Home: Copy of Master 2.10 • Refer to data Master 2.8

24. Vaccines, Ethics, Social Policy(Fairness and Respect) • Master 2.7, 2.8, 2.10 • Master 2.11 Read Scenarios • Master 2.12 • How much of a Role of state to enforce vaccines? • Coercive of forceful implementation? • Master 2.13 Letter for state policy

25. 1.03Allocating Scarce ResourcesThe case of Organ TransplantationModule 3

27. Pre-Module Homework(Required) • Master 3.1-3.3 Historical cases • Fairness? • Possible criteria? • Relevance? • Pros and Cons?

28. Organs- scarce organs • Bone Marrow- function and location of stem cells, diseases treated with stem cell transplant, significance of matching tissue types, donors from different ethnic backgrounds. • Blood transfusions- blood groups, matching donor/recipients • Tissues- corneas, skin, bone, tendons, cartilage, heart valves, blood

29. Organs that can be transplanted • Kidney Pancreas Liver • Heart Intestine Lungs • Tissues that can be transplanted • Skin Corneas Heart Valves • Bone Marrow Blood • Connective tissues: • Bone, tendons, cartilage and ligaments

30. Factors that affect waiting times • Blood type • Tissue Type • Height and Weight • Size of donated organ • Medical urgency • Geographical location • Number of donors in the local area

31. Organs after death • One person can help as many as 8 people, and many more by donating tissue. • Organs can only be donated by people that die in the hospital. WHY? • Most Tissues need to be donated within 24 hours of death, but person does not have to die in the hospital.

32. Myths about donation • Medical treatment of the pt will be affected. • Family must pay additional expenses • Unable to have “open casket” after donation • Religious groups disapprove of organ/tissue • Donation • Rich and/or famous people receive donations more quickly • Having a “heart” on my Driver’s License means I am an organ donor and I don’t have to tell anyone, even if not 18 yrs old

33. What is Brain Death? • “The total and irreversible destruction of the brain and brain stem” • An established medical and legal diagnosis of death • SOME CAUSES: • TRAUMA TO THE BRAIN, CVA, ANOXIA, TUMOR • BRAIN DEATH is not a coma or persistive vegetative state!

34. Brain Death vs Coma • Brain Death: • All brain tissue is dead • No blood flow to the brain • No electrical activity present in the brain • Coma: • A portion of the brain is injured • Brain still receiving blood flow • Electrical activity still present in the brain

35. Blood/Organ Donation • Virtual blood donation • http://www.giveandletlive.co.uk/en/donation/blood/virtual_session/index.html • Facts about organ donation: • http://www.giveandletlive.co.uk/en/donation/donor_body/donor_body.html

36. FAIR ALLOCATION / CRITERIA • SO, how are organs allocated (allocation)? • allotment, assignment, distribution, apportionment, sharing out, handing out, dealing out,doling out, giving out, dishing out, parceling out, rationing out, dividing up/out;informaldivvying up • What are some of the criteria? • Who decides? • What are the current UNOS policies? • How are the “new” policies different from previous policies? • Which policy is “fairer”, and why? • Movie: “John Q” Ethical vs Insurance

37. What are YOUR wishes? • Could or would you consider being an organ donor? Why or why not? • Have you ever had this discussion with your family? • Have your views/opinions changed since starting this lesson?

38. What is your recommendation? • Based on the criterion in previous module, do you think it’s a “fair system” for allocating organs? • What do you think is the MOST important criterion? Why? • What criterion do you think is the LEAST important? Why? • Should one criterion be MORE important depending on the patient’s situation? Why?

39. What is the answer to shortages on organs for transplantation? • Tissue engineering is the use of a combination of cells, engineering and materials methods, and suitablebiochemical and physicochemical factors to improve or replace biological tissues.

40. What is tissue engineering??? • Youtube • https://www.youtube.com/watch?v=o1ewAheYSXs

41. What does this mean to the future of organ transplantation? • Youtube- Tissues and 3D Printing • <iframe width="560" height="315" src="https://www.youtube.com/embed/80DhBLEhdzk?list=PLJVkT6KGkUNTB6rw7AhR-D06DmfCOMIZe" frameborder="0" allowfullscreen></iframe> • https://youtu.be/80DhBLEhdzk?list=PLJVkT6KGkUNTB6rw7AhR-D06DmfCOMIZe

42. Why “GROW” organs?

43. How is it done? • PBS NOVA: Replacing body parts

44. 1.04 Weighing Benefits and HarmsEthical Issues in Genetic TestingModule 4

45. Geneticists are scientists who study genes and their variations, how information is used and controlled by cells and transmission from one generation to the next.

46. Knowledge of Genetics is fundamental to understanding Biology and essential • for understanding many of • the most important • public issues that we face. Genes are bits of biochemical information, and the information they carry is transmitted from generation to generation by coiled molecules called DNA • The DNA that carries genetic information in cells is usually packaged in the form of one or more large molecules called Chromosones

47. Our genes are our “Blueprints” that direct the synthesis of proteins--- the molecular laborers that carry out all life-supporting activities in the cell. ALL humans share the same set of genes, but individuals can inherit forms of a given gene from their parents, making each person genetically unique, EXCEPT FOR……….. • Identical twins, • whose genes are exactly the same. • Or, are they? • The causes of monozygotic twinning are generally unknown and unidentified. No one really knows why an egg splits; technically it's a malfunction of the normal development process.

48. What is DNA? • Because the individuals originate from a single combination of egg and sperm, they share the same DNA. According to the  Biology Expert, DNA is "a type of macromolecule known as a nucleic acid. It is organized into structures called chromosomes and housed within the nucleus of our cells. DNA contains the genetic information necessary for the production of other cell components and for the reproduction of life." The DNA, shaped like a double helix, are organized into chromosomes.

49. Every cell contains forty-six chromosomes. The father's sperm contributes half of their chromosomes (23) while the mother's ova, or egg, contributes the other half (23). Since monozygotic twins originate from the same egg/sperm combination, they have the same DNA. • However, although they share the same genetic characteristics, identical twins are not necessarily exactly alike.

50. Modern genetics involves Genetic Engineering, or Gene Manipulation. • This has produced many advances in medicine and industry, but the potential for abuse with the techniques has raised many ethical and legal questions. • Genetics influences us daily by the foods we eat, identifying criminals and treating diseases. • Current issues are cloning, treating diseases with stem cell & gene therapy, genetic testing for diseases, gender identity and recent privacy laws requiring personal medical information.