Bioethics week 15 REPRODUCTIVE ISSUES oAbortion The expulsion of a living fetus from the mothers womb before it is viable.

.In medical parlance, according to Dr. Andre E. Hellegers, abortion is the termination of pregnancy spontaneously or by induction prior to viability. Moral Issues on Abortion Article 11, Section 12 of the 1987 Constitution provides that The state recognizes the sanctity of life and shall protect and strengthen the family as a basic autonomous social institution. It shall equallyprotect the life of the mother and the life of the unborn from conception. The sanctity of human life demands that it must be respected and protected because this possesses the inviolable right to life. Based on the study conducted by the National Economic Development Authority (NEDA), the number of cases of induced abortion in the Philippines ranges from 150,000 to 750,000 every year. In one Metro Manila hospital alone, 4,000 cases of abortion are undertaken annually. Types of Abortion Spontaneous Abortion occurs naturally with no artificial means and the fetus is usually lost in the first trimester. However the direct cause is not always determined. 1. Chromosomal structure and number are normal in both partners, but abnormal offspring can result sporadically and unpredictably. 2. One of the partners is a carrier of a balanced translocation thus, repeated abortion may result. 3. The most common causes of spontaneous abortion are related to abnormal developments of the embryo or fetus. The abnormal development maybe due to drugs or genetic make-up, faulty implantation due to abnormalities, chronic maternal diseases, and endocrine imbalance. 4. Most spontaneous abortions appear to be related to imperfections in sperm or ova or to effects of teratogenic drugs. 5. Endocrine imbalance, particularly are induction of progesterone and estrogen in early pregnancy, can retard the normal growth of the endometrial lining of the uterus. In the later pregnancy, a decrease in Human Chorionic Gonadotropin (HCG) produced by the placenta can cause loss of pregnancy. Classification of Spontaneous Abortion 1.Threatened abortion is characterized by unexplained bleeding, cramps and backache that may jeopardize the fetus. Bleeding persists for days and the cervix is closed.It maybe followed by partial or complete expulsion of pregnancy. 2.Imminent abortion is manifested by increased bleeding and cramping. The cervix dilates and membranes may rupture. The term inevitable abortion applies. 3.Complete abortion is when all the products of conception are expelled. 4.Incomplete abortion means that parts of the products of conception are retained, most often the placenta. The cervix is dilated and will admit one finger. 5.Missed abortion means that the fetus dies in utero but is not expelled. Uterine growth ceases, breasts change regress, and the woman may report a brownish vaginal discharge. The cervix is closed. 6.Habitualabortionmeansabortion occurs consecutively in three or more pregnancies. Induced Abortion -This occurs as a result of artificial or mechanical interruption or due to involuntary and effective human intervention. It maybe sought as an end or as a means. In the first case, i.e., as an end, the main purpose is to get rid of the baby. As a means, other effects are sought as in the so-called therapeutic abortion wherein the health of the mother is concerned. Induced abortion could already be qualified as homicide. Techniques of Induced Abortion 1.Abortion by D and C (Dilatation and Curettage) This is accomplished in the periods between 7-12 weeks of gestation, utilizing a curved blade introduced

through the vagina into the cervix until it reaches the endometrial wall. The endometrial is then scraped carefully and thoroughly until all embryonic or fetal matters and surrounding placental tissues are removed. This eliminates the risk of infection or hemorrhage for an abortant mother should any tissue remains. D and C is performed under general anesthesia 2.Abortion by Caesarian Section or by Abdominal Hysterectomy This is carried out in a similar fashion as in any caesarian operation. Abdominal incision is followed by extraction of the fetus from the uterus. However, there is one radical difference. After umbilical cord is cut, the neonate is left to die without resuscitation. Abortion of this type is undertaken during the last trimester of pregnancy since no other technique is available at this stage. 3.Abortion by Suction This was pioneered by communist abortionists who utilized the suction apparatus. Later, western abortionist adopted it. Under this technique, abortion is carried out by aspirating the substance adherent to the wall and contained within the uterine cavity by means of a potent vacuum suction machine. Incomplete suctioning of the all the parts of the fetus may result to hemorrhage, thus it is necessary that the parts will be counted after the procedure. Abortion is easily accomplished within two minutes. The suction technique guarantees death of the fetus at whatever moment during the first to the 12th week of gestation (3 months). 4.Abortion via Intra-amniotic Infiltration Done by first extracting about 10-300 cc of amniotic fluid through an abnormal puncture. This is followed by infiltration of a 20% hypertonic saline solution or 50% dextrose of water into the amniotic sac. This causes necrosis of the placenta and saline intoxication of the fetus. The fetus eventually dies within an hour. Abortion is complete with the expulsion of the fetus at about 36 hours after the infiltration of hypertonic solution. This technique carries a certain risk of uterine perforation, and/or the death of the abortant mother due to the passage of the saline solution into the blood. However, it guarantees the death of the fetus of about 16 weeks (4 months) gestation period during which the amniotic sac contains sufficient fluid to permit the lethal injection. 5.Abortion via IV Infusion of Prostaglandin Prostaglandin exerts powerful effects upon the contractibility of the uterine muscles whenever this is infused slowly using the IV route. It virtually takes effect within a few hours causing the expulsion of the fetus. This procedure supersedes abortion by intra-amniotic infiltration. It is difficult to abort fetuses aging from 12-16 weeks (3-4 months) since during this period, the tiny human being has acquired sufficient mass, making it difficult to suction, as the mangled parts may not easily pass through the tubing. Neither can one abort by infiltrating hypertonic solution because there is not sufficient liquid in the amniotic sac. Therefore, slow intravenous infusion of prostaglandin is used by those bent on getting rid of the unborn baby at this time. END- OF- LIFE ISSUES oEuthanasia Euthanasia is defined as the intentional killing of a dependent human being, by act or omission, for his or her alleged legal benefit. The key word is intentional. If death is not intended, then it is not an act of euthanasia. Euthanasia is derived from the Greek words Eu which means good and thanatos which means death. It etymologically signifies good death, a pleasant and gentle death without awful suffering. Euthanasia is defined as an action or omission that by its very nature, or in the intention, causes death, for the purpose of eliminating whatever pain. Nature of Euthanasia Francis Bacon used the word euthanasia for the first time in 1623. He affirmed that the task of the physician is to bring back health, to mitigate suffering and pain not so much in that this mitigation can lead to a cure, but that it may also serve to procure a peaceful and easy death (Euthanasia, Historia Vitae et Mortis). The word is used

today to signify that procedure which facilitates death and liberates one from all types of pain, provoking the death and the hopeless patient and suppressing useless human lives. Classifications of Euthanasia Suicidal Euthanasia It is called as such when the subject himself (alone or with the help of other people) resorts to lethal means to interrupt or suppress his life. Therefore, it is done with the subjects consent. Homicidal Euthanasia Euthanasia for Piety or Pious Homicide is performed to liberate a person from a terrible disease. Today, this type of euthanasia is presented as the most reasonable compared to other types. It prescribes Death without suffering for hopeless patients; saving them from further useless, unnecessary suffering. Social or eugenic euthanasia seeks to eliminate lives devoid of vital value or to purify the race. Ortothanasia Etymologically, the word ortothanasia (no desperate measures) means passive death. The subject is left to die by omitting any medical assistance. But for some authors, this terminology has another meaning (just death, death in its due time) which is considered ethical. Positive and Negative Euthanasia Positive euthanasia- provokes death through adequate intervention (equivalent to suicidal and homicidal euthanasia). On the other hand, negative euthanasia results when medical support is omitted. Active (Direct) Euthanasia and Negative (Indirect) Euthanasia There is growing tendency today to impose the terminology,active or direct euthanasia which actually means to procure death in order to eliminate pain. Negative and indirect euthanasia, on the other hand, is not strictly euthanasia since it seeks to alleviate a patients suffering with the accompanying riskof shortening his life. Painless Death Is not euthanasia in the strict sense. Drugs are administered to modify or suppress pain and not to provoke death (painless death is inappropriately termed as euthanasia lenitive). The acceleration of death due to drug therapy, which can cure but also includes the risk of shortening ones life, could not be termed as euthanasia since the drug therapy is not intended to end ones life. Lenitive capable of easing pain or discomfort Voluntary Euthanasia means that a person requests to be killed. Non-voluntary Euthanasia is when a person did not request and gave no consent to be killed. Euthanasia by action means intentionally causing a persons death by performing an action such as by giving a lethal injection. Euthanasia by omission means intentionally causing death by not providing necessary and ordinary (usual and customary) care such as food or water. Mercy Killing Mercy killing, as an accepted medical practice, is not a usual topic that could be taken carelessly due to the fact that the act of deciding the death of a personregardless of the motives, purposes, and justificationinvolves closing all other options of maintaining a persons life. It rules out any possibility of unanticipated discovery of wrong diagnosis, new treatments, spontaneous remission, or improvement as a result of continued treatment. Ethics for Euthanasia Arthur Dyck, an ethicist, proposes a set of beliefs and propositionssuitable as an ethic for euthanasia: An individuals life belongs to that individual to dispose of entirely as he or she wishes; The dignity that attaches to personhood by reason of freedom to make choices demands also the freedom to take ones own life; There is such a thing as life not worth living whether the cause be distress, illness, physical/mental handicaps or even sheer despair for whatever reason; What is supreme in value is the human dignity that resides in the humans rational capacity to choose and control life and death. The law, with regards to mercy killing is unequivocal: personal motivation is not a defense in murder. The public is outraged when this practice involves those entrusted with health care. P Definition Suicide (Latin suicidium, fromsui caedere, to kill oneself) is the act of terminating one's own life. Many dictionaries also note the metaphorical sense of "willful destruction of one's self-interest". Causes Suicide may occur for a number of reasons, including depression, shame, guilt, desperation, physical pain, pressure, anxiety, financial difficulties, or other undesirable situations. Physician-Assisted Suicide

Assisted suicide is the process by which an individual, who may otherwise be incapable, is provided with the means (drugs or equipment) to commit suicide. It differs from euthanasia in that, inassisted suicide, the individual performs the critical action, whereas,in euthanasia, another person does it. Biological and Clinical Death Death is the termination of the biological functions that define living organisms. Clinical death is the popular term for cessation of breathing resulting to the oxygen not entering the body which eventually results in death of body tissues and cardiac arrest. Suffocation, asphyxiation, drowning, injuries, poisoning, and anaphylaxis are the few causes of clinical death. Biological Death is when brain cells die because of lack of oxygen (hypoxia). This follows clinical death. Brain death is a legal definition of death that emerged in the 1960sas a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working. In simple terms,brain death is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation. It should not be confused with a persistent vegetative state. Persistent Vegetative States This is characterized by a permanent eyes-open state of unconsciousness. The patient is not comatose; she is awake but unaware. Clinically, this suggests the irreversible loss of all neocortocoidal function. The brain stem functions remain, and the patient can breathe on their own. The patient elicits reflexes, has spontaneous respiration, and reacts to external stimuli. The eyes are often blank and often the patient assumes a severely contracted body position. Advanced Directives An advanced directive is a written expression of a persons wishes about medical care, especially care during terminal or critical illness. When individuals lose control over their lives, they may also lose their decision-making capacity,and advance directives become instructions about their future health care for others to follow. Advance directives maybe self-written instructions or prepared by someone else as instructed by the patient. Critical issues that need to be addressed in any advance directive include specific treatments to be refused or desired; the time the directive needs to take effect; specific hospitals and physicians to be used; what lawyer, if any, to be consulted; and other specific consultations, such as an ethics team, a chaplain, or a neighbour. Types of advanced directives are: Living Will This is a formal legal document that provides written directions concerning what medical care is to be provided in specific circumstances. Problems can arise when living wills consist of vague language, contain only instructions for unwanted treatments, lack a description of legal penalties for those people who choose to ignore the directives of the living wills, and when living wills are legally questionable as to their authenticity. Medical Care Directive This is not a formal legal document but it provides specific written instructions to the physician concerning the type of care and treatments that an individual wants to receive in case of incapacity. Advantage : Physicians use them as guide to know what the incapacitated patient wants in terms of specific health care treatments. Disadvantage: People cannot anticipate every medical problem in their future. People may change over time and may change their mind about future wishes even if they have delineated the instructions for their medical care directive. Durable Power of Attorney Is a legal written directive in which a designated person is allowed to make either general or specific health care and medical decisions for a patient. The durable power of attorney has the most strength for facilitating health care decisions. Deciding for Others (Proxy or Surrogate) When patients can no longer make competent decisions, families may experience problems in trying to determine a progressive right course of action. The ideal situation is for patients to be autonomous decision makers but, when autonomy is no longer possible, decision making falls to a surrogate or proxy. This is either chosen by the patient, is court appointed, or has other authority to make decisions. In cases in which individuals were incompetent to decide for themselves, the courts have generally used one of two proxy decision making standards: best standard and substituted judgment. The best standard most often takes into account such tangible factors as harms and benefits, physical and fiscal risks. In health care, the courts might rely on such truisms as health is better than illness, and life is preferable to death. In cases in which children have been denied lifepreserving care by their parents, the state has often overturned the parental decisions based on the best interest standard

The substituted-judgment standard maintains that the decision about treatment or non-treatment must remain that of the patient, based on the principle of autonomy. The fact that the patient is incompetent to make a decision for himself does not take from him the right for self-determination. A substitute is selected who is required to act in proxy for the patient that is, to make the decision that the incompetent patient would have made if the patient had been competent. In cases of the mentally retarded, and involving competent individuals who became incompetent without expressing their wishes, the substituted-judgment standard is of best interest in which the court bases its decision on the principles of beneficence and nonmaleficence rather than on the principle of autonomy.

BIOETHICS WEEK 16

GENETIC ENGINEERING Genetic engineering uses the techniques of direct molecular cloning and transformation to alter the structure and characteristics of gene. oAdvantages of Genetic Engineering Inherited diseases of man, plants and animals could be prevented. Infectious diseases can be treated by implanting genes that code for antiviral proteins that is specific to each gene. Animals and plans could be custom-/tailor-made to present desirable characteristics. Genes of trees could be manipulated for them to be able to absorb more carbon dioxide which could reduce the effect of global warming. Genetic engineering could increase genetic diversity, and generate more variant alleles which could also be crossed over and implanted into other species. oDisadvantages of Genetic Engineering Some scientists deemed that introducing genetically modified genes into the extremely complex inter-related chain of nature may have an irreversible effect with consequences that are yet to be known. There are moral issues challenging the purpose of genetic engineering, particularly involving religion, which questions whether man has the right to manipulate the laws and the natural course of nature. oProcess of Genetic Modification Isolation of the gene of interest is achieved by identifying the gene of interest that the scientist wishes to insert into the organism. Insertion of the genes into a transfer vector insertion of a gene into a vector such as a plasmoid can be doneonce the gene of interest is isolated. Transfer of the vector to the organism to be modified Transformation of the cells of the organism once the vector is obtained it can be used to transform the target organism. Separation of the genetically modified organism (GMO) from those that have not been successfully modified. oHuman Genetic Engineering The process of modifying the genotype of an individual with the goal of identifying the phenotype of an adult or a child. Through this, there is also a probability of controlling the traits that an unborn individual may possess; this may also prove helpful in knowing the etiology and treating some diseases. Types Somatic modification - involves adding genes to cells other than egg or sperm cells. For example, if a person had a disease caused by a defective gene, a healthy gene could be added to the affected cells to treat the disorder. This is noninheritable (e.g. the new gene would not be passed to the recipients offspring). Germline engineering-would change genes in eggs, sperm, or very early embryos. This is inheritable, which means that the modified genes would appear in children of all succeeding generations. oCloning Definition Cloning in biology is the process of producing populations of genetically-identical individuals that occurs in nature when organisms such as bacteria, insects or plants reproduce asexually. Molecular Cloning the process of isolating a defined deoxyribonucleic acid (DNA) sequence in order to obtain multiple copies of the DNA Cellular Cloning cellular cloning is the process of replicating an organism using an entire colony of cells. In this type of cloning, an entire cell is used to derive populations of cell rather than just using DNA. Cloning in Stem Cell Research also called research Cloning or therapeutic cloning .It aims to harvest stem cells

that could be used to study human development and to potentially treat disease Organism Cloning the process of creating a new multicellular organism that is genetically identical to another. The form of cloning is an asexual method of reproduction wherein fertilization or inter-gamete contact does not take place. 1.Horticultural the clone comes from a single plant produced through asexual reproduction, withoutfertilization. 2.Parthenogenesis some female species have this form of reproduction where growth and development of embryos or seeds (for plants) happens without fertilization by a male counterpart. 3.Reproductive cloning creates organisms that are genetically identical using the laboratory technique of Somatic Cell Nuclear Transfer (SCNT).SCNT is the method of producing a clonal embryo using the nucleus containing the DNA of a somatic cell (any body cell other than a sperm or egg cell). The nucleus is then transferred to an egg cell (whose nucleus is removed). The host cell containing the nucleus of the somatic cell is then stimulated with shock for the cells to divide. After a number of mitotic divisions, the single cell will produce a blastocyst that has almost the same DNA make-up with the original organism. SCNT may be used to create cell lines that have genes linked to a particular disease, and to genetically customize cell lines that would be generated for cell-based therapies to transplant to patients. In 1993 at the Roslin Institute in Scotland, Dolly the sheep, a Finn Dorsett ewe, was the first mammal to have been successfully cloned from an adult cell. 4.Human cloning creation of a genetically identical duplicate of an existing or previously existing human;also referred as artificial human cloning. Types of Human Cloning a.Therapeutic involves cloning cells from an adult to be used in active research and development of medicine b.Reproductive involves cloning of human beings; has not yet been undertaking as such is illegal in many countries. c. Replacement a theoretical possibility and is a combination of both the therapeutic and reproductive cloning; involves replacing extensive damage, failed, or failing body cloning followed by full or partial brain transplant. Ethical Issues on Cloning The belief that it is unethical to use human cloning in order to save the life of another. The opposition of religious organizations to all forms of cloning arguing that life only begins at conception. The point of view of classical liberalism which is concerned about the protection of identity of an individual and the right to protect ones genetic identity. oIn Vitro Fertilization (IVF) The process of fertilization by manually combining an egg and sperm in a laboratory dish. When this procedure is successful, the process is combined with a procedure known as embryo transfer, which is used to physically place the embryo in the uterus. Basic Steps in the IVF and Embryo Transfer Process Ovarianstimulation monitor and stimulate the development of healthy egg(s) in the ovaries Egg retrieval collect the eggs and secure the sperm Fertilization combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth Selection grading of embryo quality; selecting the embryos to be transferred Embryo transfer transfer the embryo in the uterus through the cervix Complications of IVF There is high risk of multiple births that is directly related to the practice of transferring multiple embryos at the time of transfer. Complication comes from the multiple births that could increase risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity. The risk of ovarian stimulation to be able to produce and harvest multiple numbers of eggs may lead to ovarian hyperstimulation syndrome. If the principal cause for infertility is due to abnormalities in spermatogenesis, it is possible (though it is too early to

examine) that the abnormality will be passed to the male offspring. HUMAN GENOME PROJECT (HGP) This project refers to the 13-year undertaking that formally begun in October 1990 and was completed in 2003 which was coordinated by the US Department of Energy and the National Institutes of Health. Other countries that took part in this project are United Kingdom, France, Germany, and China among others. oProject Goals Identify all the approximately 20,000-25,000 genes in human DNA. Determine the sequence of the 3 billion chemical base pairs that make up the human DNA. Store this information in databases. Improve tools for data analysis. Transfer related technologies to the private sector, and address the ethical, legal, and social issues (ELSI) that may arise from the project. oPotential Benefits Some current and potential applications of genome research include: Molecular Medicine Improved diagnosis of disease Earlier detection of genetic predispositions to disease Rational drug design Gene therapy and control systems for drugs Pharmacogenomics the study of how an individuals genetic inheritance affects the bodys response to drugs. This holds the promise that drugs might one day be designed to be custom made for every individual, and adapt to each persons genetic makeup. Energy and Environmental Applications Usemicrobial genomics research: to create new energy sources (biofuels) to develop environmental monitoring techniques to detect pollutants for safe, efficient environmental remediation for carbon sequestration

Risk Assessment Assess health damage and risks caused by radiation exposure, including low-dose exposures Assess health damage and risks caused by exposure to mutagenic chemicals and cancer-causing toxins Reduce the likelihood of heritable mutations Bioarchaeology, Anthropology, Evolution, and Human Migration Study evolution through germline mutations in lineages. Study migration of different population groups based on female genetic inheritance. Study mutations on the Y-chromosome to trace lineage and migration of males. Compare breakpoints in the evolution of mutations with ages of populations and historical events. DNA Forensics (Identification) Identify potential suspects whose DNA may match evidence left at crime scenes. Acquit persons wrongly accused of crimes. Identify crime and catastrophe victims. Establish paternity and other family relationships. Identify endangered and protected species as an aid to wildlife officials (could be used for prosecuting poachers). Detect bacteria and other organisms that may pollute air, water, soil, and food. Match organ donors with recipients in transplant programs. Determine pedigree for seed or livestock breeds. Authenticate consumables such as caviar and wine. Agriculture, Livestock Breeding, and Bioprocessing Disease, insect, and drought-resistant crops Healthier, more productive, disease-resistant farm animals More nutritious produce Edible vaccines incorporated into food products New environmental cleanup uses for plants like tobacco o Fairness in the use of genetic information by insurers, employers, courts, schools, adoption agencies, and the military. Who should have access to personal genetic information, and how will it be used? o Privacy and confidentiality of genetic information.

Who owns and controls genetic information? o Psychological impact and stigmatization due to an individuals genetic differences. How will personal genetic information affect the individuals and societys perception? How does genomic information affect members of communities minority groups? o Reproductive issues including adequate informed consent for complex and potentially controversial procedures, use of genetic information in reproductive decision making, and reproductive rights. Do health care practioners properly counsel parents about the risks and limitations of genetic technology? How reliable and useful is fetal genetic testing? o Clinical issues including education of doctors and other health care providers, patients, and the general public regarding genetic capabilities, scientific limitations, and social risks, and implementation of standards and quality-control measures in testing procedures. How will genetic tests be evaluated and regulated for accuracy, reliability, and utility? How will we prepare health care professionals for the new genetics? How do we prepare the public for informed choices? How do we, as a society. balance current scientific limitations and social risk with long-term benefits? o Uncertainties associated with gene tests for susceptibilities and complex conditions (e.g. heart disease) linked to multiple genes and gene-environment interactions. Should testing be performed when no treatment is available? Should parents have the right to have their minor children tested for adult-onset diseases? Are genetic tests reliable and interpretable by the medical community? o Conceptual and philosophical implications regarding human responsibility, free will versus genetic determinism, and concepts of health and disease. Do peoples genes make them behave in a particular way? Can people always control their behavior? o Health and environmental issues concerning genetically modified foods (GM) and microbes. Are GM foods and other products safe to humans and the environment? How will these technologies affect developing nations dependence on the West? o Commercialization of products including property rights (patents,copyrights, and trade secrets) and accessibility of data and materials. Who owns a persons genes and other pieces of his DNA? Will patenting DNA sequences limit their accessibility? oGene Testing allows genetic assessment and diagnosis of susceptibilities to inherited diseases, and can also be utilized to verify a persons ancestry. oGene Therapy the insertion of genes into an individuals cells and tissues to treat a disease. For inherited diseases, the defective mutated allele is replaced with a functional allele. oPharmacogenomics Anticipated Benefits of Pharmacogenomics More powerful medicines Better, safer drugs the firs time the standard trial-and-error technique of matching a patient and his disease to the right drug will be eliminated More accurate methods of determining appropriate drug dosages Advance screening for disease Better, inexpensive, stable, easy to store vaccines Improvements in drug discovery and approval process Decrease in the overall cost of health care oGenetic Anthropology this is an emerging discipline that put together DNA and physical evidences to disclose the history of ancient human migration. Benefits of Genetic Anthropology To emphasize how people are closely related to one another as part of the extended human family. To provide a detailed snapshot of human genetic variation that can assist in answering the questions on mankinds migration, cultures impact on human genetic variation, and common ancestry (plus the reason why people look different when they come from the same lineage). To provide studies and its databases to be used for medical research that may lead to treatments for genetic diseases. To be able to estimate chromosome mutation rates through the utilization of the different studies database. oHuman Behavioral Genetics this is a relatively new field that seek to understand both the genetic and environmental contributions to individual differences of the human behavior Biological Basis for Behavior

Behavior is often specie specific. Behavior can be reproduced in successive generations of organisms. Behaviors change in response to alterations in biological structures or processes. In human, some behaviors persist in the family. Behavior has an evolutionary history that endures across related species.

oGenetically Modified Organisms (GMO) Genetic modificationis a special set of technologies that alter the genetic makeup of organisms such as animals, plants, or bacteria. Biotechnologyis a more general term which refers to the utilization of organisms or their components (e.g. enzymes) to make wine, cheese, beer and yogurt. Recombinant DNA technologycombines genes from different organism resulting to genetically modified, genetically engineered, or Transgenic organisms. Medicines, vaccines, food and food ingredients are the current products that are genetically modified. Benefits of GM Products Crops 1. Enhanced taste and quality. 2. Reduced maturation time. 3. Increased nutrients, yields, and stress tolerance. 4. Improved resistance to disease, pests, and herbicides. 5. New products and growing techniques. Animals 1. Increased resistance to diseases and pests, productivity,hardiness, and feed efficiency. 2. Better yields of meat, eggs, and milk. 3. Improved animal health and diagnostic methods. Environment 1. "Friendly" bioherbicides and bioinsecticides. 2. Conservation of soil, water, and energy. 3. Bioprocessing for forestry products. 4. Better natural waste management. 5. More efficient processing. Society Increased food security for growing populations. Safety 1. Potential human health impacts, including allergens, transfer of antibiotic resistance markers, unknown effects. 2. Potential environmental impacts, including: unintended transfer of transgenes (i.e. genetic materials transferred naturally) through cross-pollination, unknown effects on other organisms (e.g., soil microbes), and loss of flora and fauna biodiversity. Access and Intellectual Property 1. Control of world food production by a few companies. 2. Increasing dependence on industrialized nations by developing countries. 3. Biopiracy or foreign exploitation of natural resources. Ethics 1. Violation of natural organisms' intrinsic values. 2. Tampering with nature by mixing genes among species. 3. Objections to consuming animal genes in plants and vice versa. 4. Stress for animals. Labeling 1. Labeling is not mandatory in some countries (e.g., United States) 2. Mixing GM crops with non-GM products puzzles labeling attempts Society New advances may twist the interests of other countries

BIOETHICS- WEEK 17

ORGAN DONATION AND TRANSPLANTATION Organ donation is the taking of healthy organs or tissues from one person for transplantation into another. Organ donors provide one or more of their organs voluntarily, usually without a fee. These

donors are either living or deceased. Organ transplantation takes place when a persons one or more organs fail to function due to illness or injury. The primary purpose of organ transplantation is to replace a persons damaged or failing organ with a healthy, functioning organ from a donor.At present, human tissues that can be transplanted include bone, corneas, skin, heart valves, veins, cartilages, and other connective tissues .Human organs that can be donated and transplanted are the heart, intestine, kidney, liver, lung and pancreas. The blood, bone, bone marrow, kidney, partial liver, and partial lung are the tissues and organs that can be donated by a living donor. oTypes of Tissue and Organ Transplants Auto graft the transplanting of an organ or tissue within the same individual from one part of the body to another; also called syngenic transplantation. Xenotransplantation transplant of cell, tissues, or organs from one species to another of a different species (e.g. transplants of heart valves of bovines from humans); also called xenograft and heterograft. Allotransplantation transplantation of cells, tissues, or organs supplied from a genetically different but same member of species as the recipient; also called allograft, allogeneic transplant, or homograft. Isograft subset of allotransplantation; a splice of tissue transplanted between two individuals who are genetically identical, such as the case with monozygotic twins; also called isogenic transplantation. Split Transplants an organ is divided between two recipients (e.g. could be the case with liver transplant for an adult and a child recipient). Domino Transplants a sequential transplant procedure wherein an organ from a deceased donor is transplanted into the first recipient and the first recipients organ is then transplanted into a second recipient. This kind of transplant is rare but is an effective way to overcome the shortage of organs available for transplants. oTypes of Donations Two main sources for transplantation: Cadaveric Organ Donations the donor has suffered injury by trauma or disease to the brain, destroying brain functions. Before an individual can become a cadaver donor, he/she has to be certified as brain dead by a neurosurgeon/neurologist supported by imaging studies (CT scans, MRI, ECG, X-ray). Living Organ Donations Subtypes of Living Organ Donations Living Related Donation organ and tissue donation between genetically related persons. Living Unrelated Donation donation between non-genetic or non-emotional persons; there may also be emotionally related transplantations (e.g. a fianc donated a kidney to his partner). Crossover Transplantation in renal transplantation certain donors cannot donate their organs to a particular recipient because of the blood type (ABO) incompatibility and other problems with histocompatibility, but the organ matches with other recipients. For example donor A cannot give a kidney to recipient A but he/she can give it to recipient B. Similarly, donor B cannot give a kidney to recipient B but he/she can give it to recipient A. Indirect Living Organ Donation close relative of a recipient is willing to donate his/her kidney to the recipient, however transplantation is not possible due to the blood group incompatibility. What happens is that the recipient is placed higher on the waiting list, while the organ from the donor is added to the organ pool.

oMyths on Organ Donation Myth #1:If one agrees to donate his/her organs, the doctor or the emergency room staff wont work as hard to save his/her life. They will remove his/her organs as soon as possible to save somebody else. Fact : When one goes to the hospital for treatment, doctors and health care staff focus mainly on saving that persons lifenot somebody elses. The doctors and health care professionals (whose specialty

most closely matches with a persons need) is onlyin-charge with that persons treatment and care, they have nothing to do with the organ donation and transplantation. It is always that a different team of health care professionals over-see the organ donation and transplantation. Myth #2:Maybe the person is not really dead when they sign his/her death certificate. If this is the case, it will be too late for him/her if the transplant team has harvested his/her organs for transplantation. The person might have recovered. Fact :Although, this is a popular topic of folklore, people dont suddenly wake up from the dead if they are already declared as so. In fact, people who have volunteered for organ donation when they were still living are given more tests (than those who havent agreed to organ donation) to determine that they are truly dead. Myth #3:Organ donation is against a persons religion. Fact: Organ donation is consistent with the beliefs of most religions; this includes Catholicism, Protestantism, Islam and most branches of Judaism. Many religious and secular approaches justify organ donation and transplantation because it promotes life. One could also consult a head of their religion if they are unsure or uncomfortable with information or decision he/she has. Myth #4:People age 18 are under age and are too young to make decisions regarding organ donation. Fact:In legal sense, this is true, however if a person aged 18 expresses that he/she wishes to donate, his/her parents could authorize this decision and provide consent for the child. Myth #5:An open-casket funeral could not take place if a persons organs or tissues are donated. Fact:Organ and tissue donation does not hinder with having an open- casket funeral. The donors body is clothed for burial, thus there will be no visible signs of organ or tissue donation. For eye donation, an artificial eye is inserted and the lids are closed. For bone donation, a rod is inserted where the bone is removed. While with skin donation, a very thin layer of skin similar to a sunburn peel is taken from the donors back; since the donor is clothed and is laying on his/her back the difference would be unnoticeable. Myth #6: People who are too old could not donate since nobody would want their aged organs. Fact: There is no definite age limit for donating organs. Organs have been successfully transplanted from donors who are in their 70s and 80s. Organ donation is based on strict medical criteria and not age. One should not disqualify him/herself prematurely due to his/her age.Specialists will be the one to determine if a persons organs and tissues are suitable for transplantation at the time of the persons death. Myth #7:People who have poor eyesight and are not in the greatest of their health could not be an organ donor since nobody would want their not so good organs and tissues. Fact: There are very few medical conditions that automatically disqualify a person as an organ donor. There are strict medical criteria that stand as the basis for this, thus it may turn out that certain organs are unsuitable for transplantation while other tissues and organs are fine. Only medical professionals, at the time of ones death, can determine whether ones organs are suitable for transplantation. Myth #8 :A person desires to donate one of his/her kidneys now, rather than to wait until his/her death. However, he/she cannot do it unless he/she is donating this to a close family member who is in need. Fact: This is used to be the case, before; now, whether it is a distant family member, a friend or a complete stranger, one could donate a kidney through certain transplant centers. If a person decides that he/she wants to be a living donor, he/she will undergo extensive questioning to guarantee that he/she is aware of the risks and also, to make known the persons reason for donating a kidney (i.e. that is to make sure that he/she is doing it out of goodwill and not for financial or monetary gains). Other testing will also be undergone ascertaining that the kidneys are in good shape and that the donor could live a healthy life with just one kidney. Myth #9:The family/relatives/support system of the donor will be charged for donating an organ. Fact: The organ donors family/relatives/support system is never charged for donating. The cost of all the final efforts to save the organ donor will be charged to the family but the cost for the organ removal goes to the transplant recipient. Myth #10:Rich, famous, and powerful people always seem to move to the front of the line when they need a donor organ. There is no way to ensure that a donors organ will be given to those who have waited the longest or those who needs it the most. Fact:The rich and the famous are not given priority when it comes to allocating organs. It may appear that way due to the amount of publicity produced when celebrities receive a transplant, but they are

treated no differently from anyone else in the waiting list. oNurses as Organ Donor Educators and Requestors Nurses are encouraged to become more involved in the tissue and organ donation process. The role of the nurse in the tissue and organ donation process is one of utmost importance, as nurses tend to have a closer relationship with patients and their family members than many other medical professionals. Because of this, nurses are deemed to have increasing roles with regards to becoming donation educators and requestors. Special programs educating nurses to become donation requestors are now available. A nurse must be specifically trained as a designated requester before he/she is allowed to talk with prospective donors and families. The nurse is an advocate for tissue and organ donation, and her responsibilities revolve around the following: Being familiar with types of donation and donation criteria Knowing the agency policy on general criteria, exclusion criteria, and other standards Contacting local tissue and organ banks to determine eligibility Identifying potential donors and contacting the appropriate source to verify if the patient is eligible for tissue or organ donation Discussing the possibility of donation with the primary physician Investigating if the patient has any indication in their belongings (e.g. donor card or donor tag) that they wished to be an organ donor Obtaining permission from the medical examiner or coroner Offering the family the option for donation Providing bereavement support to the family of the donor COMPLEMENTARY AND ALTERNATIVE MEDICINE oDefinition According to the National Center for Complementary and Alternative Medicine (NCCAM), Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. The Institute of Medicine (IOM) of the United States accept this Definition of complementary and alternative medicine: Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominants systems are not always sharp or fixed. Conventional medicine medicine practiced by medical doctors or doctors of osteopathy degrees and by allied health professionals, such as physical therapist, psychologists, and registered nurses. Complementary medicine medicine used together with conventional medicine. Alternative medicine medicine that is used in place of conventional medicine Integrative medicinemedicine that combines treatments from conventional practiced and CAM for which there is some high-quality evidence of safety and effectiveness; also called integrated medicine oMajor Types of Complementary and Alternative Medicine Whole Medical Systems involve complete systems of theory and practice that have evolved independently from or parallel to conventional form of medicine. Many of these are traditional systems of medicine practiced by individual cultures throughout the world. Eastern Whole Medical Systems Traditional Chinese Medicine a system that originated in china. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. There are three main therapeutic modalities that aid healing by restoring the yin-yang balance and the flow of qi: 1.Acupuncture and moxibustion( moxibustion is the application of heat from the burning of the herb moxa at the acupuncture point)

2.Chinese Materia Medica the catalogue of natural products used in Traditional Chinese Medicine 3.Massage and manipulation Massage the application, usually by hand, of systematic stroking or manipulation to the soft tissues of the body for therapeutic purposes. Manipulation a form of manual therapy where an application of forces to structures such as muscles, joints and bones is presented, where the goal is restoration of normal joint motion and the elimination of pain secondary to disturbed biomechanics. Ayurveda literally meansthe science of life;a natural healing system developed in India. It is a comprehensive system of medicine that places equal emphasis on the body,mind, and spirit, and strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, mediations, herbs, massage, exposure to sunlight, and controlled breathing. Western Whole Medical Systems Naturopathy literally translated asnature disease;a system of healing that originated from Europe; views disease as a manifestation of alterations in the process by which the body naturally heals itself. It emphasizes health restoration as well as disease treatment. Six Principles that form the basis of naturopathic practice in North America: 1. The healing power of nature 2. Identification and treatment of the cause of disease 3. The concept of first do no harm 4. The doctor as teacher 5. Treatment of the whole person 6. Prevention The core modalities supporting the six principles include diet modification and nutritional supplements, herbal medicine, acupuncture and Chinese medicine, hydrotherapy, massage and joint manipulation, and lifestyle counseling. Homeopathy this whole medical system originated in Europe; it seeks to stimulate the bodys ability to health itself by giving very small doses of highly diluted substances that in larger doses would produce illness or symptoms (principles of similars). Mind-Body Medicine utilizes a variety of techniques designed to enhance the minds capacity to affect bodily functions and symptoms. Meditation, prayer, mental healing, patient support groups, cognitive-behavioral therapy, and therapies that use creative outlets (i.e. art, music, dance). Biologically Based Practices use substances that can be found in nature such as herbs, foods, and vitamins (e.g. dietary supplements, herbal products, other so-called natural but still scientifically unproven therapies). Manipulative and Body-Based Practices medicine practice that is based on manipulation and/or movement of one or more parts of the body. Chiropractic or osteopathic manipulation, and massage are some examples of this practice. Manipulation the application of controlled force to a joint moving it beyond the normal range of motion in an effort to aid in restoring health. This may performed as a part of other therapies or whole medical systems, including chiropractic medicine, massage, and naturopathy. Osteopathic manipulation a type of manipulation practiced by osteopathic physicians. It is combined with physical therapy and instruction in proper posture. Massage pressing, rubbing, and moving muscles and other soft tissues of the body, primarily by using

the hands and fingers. The aim is to increase the flow of blood and oxygen to the massaged area. Energy Medicine involves the use of energy field. Two types are: Biofield therapies these are intended to affect energy fields that supposedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate the biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples are: 1.gi gong a component of traditional Chinese medicine that combines movement, meditation, and controlled breathing. The intent is to improve blood flow and the flow of qi. 2.Reiki a therapy in which the practitioners seek to transmit a universal energy to a person, either from a distance or by placing their hands on or near that person. The intent is to heal the spirit and thus the body. 3.Therapeutic touch a therapy in which practitioners pass their hands over another persons body with the intent to use their own perceived healing energy to identify energy imbalances and promote health. Bioelectromagnetic-based therapies these involve the unconventional electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields. MEDICAL TOURISM Medical tourism can be broadly defined as a health holiday along with a provision forcost effective private medical care in collaboration with the tourism industry for clients needing surgical and/or other forms of specialized treatment. This kind of tourism combines wellness and health care together with leisure and relaxation aimed at rejuvenating the totality of a person. It is also the act of traveling to other countries to obtain medical, dental, and surgical care. The term medical tourism is initially coined by travel agencies and the mass media to connote the rapidly-growing practice of traveling across international boarders to acquire health care services. Medical tourism is also called medical travel, health tourism, and global health care. o Services that are offered include the following: Elective surgical procedures as well as complex specialized surgeries Every type of health care which includes psychiatry, alternative treatments, restorative care, and even burial services Reproductive tourism which offers in-vitro fertilization, surrogate pregnancy, and other assisted reproductive technology, as a subset of medical tourism oFactors that lead to the recent increase in popularity of medical tourism: Very expensive costs of health care in industrialized nations Ease and affordability of international travel Favorable currency exchange rates in the global market Rapidly improving technology and standards of care in many countries of the world Medical tourists are mostly residents of the industrialized countries of the world, the countries they travel are in general less developed ones with favorable currency exchange ratios. There are also companies that can help arrange the clients surgery, accommodations, travel arrangements and tours. Various companies are partners with specific hospitals, thus arranging a cheaper price for their clients than one could arrange by going directly to a hospital. This is a rapidly growing industry in countries like Mexico, Brazil, Costa Rica, Dominican Republic, Hungary, India, Israel, Jordan, Lithuania, Malaysia, South Africa, Thailand, and the Philippines. Tourists are greatly encourage to travel to these countries not only to tour, sight-see and shop but also to acquire medical, dental, and surgical services from hospitals and other health care agencies/destinations. Here in the Philippines, the concept of medical tourism should not be something unfamiliar to Filipinos. It was reported that as early as the 70s, faith healers were already offering package tours to foreigners who were seeking treatment using alternative forms of medicine. These faith healers even have their own inns for accommodations. However, this practice has declined after several years. o Although medical tourism has its advantages both for the countries promoting it and the clients needing cost effective health care, thereare also disadvantages and risks that surrounds medical tourism

such as: Illegal purchase of human organs and tissues needed for transplants Risk of acquiring infectious diseases Quality of post-operative care; the client has to make post-operative arrangements of his own (unless this is not included in the packages offered) Long-distance travel requiring at least one company (this increases the travel cost) Inability to scout the best hospital and clinics, and visit doctors personally