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Law & legislation week6

Open Posted By: surajrudrajnv33 Date: 15/02/2021 Graduate Rewriting & Paraphrasing

Professional Liability for Healthcare Professionals:  Analysis, Description, & Coverage. For this assignment, you areencourage to choose any profession from the Health Care area and critically evaluate, state and describe the professional liability insurance coverage offered, cost and Policy Features. The paper will be 3-4 pages long. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA style 7th edition format when referring to the selected articles and include a reference page.

Category: Engineering & Sciences Subjects: Biology Deadline: 12 Hours Budget: $120 - $180 Pages: 2-3 Pages (Short Assignment)

Attachment 1

Labor Relations

Chapter 18

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LEARNING OBJECTIVES

Explain various federal & state labor acts.

Discuss rights & responsibilities of unions & management.

Describe purpose of an “Affirmative Action Plan.”

Describe patients rights during labor disputes.

Discuss types of discrimination that occur in the workplace.

Describe sexual harassment & forms it can take.

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Federal & State Labor Laws

Relationships between employees & employers are regulated by state & federal laws.

Federal laws generally take precedence over state laws when there is conflict between state & federal laws.

State laws generally applicable when more rigid than federal laws.

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U.S. Department of Labor

Cabinet level department

Functions

promote welfare of wage earners

improve working conditions

advance opportunities for profitable employment

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National Labor Relations Act

Enacted 1935 to govern labor-management relations of business firms engaged in interstate commerce.

Act defines certain conduct of employers & employees as unfair labor practices

provides for hearings on complaints that such practices have occurred.

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National Labor Relations Act – II

Act modified by

Taft-Hartley amendments of 1947

Landrum-Griffin amendments of 1959

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National Labor Relations Board

NLRB enforces & administers the NLRA

has jurisdiction over matters involving proprietary & not-for-profit health care organizations.

agency independent of department of labor, that is responsible for preventing & remedying unfair labor practices by employers & labor organizations.

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National Labor Relations Board – II

Unions & Healthcare Orgs

Through mid-1930s, little union organizational

slow growth until late 1950s.

Union activity successful in geographic areas in which unions have been active in other industries

Limitations on # of bargaining units

employees can form up to 8 bargaining units

upheld by U.S. Supreme Ct.

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National Labor Relations Board – III

Elections

NLRA sets out procedures by which employees may select a union as their collective bargaining representative to negotiate employment and contract matters.

Unfair Labor Practices

Unlawful Interrogation

Failure to Discharge Non-Dues Paying Nurses

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Unions & HC Organizations

Limitations on Bargaining Units

Elections

Unfair Labor Practices

State Employees Excluded from Paying Union Dues

Unlawful Interrogation

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Norris-LaGuardia Act

Aimed at reducing number of injunctions to restrain strikes & picketing.

Sets procedures for handling labor disputes.

Creates board of inquiry if a dispute threatens to interrupt health care.

Board’s findings provide framework for arbitrators’ decisions.

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Labor-Management Reporting & Disclosure Act

Places controls on labor unions & relationships between unions & membership.

Requires employers to report payments to representatives of labor orgs.

Expenditures made to influence way employees exercise rights.

Disclosure of agreements with labor consultants.

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Fair Labor Standards Act

Establishes

minimum wages

maximum hours of employment

overtime pay provisions

exempt employees provisions

work week options

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Civil Rights Act of 1964

Prohibits private employers & state & local governments from discrimination in employment in any business on basis of:

race,

color,

religion,

sex, or

national origin.

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OSHA

Sets & enforces safety standards

Provides training, outreach, & education

Establishes partnerships

Encourages continual improvement in workplace safety & health

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OSHA – II

Promulgation & Enforcement of OSHA Standards

Recordkeeping

Education

Infectious Body Fluids

Employee Complaints

State Regulation

Legal Liability

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Rehabilitation Act of 1973

Protection for handicapped employees

Applied to public & private orgs

Requirement to perform self-evaluation of compliance

Jobs must not be designed to eliminate hiring of disabled persons

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Family and Medical Leave Act

Enacted to grant employees temporary medical leave under certain circumstances.

Covered employers must grant eligible employees up to a total of 12 workweeks of unpaid leave during any 12-month period.

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Family and Medical Leave Act – II

Leave granted for:

birth & care of employee’s child.

placement of adopted or foster child with employee.

care of immediate family member (spouse, child, or parent) with a serious health condition.

inability to work because of serious health condition.

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Family and Medical Leave Act – III

Illegal to terminate health insurance coverage for an employee on FMLA leave.

Following FMLA leave, employee’s job—or an equivalent job with equivalent pay, benefits, & other terms & conditions of employment—must be restored.

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State Labor Laws

Laws Vary State to State

Union Security Contracts & Right-to-Work Laws

Wage and Hour Laws

Child Labor Acts

Workers’ Compensation

Physical Injury

Job Stress

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Labor Rights

Organize & bargain collectively

Solicit & distribute union info

Picket

Strike

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Management Rights

Receive a strike notice

Hire replacement workers

Restrict union activity

Prohibit union activity during working hrs

Prohibit supervisors from participating union activity

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Patient Rights & labor Disputes

Patient rights take precedence over labor-management rights

Patients have right to

privacy

well-being

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Affirmative Action Plan – I

Prohibits discrimination on basis of age, race, color, religion, sex, national origin.

Affirmative action program includes

collection & analysis of data on the race and sex of all applicants for employment.

non-discrimination clause in manuals.

use of data to show compliance with the law.

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Affirmative Action Plan – II

Failure to comply can result in denial of federal funds.

Health care orgs should have equal employment opportunity or affirmative action plan in place.

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Injunctions

Court order directing that a certain act be performed or not performed.

Persons who fail to comply with court orders are said to be in contempt of court.

Earliest use of injunctions in labor relations was by employers to stop strikes or picketing by employees.

Availability of injunctive relief limited.

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Administering Collective Bargaining Agreement

Administered in “good faith”

Supervisors should familiarize themselves with the agreement

Importance of recordkeeping

Grievance procedures

Arbitration

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Discrimination in the Workplace – Age

Discrimination in Employment Act

Promotes employment of older persons

Prima facie case

complainant is in a protected age group

complainant is qualified for his or her job

complainant was discharged

discharge occurred in circumstances that give rise to inference of age discrimination

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Workplace Discrimination – Disability

Americans with Disabilities Act

enacted by Congress to prohibit age discrimination

Tips for Employers

train managers as to ADA requirements

review & revise job descriptions for compliance

bring physical environment into compliance

post notice describing purpose of ADA

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Workplace Discrimination – III

National Origin

Pay Discrimination

Equal Pay for Equal Work

Pregnancy Discrimination

Race

Religion

Sexual Harassment in the Workplace

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Sexual Harassment

Unwelcomed sexual advance

Request for sexual favors

Verbal or physical conduct of a sexual nature

Creating an environment that is unreasonably intimidating or offensive

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Preventing Sexual Harassment

Implement an anti-harassment policy.

Prompt action to prevent & correct any harassment.

Encourage employees to promptly report harassment.

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REVIEW QUESTIONS

1. Provide a general overview of the NLRA.

2. Using the hospital as a setting, give two examples of what would violate the NLRA.

3. How do patients' rights come into play during a strike by nurses?

4. What is the purpose of OSHA?

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REVIEW QUESTIONS – II

5. Why was the Norris-LaGuardia Act enacted by Congress?

6. Discuss various ways in which discrimination can occur in the workplace.

7. What steps can an organization take to prevent successful lawsuit brought forward on the basis of sexual harassment.

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Attachment 2

Legal Reporting Requirements

Chapter 17

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LEARNING OBJECTIVES

Describe various forms of child abuse, how to recognize it, & reporting requirements.

Describe various forms of elder abuse, how to recognize it, & reporting requirements.

Explain why it is important to report communicable diseases, adverse drug reactions, & infectious diseases.

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LEARNING OBJECTIVES - II

Discuss the importance of reporting births & deaths.

Describe the types of patient events reportable under state law.

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Abuse in Health Care Setting

Involves most vulnerable & dependent on others for care.

Abuse can take many forms

Physical

Psychological

Medical

Financial

Not Always Easy to Identify

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Child Abuse

A child is one who has suffered intentional serious mental, emotional, sexual, and/or physical injury inflicted by a family or other person responsible for the child's care. Some states extend the definition to include a child suffering from starvation.

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Child Abuse – II

Reporting Child Abuse

Caregivers (e.g., physician, nurse, administrator)

Detecting Abuse

Physical Signs

bruises

burns

broken bones

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Child Abuse – III

Behavioral Indicators

diminished psychological & intellectual functioning

failure to thrive

no control of aggression

self-destructive impulses

decreased ability to think & reason

acting out & misbehavior

habitual truancy

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Good Faith Reporting

Reasonable cause to believe injuries not accidental.

Professional not acting in bad faith to injure another in filing an abuse report.

Psychologist Immune from Liability

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Failure to Report Child Abuse

Psychologist

Failure to Report Past Abuse

Nurse

Failure to Document & Report

Physician

Text Case: Physician Immune from Liability

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Elder Abuse Signs of Abuse

Unexplained or unexpected death

Development of "pressure sores“

Heavy medication & sedation used in place of adequate nursing staff

Occurrence of broken bones

Sudden emotional outbursts, agitation, or withdrawal

Bruises, welts, discoloration, burns, etc.

Absence of hair and/or hemorrhaging below scalp

Dehydration/malnourishment without illness

Hesitation to talk openly

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Elder Abuse Signs of Abuse – II

Implausible stories

Unusual or inappropriate activity in bank accounts

Signatures on checks & other written materials that do not resemble patient's signature

Recent legal changes or creation of a will, when person is incapable of making such decisions

Missing personal belongings, including jewelry

An untreated medical condition

Patient unable to speak for himself or herself, or see others, without presence of caregiver/suspected abuser

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Documenting Abuse

Caregivers

record symptoms and condition

Witnesses

record information provided by witnesses

Photographs

photograph injuries

Preserve the evidence

use of rape kits

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Documenting Abuse – II

Suspected abuse should be defined clearly & objectively.

Witnesses: Reporters of abuse must describe statements made by others as accurately as possible

what actions were taken, by whom, when, where, etc.

Info should be included about how witnesses may be contacted.

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Documenting Abuse – III

Photographs: It may be necessary to photograph wounds or injuries.

hospital emergency room or the police department can be asked to photograph in emergency situations.

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Births & Deaths

Reportable by statute

Necessary to maintain accurate census records

Suspicious Deaths

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Suspicious Deaths

Referral to medical examiner

Violent deaths

Criminal activity

Medical Examiner

Determines cause of death

Provides information for criminal investigation

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Communicable Diseases

Reported to protect citizens from infectious diseases

Reporting required by statutes

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Adverse Drug Reactions

harmful reactions that occur as a result of administration of a drug or combination of drugs

Report adverse drug reactions to the FDA

FDA https://www.accessdata.fda.gov

FDA, 10903 New Hampshire Avenue Silver Spring, MD 20993

800-332-1088 or 888-463-6332

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HOSPITAL-ACQUIRED INFECTIONS

2006, Archives of Internal Medicine

up to 98,000 deaths annually

Approximately 30 states have requirements to report infections

2010 PPAHCA requires acute care hospitals to report hospital-acquired infections or be subjected to reduction in Medicare reimbursement.

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Physician Competency

Health Care Quality Improvement Act of 1986

Authorizes National Practitioner Data Bank to collect & release information on competence & conduct of health care practitioners.

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National Practitioner Data Bank

Reporting requirements

Required queries

Medical Staff Privileges

Who should report?

Data bank queries

Confidentiality of data bank information

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Incident Reporting

Hospital Incident Reports

do not place in patient’s record

direct reports to legal counsel to help prevent discovery

State Reportable Incidents

defined by state law/regulations

Infections

patient injuries

Failure to Report

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State Reportable Incidents

State reportable events include

reporting communicable diseases

Infections

unusual or an unexpected cluster of patients with symptoms/diseases or exposures suggestive of a health emergency or terrorism event

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REVIEW QUESTIONS

What is child abuse?

Who should report child abuse?

Describe the signs of elder abuse.

Describe a variety of the types of reportable incidents.

Describe the purpose of the National Practitioner Data Bank.

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Attachment 3

End of Life Issues

Chapter 16

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LEARNING OBJECTIVES

Discuss the human struggle to survive and the right to autonomous decision-making.

Describe how patient autonomy has been impacted by case law and legislative enactments.

Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.

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LEARNING OBJECTIVES – II

Discuss the purpose of an ethics committee and its consultative role in the delivery of patient care.

Explain end-of-life issues as they relate to autopsy, organ donations, research experimentation, and clinical trials.

Describe how human genetics and stem cell research can have an impact on end-of-life issues.

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Dreams of Immortality

Human struggle to survive

Desire to prevent & cure illness

Advances in medicine & power to prolong life

Process of dying can be prolonged

Ethical & legal issues have increased

involving entire life span, from right to be born to right to die

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Scope of Ethical Issues

Entire Life Span

The Right to be Born

The Right to Die, &

Everything in between, e.g.,

to choose treatment

to refuse treatment for oneself

to refuse treatment for another

to limit the suffering one would endure

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Ethical Dilemmas Arise

When values,

rights,

duties

& loyalties conflict.

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Autonomy

Right of a person to make one’s own decisions.

Patient has right to accept or refuse care even if it is beneficial to saving his or her life.

Autonomy may be inapplicable in certain cases

affected by one’s disabilities, mental status, maturity, or capacity to make decisions.

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Quinlan court Relying on: Roe v. Wade

Announced the constitutional right to privacy protects a patient’s right to self-determination.

State’s interest did not justify interference with her right to refuse treatment.

Quinlan’s father was appointed her legal guardian

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Cruzan Case

Supreme Court held that right-to-die should be decided pursuant to state law, subject to a due-process liberty interest, and in keeping with state constitutional law.

Cruzans returned to Missouri probate court:

Judge Charles Teel authorized physicians to remove the feeding tubes from Nancy.

testimony presented demonstrated clear & convincing evidence Nancy would not have wanted to live in a persistent vegetative state.

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Legislative Response: Patient Self-Determination Act of 1990

Requires healthcare organizations to explain to patients their legal right to direct their own care

Right to refuse medical treatment

Right to formulate advance directives

Right to appoint surrogate decision-maker

Federal reimbursement requires compliance with Act

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Preservation of Life

Medical ethics does not require patient’s life be preserved at all cost under all circumstances.

Ethical integrity

of a profession is not compromised by a patient’s decision to forego medical care.

Right to body integrity.

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Euthanasia

Mercy killing of hopelessly ill, injured or incapacitated

Active

intentional commission of an act, such as giving patient lethal drug

Passive

occurs when life-saving treatment (such as a respirator) is withdrawn or withheld

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Physician-Assisted Suicide

Oregon’s Death with Dignity Act of 1994

physician-assisted suicide became a legal medical option for the terminally ill residents

U.S. Supreme Court, in two unanimous & separate decisions, ruled

laws in Washington & New York prohibiting assisted suicide are constitutional

yet U.S. Supreme Court also ruled that states can allow doctors to assist in suicide of their terminally ill patients.

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Advance Directives – I

Making Preferences Known

Obligation to make medical preferences known to treating physician.

Any glimmer of uncertainty as to a patient's desires in an emergency situation should be resolved in favor of preserving life.

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Advance Directives – II

Living Will

Health Care Proxy

Determining Incapacity

Agent’s Rights

Durable Power of Attorney

Guardianship

Substituted Judgment

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Futility of Treatment

Physician recognizes effect of treatment will be of no benefit to the patient.

Morally, a physician has a duty to inform patient when there is little likelihood of success.

Determination as to futility of medical care is a scientific decision.

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Withholding & Withdrawing Treatment – I

Withholding of treatment

decision not to initiate treatment or medical intervention for the patient. 

Withdrawal of treatment

decision to discontinue treatment or medical interventions for the patient.

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Withholding & Withdrawing Treatment - II

When

Patient in a terminal condition & there is reasonable expectation of imminent death.

Patient a non-cognitive state with no reasonable possibility of regaining cognitive function.

Restoration of cardiac function will last but for a brief period.

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DNR Orders

DNR orders written by a physician, indicate that in event of cardiac or respiratory arrest, no resuscitative measures should be used to revive patient.

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Ethics Committee

Committee offering objective counsel when facing difficult health care issues & decisions resource to patients, families, & staff.

Includes wide range of community leaders.

Analyzes ethical dilemmas, advise & educate health care providers, patients, & families.

Assists patients & family in coming to consensus with options that best meet patient's care needs.

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Ethics Committee Function

Policy & procedure development

Educational role

Consultative role

Political Advocacy

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Autopsy

Postmortem examinations to determine cause of death.

Add to medical knowledge.

Necessary for criminal activity or suspicious deaths.

Deaths during surgery are reportable.

Consent required.

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Organ Donations – I

Federal regulations

hospitals to have, & implement, written protocols regarding organ procurement.

notification duties concerning informing families of potential donors.

Discretion & sensitivity in dealing with families.

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Organ Donations – II

Education

facilitate timely donation & transplantation

Uniform Anatomical Gift Act

allows a person to make a decision to donate organs at the time of death and allows potential donors.

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Organ Donations – III

Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one.

—Alex Tabarrok, The Wall Street Journal, January 8, 2010

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Research, Experimentation & Clinical Trials

Combination of federal & state regulations

Office of Research Integrity

Institutional Review Board

Informed Consent

Duty to Warn

Risks, benefits, alternatives

Food & Drug Administration

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Organ Human Genetics – I

Study of inheritance as it occurs in human beings, includes stem cell research, clinical genetics (e.g., genetic disease markers) & molecular genetics.

Genetic markers are genes or DNA sequences with a known location on a chromosome that can be used to

identify specific cells & diseases

individuals & species

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Organ Human Genetics – II

Genetic Information Nondiscrimination Act of 2008 prohibits

discrimination on the basis of genetic information with respect to the availability of health insurance & employment

employers from using an individual’s genetic information when making hiring, firing, job placement, or promotion decisions

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STEM CELL RESEARCH

Use of embryonic stem cells to create organs and various body tissues.

highly controversial, involving religious beliefs and fears as to how far scientists might go in their attempt to create, e.g., another human being.

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When We Finally Know

… When we finally know we are dying,

All sentient beings are dying with us,

We start to have a burning, almost heart-breaking sense of the fragility and preciousness of each moment and each being, and from this can grow a deep, clear, limitless compassion for all beings.

−Sogyal Rinpoche

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REVIEW QUESTIONS – I

Discuss how one caregiver’s beliefs can be in conflict with another when making end-of-life decisions. Consider topics discussed on morality, virtues, situational ethics, autonomy, and medical paternalism when framing your answer.

Discuss the ever-expanding role of ethics committees, including internal operational issues & external influences that affect internal operations.

What are the differences between allowing a patient to die and physician-assisted suicide?

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REVIEW QUESTIONS – II

Examine the statement: "The inherent risk is that society's faith in doctors as healers would become subverted if doctors participate in physician-assisted suicide.“

Constitutionally, what gives patients the right to self-determination?

Explain why you think the Schiavo case is an example of legislating morality.

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