Reproductive and Pediatric Ethics Flashcards
What are the 5 core categories involving reproductive ethics
- contraception
- assisted reproductive technologies
- termination of pregnancy
- genetics/congenital conditions
- maternal-fetal conflict
Discuss contraception: what contraception is, pt’s rights, and duties of providers
- prevention of pregnancy using IUDs, pills, tubal ligation, or injections
- women/adolescents have right to make decision about contraception use/methods
- providers have duty to provide info about contraception options so pt can make informed decision
- when pt “conscientiously objects” and providers do NOT agree w/ contraception do NOT have to provide Rx; best scenario is to be transparent regarding policies
What are some ethical issues that may emerge about contraception
- women forced to use contraception
- women forced to become sterilized against their will
- disagreement b/w partners
- disagreements b/w pt and clinician
What are some ethical issues that may emerge about assisted reproductive technologies
- medical risks to mother
- donor/surrogate rights
- pre-implantation genetic diagnostic screening
- donation/destruction of embryonic tissue
- # of embryos implanted vs selective reduction
- finances/success rates
What are some ethical issues that may emerge about pregnancy termination
- pro-choice vs. pro-life (woman’s autonomy vs. fetus autonomy)
- Roe vs. Wade=right to make own choice regarding pregnancy termination
- Planned Parenthood vs. Casey= upheld initial Roe ruling but stipulated states may ban abortions after point of fetal viability (23-24 weeks)
- Hyde Amendment + barring use of federal funds to pay for abortions expect to save mothers life and in cases of rape/incest
Discuss maternal-fetal conflict: what is maternal-fetal conflict, and duties of providers
- when caring for pregnant pts must consider risks/benefits/outcomes for both mom and baby
- as fetus gets to viability (23-24 weeks) more compelling to consider/advocate for fetus
- concern for fetus should NOT lead to inappropriately withholding effective therapies for mom
What are some ethical issues that may emerge about maternal-fetal conflict
- lifestyle conflicts (smoking, drinking, illicit drug use)
- tx refusal by pregnant pt
- pt declared “brain dead”
- when fetus is considered “a person”
Which organization feels health providers and policy makers need to use advocacy of health behavior rather than punative action to manage maternal-fetal conflict
-ACOG
What are some reasons to have prenatal diagnostic testing done
- possible heritable condition in 1 or both parents
- FMHx of 1 or more heritable conditions
- high risk population group (Ashkenazi Jewish)
- couples are blood relatives
- couple are anxious about reproductive risks
What impact can prenatal diagnostic testing have on potential or having current or future pregnancies
-depending if testing shows non-significant/significant genetic risks parents may/may not decide to have kids
Who can give consent for a child
- parent’s presumed appropriate decision maker
- have ethical/legal obligation to obtain parental permission to perform recommended medical interventions
- parents do NOT have absolute power to refuse care though
- ultimate goal = parental permission + child’s assent
When are parents not considered to have decision making power
- in cases where typical supportive-loving parent-child relationship is not present
- would need to get court appointed guardian
- emergencies
- clinician can act in pts best interest if parent is no available and delay of tx would lead to significant harm
- reach age 18 in majority of states
- minor status (emancipated minors)
When can clinicians break confidentiality of minors
- if danger to self or others
- if in dangerous situation (abuse or neglect)
- for absence notes (need to miss school; no need to disclose dx or reasoning)
- for note to use meds at school
What should be done when provider and parent disagree
- try and persuade parent/guardian to accept effective/appropriate care
- further response depends on specific case (may involve court or ethics committee)
What should be done when child refuses tx
- response depends on:
- seriousness of clinical situation
- effectiveness of tx
- side effects of tx
- side effects of NOT receiving tx
- reasons behind refusal
- parents preferences on tx
- difficult to force long term tx (inhalers, insulin)
Describe typical gestation, term gestation, and pre-term
- typical gestation= 40 weeks
- term gestation=37 weeks
- pre-term= born prior to 37 weeks
- early= before 34 weeks
- late=b/w 34-37 weeks
Describe low birth weight, very low birth weight, and extreme low birth weight
- low BW = <5.5lbs
- very low BW= <3.3lbs
- extreme low BW= <2.2lbs
How has increased access to highly specialized NICUs affected low birth weight infant survival/mortality rates
-has led to shift from high mortality rate to high morbidity rate
What are the factors to consider when providing aggressive care to very low borth weight infants or critically ill infants
- chance that therapy will be successful
- risks associated w/ tx and non-tx
- degree to which therapy, if successful, will extend life
- pain/discomfort associated w/ therapy
- anticipated QOL for the newborn w/ and w/o tx
What are the ethical issues surrounding very low birth rate babies
- significant acute/chronic medical conditions
- parental autonomy
- best interest of infant
- financing/rationing of care
- autonomy of provider
What is Baby Doe Regulation of 1985
- allows withholding of care in infants <1 y/o if:
- infant is irreversibly comatose
- tx would prolong dying
- tx would be futile in terms of survival
- tx would be ineffective in correcting all nonthreatening conditions
What is Born Alive Infant Protection Act of 2002
- complete explusion of infant at any stage of development that has a heartbeat, pulsation of umbilical cord, breath, or voluntary muscle movement
- law offers protection for these cases
What are mature minors
- depending on state can make own medical decisions
- can seek evaluation/tx for physical/sexual abuse, substance abuse, STIs, contraception, pregnancy, and mental illness w/o parental consent
What are emancipated minors
- conditions vary by state
- usually when child had married, been in armed forces, or been pregnant
What are emancipated minors based on PA law
- at least 16 y/o who have:
- left parental household
- established themselves as separate entities
- capable of acting independently w/o parental conduct
- an orphan who is at least 16 y/o and acts responsibly
- minor who is married
What is Mature Minor Doctrine of 1967
- allows minors w/ adequate decisional capacity and understanding of their condition the right to consent to tx w/o parental permission
- requires minor to be at least 16 y/o in most states; sometimes as young as 14 y/o
What is Doctrine of Parens Patriae
- state may act as parental authority for child’s best interest
- allows for abused/neglected kids to be removed from their situations
T/F - All states and DC allow young people to consent to STI services
True though some states still require parental notification if not 12 or 14 y/o or older
T/F - 18 states, including NJ, PA, and DE, allow but do not requirea physician to inform a child’s parents that they are seeking/recieving STI services when deemed in pt’s best interest
True
T/F - 32 states and DC explicit allow all individuals younger than 18 y/o to consent to prenatal care
True
T/F - 21 states do NOT require parental permission to consent to abortion
False, 21 states require at least 1 parent provide consent before a child (<18 y/o) can obtain an abortion
