Week 11: Legal and Ethical Issues at the Beginning of Life Flashcards
Should a child conceived through donor insemination be told?
In Canada, sperm and egg donation (collectively referred to as gamete donation) can be known or anonymous.
– A child conceived using anonymously donated gametes does not presently have a right to know the identity of his or her donor; Ethics Committee of the American Society for Reproductive Medicine urges parents to tell these children about it
Should people be able to pay for gestational surrogates, donor sperm or donor ova?
In Canada, it is illegal to purchase sperm or eggs from a donor (or person acting on behalf of a donor) or pay a female person to be a surrogate.
– However, donors and surrogates may be reimbursed for out-of-pocket expenditures incurred because of their donation or surrogacy that are provided for in the regulations.
What is Quantitative/Medical Futility?
likelihood of benefit is poor– the desired outcome is not likely or not possible
What is Qualitative Futility?
quality of benefit produced is poor – desired outcome is not worth pursuing
What is Gene therapy?
Gene therapy is an experimental approach to treating genetic disease
- the faulty gene is fixed, replaced or supplemented with a healthy gene so that it can function normally.
- Most genetic diseases cannot be treated, but gene therapy research gives some hope to patients and their families as a possible cure.
What is the “ Right to an Open Future” doctrine?
Parents should not make choices that restrict future rights
- This means erring on the side of providing lifesaving measures so that a child can reach a developmental stage where they can make their own choices
What is the “Right to Try”
– argues for access to experimental drugs as a last resort
- Includes unproven or unapproved treatments
- Considered for people whose condition is terminal anyway – they have “nothing to lose”
- Canadians don’t have rights to use drugs not approved by Health Canada
What are the points that can determine if a pediatric PT may be appropriate to withhold or withdraw life-sustaining interventions?
*progression to death is imminent or irreversible,
*proposed interventions are ineffective or likely to result in greater harms than benefits, or
*interventions only prolong the dying process, and discontinuing them would allow for better provision of palliative care
Define Withholding Treatment
- A competent person, or their substitute decision-maker acting on their behalf, has the right to refuse any medical intervention, even if it means they will die.
- The patient’s underlying causes their death, not the act of withholding the intervention.
- They need to be making a fully informed decision. In the case of an extremely premature infant, the parent(s) are responsible for deciding.
Define Withdrawing Treatment
- A competent person, or the substitute decision maker acting on their behalf, has the right to request that any ongoing medical intervention be stopped or withdrawn.
- Again, the request needs to be well-informed and made by the patient or their substitute decision maker (e.g., the parent).
What is considered extremely premature?
Babies born at less than 36 weeks gestation are considered premature. The earlier they are born, the more likely they are to require medical interventions.
– 23-24 weeks is generally considered to be the limit of extrauterine viability. Babies born this early require extensive medical support and have a high chance of death or permanent disability.
