Week 6

Question 1

what are some examples of issues r/t reproductive ethics (7)

Answer 1

• abortion
• surrogacy
• reproductive technologies
• genetics/genomics
• equity of access to reproductive technologies
• implications for offspring
• financial incentives

Question 2

describe the laws regarding abortion in Canada

Answer 2

• there is no law in Canada governing termination of pregnancy
• termination can be done at any stage of pregnancy

Question 3

what does abortion require

Answer 3

• fully informed consent

Question 4

abortion is a safe medical or surgical procedure in..

Answer 4

• the first trimester

Question 5

describe the ethical principle “respect for autonomy” (4)

Answer 5

• recognizes right to self-determination
• emphasis on making choices consistent w values
• permits choice among medically indicated options
• requires: info & equitable access

Question 6

what is gene therapy

Answer 6

• experimental therapy that makes it possible to cure or prevent certain congential conditions

Question 7

what are some cons of gene therapy (3)

Answer 7

• may have unexpected/unintended effects
• may affect all future generations/evolution (germline editing)
• future generations cannot consent

Question 8

describe routine screening r/t genetic conditions

Answer 8

• can identify anomalies –> helps parents prepare for the birth or inform decision-making process
  ex. termination of pregnancy

Question 9

what is the right to try

Answer 9

• argues for access to experimental drugs as a last resort

- includes unproven or unapproved treatments

Question 10

who is the “right to try” considered for

Answer 10

• people whose condition is terminal anyways –> they have “nothing to lose”

Question 11

what is a benefit of the “right to try”? con?

Answer 11

• benefit: encourages hope & empowerment, taking control of one’s response to a health condition
• con: trades on vulnerability & lack of info about the efficacy & safety of the drug

Question 12

describe the Charlie Gard case

Answer 12

• parents wanted to access experimental/unproven therapy

- hospital felt palliative care was in his best interests

Question 13

the right to an open future doctrine suggests that (2)

Answer 13

• 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

Question 14

provide an example r/t “right to an open future”

Answer 14

• for a child born w genetic condition such as CF, parents generally consent to medical intervention in infancy so that the child has the opportunity to grow to an age where they can decide if they want continued or more invasive treatments

Question 15

define: futility

Answer 15

• intervention which will not produce a significant benefit

Question 16

what is quantitative or medical futility

Answer 16

• likelihood of benefit is poor

- desired outcome is not likely or possible

Question 17

what is qualitative futility

Answer 17

• quality of benefit produced is poor

- desired outcome is not worth pursuing

Question 18

what are our obligations when a pt wants something that is futile? (2)

Answer 18

• there is no obligation to provide treatments known to be ineffective (ex. antibiotics for a virus)
• there is a continued obligation to provide what is indicated (ex. empathy, communication, comfort care)

Question 19

babies born less than… are considered premature

Answer 19

36 weeks

Question 20

what is generally considered to be the limit of extrauterine viability?

Answer 20

• 23-24 weeks

Question 21

decision-making around what kind of interventions to provide an extremely premature infant includes (4)

Answer 21

• informed consent
• autonomy
• best interests
• QOL

Question 22

what is the purpose of Informed consent (5)

Answer 22

• demonstrates respect for the dignity & inherent worth of each person
• promote pt autonomy, do good, and prevent/avoid harm
• ensures treatment plans are aligned w their values
• providers an opportunity to prepare for risks & minimize harms
• actions may be well-meaning but are not necessarily risk free

Question 23

what are the 3 elements of consent for health care intervention

Answer 23

• capacity
• voluntary
• understanding

Question 24

describe capacity r/t informed consent

Answer 24

• the person must have the legal & mental capacity to make a decision about the treatment

Question 25

describe voluntary r/t informed consent

Answer 25

• the consent must be given freely and without coercion or lack of important relevant info

Question 26

describe understanding r/t informed consent

Answer 26

• all relevant info about risks & benefits required to make a decision that is consistent w their values, in a way they can easily understanding

Question 27

who needs to consider what is in the baby;s best interests?

Answer 27

• health care team & parents

Question 28

what are some questiosn to assess the best interests of a baby (6)

Answer 28

• will the pts condition be improved by treatment
• will the pts condition deteriorate without treatment
• do benefits of treatment outweigh risks of harm
• is treatment the least restrictive and least intrusive to improve condition
• how much pain and suffering is it reasonable to inflict, toward the long-term goal of survival?
• is survival the only goal to consider? QOL? milestones?

Question 29

define: withholding treatment

Answer 29

• intervention is possible but not initiated

Question 30

define: withdrawing treatment

Answer 30

• intervention has been initiated but is stopped because it is no longer in the pt’s best interests

Question 31

in the case of withdrawing & withholding interventions, what is the cause of death?

Answer 31

• cause of death is the underlying medical condition, not the act or omission of care

Question 32

the decision to withdraw or withhold interventions is made by?

Answer 32

• a competent person

- or their substitute decision maker acting on their behalf

Question 33

the case of Nancy B is the precedent for?

Answer 33

• the right to refuse treatment even if it will result in death

Question 34

in the case of an extremely premature infant, who is responsible for deciding whether to withold treatment

Answer 34

• parents

Question 35

in relation to withholding or withdrawing treatment, never refer to it as??? why?

Answer 35

• never refer to “withdrawing care”

- it implied that refusal of an intervention means the therapeutic relationship will end

Question 36

many decisions are based on?

Answer 36

• the projected QOL after the intervention –> will it improve? be tolerable?