WEEK 7 Flashcards
Name, and explain, the 4 methods used for abortions.
- Medical
- Recommended by RCOG for pregnancies up to 13 weeks
- First pill = Mifepristone (prevents implantation of early embryo)
- Second pill = Mifoprostol, taken 2 days later (breaks down uterine lining)
- First pill administered in hospital/clinic, second possibly at home. The longer the pregnancy, the more risk for complications. - Vacuum aspiration/suction (From 7 to 15 weeks)
- Can be done under local or general anaesthetic
- Pill is given to soften cervix, and gentle vacuum is used - Surgical D&E (15 weeks onwards)
- Performed under general anaesthetic
- Cervix is dilated, fetus and tissue removed with forceps/suction - Late Abortions (20 weeks onwards)
- Either medical or surgical
- Experience may be similar to vaginal delivery
- Increased risk of complications, may require overnight stay in hospital
Outline the historical development of abortions.
1861 Offences Against the Person Act
- Abortion illegal under any circumstance
- Woman performing abortion on self = felony
- Person assisting in abortion = misdemeanour
1929 Infant Life Preservation Act
- Abortion not an offence to save the life of the mother
1967AbortionAct
- Abortion legalized under certain circumstances
What is the present legislation of termination of pregnancy?
Abortion permitted when:
- 24 weeks and under, if continuing is a greater risk to
woman’s physical or mental health or existing children
- Beyond 24 weeks, when necessary to prevent permanent injury
- Beyond 24 weeks, when continuing prevents risk to life of woman
- Beyond 24 weeks, when there is substantial risk of child being born with serious handicap
- Two doctors must agree abortion is indicated
- Females
Discuss the different approaches to determining the moral status of the embryo
- Characterised by rationality/capacity for relationships
- Just by virtue of being a member of Homosapiens
- Linked to viability: once viable,should be protected the same as newborn
- Argument from potential: embryos are potential persons, and should have moral status of persons
- Personhood is a gradual process: increasing moral status from fertilisation until birth
NOTE: Whilst you are entitled to your view, not entitled to influence patient care based on view. - Regardless of your beliefs, certain requirements must be met: —— Continuity of care(referrals)
—— Non-judgmental and compassionate care
—— Provision of care within laws and regulations(in both refusal and provision)
Identify and discuss the particular ethical difficulties surrounding start of life in the areas of selective feticide, fathers’ rights & the obligations of a pregnant woman to the foetus. (HINT: there’s 4)
- What is a serious handicap?
- Feticide
- Feticide recommended for abortions 22 weeks and
beyond
- Injection given to kill the fetus before extraction/induction proceeds
- Aim = prevent newborn suffering and pain, & prevent maternal distress
- Might be preferable in cases of abnormalities inconsistent with life (same outcome, prevention of suffering)
- Ethically questionable practice in regards to non-fatal abnormalities (cleft palette, Down’s Syndrome, etc.) - Potential father’s rights
- Differs once embryo is implanted; during pregnancy, father generally as no rights in regards to abortion or other courses of action
4.Obligations of woman to foetus
- At what point does autonomy of a woman end, and
rights of a fetus begin?
- Health guidelines encourage maternal choice and involvement in birth and throughout pregnancy
- Women cannot demand a certain method (C-section over vaginal birth)
What implications did the case of St George’s Healthcare NHS Trust vs S has had on medical practice?
It was determined that dispensation was wrongly granted
- Capacity is not automatically effected due to pregnancy, pregnant women retain capacity to consent all else considered
- Foetus had no legal right to life
- Forced treatment for mental disorders under Mental Health Act don’t include physical treatments outside the scope of the mental disorder
- Takeaway: a woman cannot be forced to agree to treatment or procedure (if she retains capacity to consent) even if thinking process is “bizarre and irrational”
Identify the different categories of euthanasia (by choice and by action).
- Euthanasia: X intentionally kills Y, or permits Y’s death, for Y’s benefit
- Active euthanasia: X performs an action which itself results in Y’s death
- Passive euthanasia: X allows Y to die. X withholds life prolonging treatment or withdraws life-prolonging treatment
- Voluntary euthanasia: Euthanasia when Y competently requests death himself
- Non-voluntary euthanasia: Euthanasia when Y is not competent to express a preference
- Involuntary euthanasia: Death is against Y’s competent wishes, although X permits or imposes death for Y’s benefit
What is the link between pyramid pain killing and the doctrine of double effect? Explain.
This is where increasing doses of painkiller is given, to alleviate pain, but with the possibility of causing death.
This involves looking at the distinction between intending death, and foreseeing death.
What is the availability and regulation of euthanasia in the Netherlands, Switzerland & Oregon (in the US)?
- NETHERLANDS
Euthanasia is allowed if:
- Patient incurably ill
- Patient experiencing unbearable suffering
- Patient requested his/her life be terminated
- Termination is performed by the patient’s own doctor
Three points to note:
- Advance directives are allowed
- Children > 12 can request euthanasia
- Euthanasia of severely disabled newborns allowed - SWITZERLAND
- Legally condoned
- Assisting someone to commit suicide is illegal ONLY if the motive is selfish; if motive unselfish, then NOT illegal
- Two organisations which help people to die = EXIT & Dignitas
~300 suicides are assisted by right-to-die organisations in Switzerland - OREGON
Physician-assisted suicide is legal in Oregon, not euthanasia (note: euthanasia = illegal in US, PAS varies from state-to-state)
- Death with Dignity Act 1994 only applies toresidents of Oregon
What is palliative care? Outline the values of the hospice movement.
- Palliative care = multidisciplinary approach to specialised medical care for people with serious illnesses. Focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness.
The focus of care in the hospice (palliative care) is based on a holistic view of the person:
– Physical
– Emotional
– Psychological (Spiritual)
– Social
Often there is also a focus on pain management
What are the different arrangements surrounding organ donation: opt in & opt out?
UK currently operates an opt-in system
Reasons why potential donors don’t become actual donors include:-
- Tests for brain stem death not carried out
- Refusal by relatives
- Medical contraindication to donation
- Relatives not asked about donation
- Heart stopped beating before brainstem death complete
- Organs offered but not retrieved (BMAreport,citedH,S&H,2008)
Do not allow directed/conditional donation
What factors determine who gets the organs? Compatibility, age, proximity to centre
Name, and describe, the various enzymes involved in the process of ubiquitination.
E1 enzyme: only have 2 types of it. Is the ubiquitin activating enzyme
E2 enzyme: ubiquitin conjugating enzyme
E3 ubiquitin ligase enzyme: allows for the transfer of ubiquitin. It is a combination of E2 and E3 that recognise the substrate allowing Ub to transfer onto the substrate
Once the substrate has been ubiquitinated, how is it degraded?
It is degraded through a proteasome
- found in the cytoplasm of cells
- has a CP (core particle) and a cap of an RP (regulatory particle)
- the recognition result sin unfolding of the substrate, which is then directed through the CP
- in the CP is where the substrate is cleaved into its component amino acids
- the AA are discharged through the bottom of the proteasome
What are the various checkpoints per cycle to reduce/prevent DNA damage?
At the G1 stage: - damaged DNA - unfavourable EC environment At the S and G2 stage: - damaged/incompletely regulated DNA At the M phase - chromosome improperly attached to the mitotic spindle
What is the importance of the R point?
it is where the cell has to decide whether it will grow or not grow (i.e. quiescence)
If non-proliferating: then p16 is active, and the Rb is active
If proliferatin: p16 is absent/inactive, and the Rb is inactive (and phosphorylated)
Describe the process of DNA replication, and the mechanisms involved to ensure that it only occurs once per cycle.
The pre replicative complex within the G1 phase consnists of ORC (origin recognition complex), cdc6 and other proteins
S-cdk triggers the S phase which results in the splitting of the ORC from the other proteins of the pre-RC and from cdc6, which is phosphorylated and degraded. The degradation of cdc 6 means there is not enough cdc6 to restart the process of replication again.
The free ORC then allows for the assembly of the replication fork and then the completion of DNA replication
What are the various stages of mitosis? Give a VERY rough overview.
Prophase
Prometaphase (these two stages are where the chromosomes condense)
Metaphase (chromosomes line up along equator)
Anaphase (chromosomes begin to be separated to either poles of cell)
Telophase (separation complete)
Cytokinesis (2 daughter cells begin to move apart)
What are the various phases of the cell cycle? What is the function of each stage?
- G1 phase: checks the cellular environment is right for DNA replication
- S phase: DNA replication
- G2 phase: make sure that everything is in order
- M phase: mitosis (nuclear division) & cytokinesis (cytoplasmic division)
What are the various enzymes involved in the phosphorylation/dephosphorylation of cdk’s?
- Inhibitory kinase = wee1
- Activating kinase = Cdk
- Activating protein phosphorylase = Cdc25
What proteins are used to condense DNA?
Condensins
How is the spindle formed? How to the chromosomes attach to the spindles?
- centrosome is replicated early in the cycle (G1)
- as the cell moves into the M phase there’s a massive polymerisation of microtubules, which eventually form the spindle
- the chromosomes attach o the newly formed spindles through the protein complex, known as a kinetochore, which binds to the centromere & joins it onto microtubules
Describe the breakdown of the nuclear envelope.
The key target = nuclear lamins
- cyclical process
- phosphorylated lamins move WITH chromosomes so that when they arrive at their daughter cell, they can regeerate a nuclear envelope
What important check has to be done at metaphase?
- mitosis can’t proceed until chromosomes are properly attached and under tension
- spindle checkpoint: monitors the number of connections of chromosome to the spindle & the orientation of said connections (to make sure that chromosomes are tensioned properly and => ready to move across
What happens at Anaphase? What defects can occur at anaphase? Give an example of a condition that can arise from said defect.
- the inhibitory signal in anaphase is lost and the chromosomes separate out
the cohesion complex is what holds the sister chromatids together and prevents them from moving apart too quickly - defects in this cohesion can cause disease:
e.g. Roberts syndrome: cohesions are not held so tightly together
What are the various molecules involved in the process of metaphase -> anaphase?
Inhibitory protein = securin, which is ubiquitinated and degraded.
Separase is activated by active APC (anaphase promoting complex). Separase controls the cleavage of the cohesion complex
What can defects at the spindle checkpoint cause?
Aneuploidy (cancer, wrong no. chromosomes)
What happens in cytokinesis?
The remaining microtubules form a central spindle
Nuclear envelope is formed
Contractile ring of actin & myosin filaments forming a cleavage furrow between the 2 cells
Explain necrosis, and the various types that there is.
It is a lack of blood supply. Is pathological and generally affects a solid mass of tissue. It evokes an inflammatory response. The 6 types are: 1. Coagulative = most common 2. Colliquative = the brain 3. Caseous = tuberculosis 4. Gangrene = putrefaction 5. Fibrinoid = arterioles of malignant hypertension 6. Fat = follow from trauma/pancreatitis
