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12 Pages

Course Code
PHL 302
Glen Hoffmann

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1 November 6, 2009 NURSING ETHICS – LECTURE 8 I – Introduction • The last several weeks we have been using theoretical frameworks to examine particular ethical principles and issues that arise in healthcare. • We have thus far looked at the concepts of veracity, informed consent, confidentiality, and justice. • We also looked at the issue of the just distribution of healthcare resources. • This week we will look at another important issue in healthcare ethics: genetic testing. 2 II – Genetic Testing and its Rationale • Genetic testing involves the genetic diagnosis of vulnerabilities to inherited diseases. • It allows for the identification of changes in chromosomes, genes, or proteins. • Every person carries two copies of every gene, one inherited from their mother and one from their father. • In addition to studying chromosomes at the level of individual genes, genetic testing in a broader sense includes biochemical tests for the presence or absence of key proteins that signal aberrant versions of certain genes. • In our assigned reading for this week, ‘Safeguarding Being: A Bioethical Principle for Genetic Nursing Care’, Ellen Giarelli defines genetic testing in a slightly more technical manner: Genetic testing involves analysis performed on DNA, RNA, genes, and/or chromosomes to detect heritable or acquired genotypes, phenotypes, karyotypes that are causing, or are likely to cause, a specific disease or condition. 3 • What is the purpose of genetic testing? • Its main purposes seem to be (1) diagnosis and prognosis of illnesses, and most importantly (2) clinical management of illnesses. (1) Genetic tests can be used to predict and detect illnesses and diseases. -Most commonly, genetic tests are used to determine our genetic predisposition for acquiring diseases. -For example, they can be used for prenatal diagnosis or at any time after birth to identify a genetic predisposition to common diseases. -Of course, whether a person actually develops the disease depends on the complex dynamics among genetic, behavioural and environmental factors. 4 (2) Obviously the primary aim of genetic testing is the clinical management of illnesses and diseases. -Once an illness or a genetic predisposition to an illness has been detected certain measures can be taken. -Measures can be taken for the prevention, treatment, and/or alleviation of genetically inheritable diseases. -E.G.: A set of parents, through genetic testing, may be found to have a high likelihood of producing offspring who will acquire cancer. -What can be done? -(i)They can choose not to have children. -(ii)They can choose to have children, but to warn their children about this. -The children can then take certain precautions, i.e., dietary, exercise, medication, to try to decrease their chances of acquiring cancer. 5 • Notice that genetic testing, then, can potentially be justified using some of the moral theoretical frameworks we have looked at. • In particular, since the ultimate goal of genetic testing is illness prevention, treatment, and alleviation, genetic testing is a technology that is meant to serve a good: to improve the health of the general population. • Thus, the use of genetic testing is intended to conform to the concepts of beneficence (to promote well-being) and nonmalificence (to avoid doing harm), that are generally thought to be utilitarian concepts. 6 III – Genetic Testing: Ethical Concerns • Although genetic testing ultimately has a beneficent goal the improvement of healthcare a number of ethical concerns emerge regarding exactly how and to what extent it should be implemented. • There are three main ethical concerns generated by the use genetic testing: (1) veracity, (2) autonomy, and (3) privacy and stigmatization. • We’ll look at each of these in turn. 7 (1) Veracity is an ethical principle that declares one should tell the truth (or be honest) whenever possible. • We have looked at this principle in application to healthcare ethics in general. • Its application to the use of genetic testing technologies is particularly complex. -When a genetic test is performed, medical professionals acquire information about a patient’s genetic predisposition to acquire certain illnesses. -In many cases, it will not be clear how much, if any, of this information should be given to the patient. E.G.: A patient asks for a genetic test for
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