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Chapter 13

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PSYC 3850
Heidi Bailey

Chapter 13 Attitudes toward and treatment of people with ID has always reflected philosophies of human existence and human worth. Source of ethics: rules that guide or govern conduct and define what’s good or bad Historically, ill treatments of people with ID were accepted as best for society’s interest. In today’s society, much has been condemned as barbaric and unethical, but many hypocrisies remain. Each of us operate on the basis of some set of guiding principles that are the basis for a code of ethics governing our behavior. Two philosophic positions frame our discussion: 1. Utilitarianism- based on the premise that any action is “right” if it leads to the greatest good for the greatest number of people.An individual only has those rights granted by the larger society • Strictly following this view leads to a tendency for the group with the greatest power to continue in power and often to expand that power by limiting the rights of those with less power 2. Deontology – suggests that some acts may be wrong and others right independent of their consequences • Strictly following this view leads to the rights of some being maintained while the rights of others being diminished Both views represent polarized viewpoints of the rights and worth of individuals Euthanasia • Defined in Merriam Webster’s Dictionary as: the act of practice of killing or permitting the death of hopeless or injured individuals in a relatively painless way for reasons of mercy • Case of euthanasia was brought into public eye in 1975 when a woman in new Jersey by the name of Karen Ann Quinlan was admitted into a hospital on April 1975 and for one year remained alive simply because she was on a respirator and tube feeding (an artificial support system). • By March 1976, parents wanted Karen off support system, and medical personel refused to do so. • Courts sided with the parents. Karen was taken off support system and survived in a comatose state. • Karen finally died in june 1985. • Terri Schiavo – In 1990, oxygen flow to brain was temporarily stopped which caused severe brain damage. Terri was only alive through a feeding tube. Her husband asked that the support system be stopped, but Terri’s parents pushed that she remain connected to the feeding tube. Under court order, tube was removedApril 2005 and terri died within a few days Point of view – all lives are equal under the law – written by executive director of theARC Steven Eidleman who purports that people with disabilities should be treated with equality as there are million so disabled people with varying qualities of lives. He adds that using the term “vegetables” must stop. Withholding treatment • Most specifically used as a form of euthanasia on newborns with ID. Parents may request withholding of routine surgical or medical treatment needed for the infant to survive • This used to be unaccepted in the past • 30 years ago, Robertson characterized it as a common practice for parents to ask for withholding of treatment and for physicians to accept it when dealing with infants with birth defects • Duff and Campbell conducted a study in 1973 that investigated 299 consecutive deaths that were recorded in a special-care nursery. 43 of them involved withholding treatment. This represents 14% of the sample. • Topic remains controversial Competing equities • Plays significant role in societal dilemmas • As rights of some individuals are emphasized, others’rights are diminished • Utilitarian view would argue that medical equipment and attention should not be expended on terminally ill individuals on life support, but should go to the greater good of society. • Deontological view would argue that an infant with an ID deserves treatment and medical support because of the infant’s right to life. Competing equities are evidence as one considers the potential conflict between the right of the infant and the right of the parent. Ethical issues are not limited to a given age group but some patterns relate to different stages of the life cycle Ethical issues throughout the life cycle 1. Prenatal period • Concept of preventing or eliminating ID has been considered by society, but the actual means to achieve this goal (withholding treatment, genetic screening) have been more controversial Genetic screening and counseling • some professionals think this should be routine • others view it as interference in individual rights and freedom; particularly a sensitive issue where certain ID are more common with certain ethnicities or family origins genetic screening – search for certain genes that are predisposed to disease, already diseased or may lead to disease in future generations of the same family • involved research that examines a population in search of certain genetic characteristics that relate to disease or that may cause disease in offspring • today majority of women undergo genetic screening between 16 and 24 weeks • primary purpose of ultrasound examination is to ensure child is progressing normally. If he isn’t: additional screenings and genetic counseling. Resta suggests that genetic counselor must be able to: 1. comprehend the medical facts; diagnosis, disorder and management of 2. understand heredity behind it and risk of recurrence 3. understand alternatives pertaining to recurrence 4. choose course of action that’s compatible with their risk, family goals, culture 5. make best possible adjustment to disorder • primary purpose of screening and counseling is to ensure parents or potential parents are thoroughly informed prenatal assessments includes 1. amniocentesis – prenatal assessment of fetus that involves analysis of amniotic fluic to screen for possible abnormalities, 2. chorion biopsy – diagnostic procedure for pregnant women to determine whether the fetus has chromosomal anomalies. Involves collecting a small sample fo chorion cells for karyotyping 3. fetoscopy- procedure for examining the unborn baby using a needlelike camera that is inserted into the womb to video scan the fetus for visible abnormalities 4. ultrasonography- prenatal evaluation procedure that employs high frequency sound waves that are bounced through the mother’s abdomen to record tissue densities. Ultrasound may be used as a prenatal assessment to locate fetal abnormalities • abortion is highly controversial within this topic. Some support abortion based on the notion that with the ID, the child’s quality of life will not be good and that a woman is in contr
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