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(Bioethics)
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Lesson Title: Health Care and the Near Future Part 5 Materials:
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Explain the current state of stem cell research and provide
References:
a pro and con argument for its continuance; and, Explain
the post humanist position regarding genetic science and
Ethics of Health Care: A Guide for Clinical
the discussion of ethics.
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
A. LESSON PREVIEW/REVIEW
Brain Teaser: Find the 11 words hidden in the puzzle, related to the topics They will encircle the words in the puzzle. This
will be done in 10 minutes and after answering, the instructor will call 3 volunteer students to share their answer and other
students will check their work if they got the same answers of what are mentioned.
E S E H E H E T E R O Z Y G O U S S Y
K I F E D O B E B E R P X E F S C E R
G N J T L W M R B C X S P T T T H G D
G E N E T I C E N G I N E E R I N G P
Q G G R Y A D D F U I P M O L R T E E
F U N O T G U X D E X C G X F O B N R
M E M H E B C H U I E O I U A L L E E
J E I N X O A D Z L N W D R P E L T L
Y N O J J K T N L S C U E F L M D H E
G M B O J L I V I N T L K L Y A Q E L
E D U C R T O I O N Q Z O Y W O K R L
R R E C O M B I N A N T D N A G S A A
L E S W S F A V N M K Y Y G I I L P P
M O B R R E C E S S I V E G E N E Y X
P O S T H F E R T Y H E T E R O G H B
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S C I N E G U E T W L K N Y T C W X Z
O I T E L I M S I N A M U H T S O P E
B. MAIN LESSON
1. These are immature cells that function as blank slate capable of becoming any cell in the body?
A. heterozygous
B. Recessive
C. Stem cells
D. All of the above
Answer: __C
Stem cells are immature cells that function as blank slate capable of becoming any cell in the body.______
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2. ___________ medicine is focused on growing specialized tissues for spinal cord injuries, diabetes, cancer, multiple
sclerosis, Parkinson’s disease, and many other currently unthought-of applications A. Specialized
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B. Regenerative
C. Human enhancement
D. None of the above
Answer: _B
Regenerative medicine is focused on growing specialized tissues for spinal cord injuries, diabetes, cancer, multiple
sclerosis, Parkinson’s disease, and many other currently unthought-of applications.______
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3. A speculative theory that seeks to re-conceive what is human.
A. Eugenics
B. Posthumanism
C. Human enhancement
D. Stem cell
Answer: __B
__Posthumanism is a speculative theory that seeks to re-conceive what is human.____
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4. An endocrinologist prescribed Human Growth Hormone to young boy who is 4 feet tall and he grew 5 ft. and 7 inches
by the age of 16. This situation is an example of?
A. Stem cell
B. Eugenics
C. Human engineering
D. Human enhancement
Answer: __D_
Human enhancement is the process of positively augmenting our abilities, permanently or temporarily. It includes any
technology that expands or positively alters our capabilities or appearance: drugs, hormones.
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5. A _________ carrier is a person who carries a defective gene that, when combined in reproduction with a similar one
from another person, may yield a genetic defect.
A. Recessive
B. Heterozygous
C. Genetic
D. Diseased
Answer: _C
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A genetic carrier is a person who carries defective gene that, when combined in reproduction with a similar one from
another person, may yield a genetic defect._______
Rationale:________________________________________________________________________________________
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_ C. LESSON WRAP-UP
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Lesson Title: Health Care and the Near Future Part 4 Materials:
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Explain the promise and ethical pitfalls associated with gene
References:
therapy;
2. Understand issues about our genes that causes our
Ethics of Health Care: A Guide for Clinical
behavior; and,
Practice Fourth Edition, Raymond S. Edge, J.
3. Identify different ethical issues about cloning.
Randall Groves
A. LESSON PREVIEW/REVIEW
Brain Teaser: MODIFIED TRUE OR FALSE, Write TRUE if the statement is correct and FALSE if the statement is
incorrect and write the correct word to make the statement correct.
1. Genetic screening is different from genetic testing.
2. Pharmacokinetic s is the study of how genes affect a person’s response to drugs.
3. Genetic screening requires wisdom, sensitivity, good science, and autonomy.
4. Recombinant DNA is the practice of altering DNA by splicing parts of one into another.
B. MAIN LESSON
Gene Therapy
• Copies of normal gene injected into cell with defective or non-present genes
• DNA of cell induced to incorporate new gene so that cell may function properly
• When cell reproduces, it passes along the new gene rather than the original
Cloning
• Clones are organisms that are exact genetic copies. Every single bit of their DNA is identical.
• Clones can happen naturally identical twins are just one of many examples. Or they can be made in the lab.
Below, find out how natural identical twins are like and different from clones made through modern cloning
technologies.
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B. Heterozygous
C. Polygenic
D. Monogenic
Answer: __C
Polygenic disease: A genetic disorder that is caused by the combined action of more than one gene.______
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2. Who wrote the book in 2013 entitled to Creation: How science is reinventing life itself?
A. Peter Goodfellow
B. Francis Crick
C. Bryan Appleyard
D. Adam Rutherford
Answer: __D
Adam Rutherford wrote the book in 2013 entitled to Creation: How science is reinventing life itself.___
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3. The taking of a somatic cell from an adult animal, inserting it into an egg, and growing an identical twin is an example
of? A. Cloning
B. Stem cell
C. Xenografting
D. All of the above
Answer: __A
The taking of a semantic cell from an adult animal, inserting it into an egg, and growing and identical twin is an example of
cloning.______
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4. This is the treatment of genetic diseases by the administration of genes to correct an absent or defective gene?
A. Genetic therapy
B. Genetic engineering
C. Genetic pharmacy
D. Genetic testing
Answer: __A
Genetic therapy is the treatment of genetic diseases by the administration of genes to correct an absent or defective
gene.______
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5. The President’s Council on Bioethics holds that cloning-to-produce-children would be a radically new form of human
procreation that leads to concern such as which of the following?
A. Troubled family relations
B. Prospect of a new eugenics
C. Concerns regarding manufacture
D. All of the above
Answer: __D
Cloning-to-produce-children would be a radically new form of human procreation that leads to troubled family relations,
prospect of a new eugenics and concerns regarding manufacture.______
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_ C. LESSON WRAP-UP
1) What was the most useful or the most meaningful thing you have learned this session?
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Lesson Title: Health Care and the Near Future Part 3 Pen, paper, index card, book, and class List
Learning Targets:
At the end of the module, students will be able to: References:
1. Identify the uses of recombinant DNA and the possible
danger that it will result when use in a careless way; 2. Ethics of Health Care: A Guide for Clinical
Understand the politics of genetic screening; and, 3. Define Practice Fourth Edition, Raymond S. Edge, J.
Pharmacogenomics.
Materials:
Randall Groves
A. LESSON PREVIEW/REVIEW
Brain Teaser: The instructor will give questions to the students for them to answer. The students will write short answer
of what they have understood from the previous topic.
Answer:_________________________________________________________________________________________
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B. MAIN LESSON
Genetic screening is really a term that's used to help us identify a smaller group of people from a large population. And
this smaller group of people might have a higher risk of either having a disease, developing that disease, or potentially
having children who may have that disease as well. So I want to differentiate genetic screening from the term "genetic
testing". Genetic testing is focused on an individual; genetic screening is really focused on a whole population of people,
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trying to identify those specifically who are [at] increased risk to develop it or to have children with a condition in question
or the condition being screened for.
Recombinant DNA
- Scientists recombine genetic material from one organism to another for various reasons - Not always the case
people trained in the sciences are conscious of their ethical duties - Benefits from genetic engineering too great to
ignore
Genetic Pharmacy
• Pharmacogenomics
– Study of genetic variations that influence individual response to drugs
– Combines traditional pharmaceutical sciences with understanding of common DNA variations in
human genome
– One of the most productive and promising applications of genetic engineering
• Pharmacogenomics is the study of how genes affect a person’s response to drugs. This relatively new field
combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to
develop effective, safe medications and doses that will be tailored to a person’s genetic makeup.
• Many drugs that are currently available are “one size fits all,” but they don't work the same way for everyone. It
can be difficult to predict who will benefit from a medication, who will not respond at all, and who will experience
negative side effects (called adverse drug reactions). Adverse drug reactions are a significant cause of
hospitalizations and deaths in the United States. With the knowledge gained from the Human Genome Project,
researchers are learning how inherited differences in genes affect the body’s response to medications. These
genetic differences will be used to predict whether a medication will be effective for a particular person and to
help prevent adverse drug reactions. Conditions that affect a person’s response to certain drugs include
clopidogrel resistance, warfarin sensitivity, warfarin resistance, malignant hyperthermia, Stevens-Johnson
syndrome/toxic epidermal necrolysis, and thiopurine S-methyltransferase deficiency.
• The field of pharmacogenomics is still in its infancy. Its use is currently quite limited, but new approaches are
under study in clinical trials. In the future, pharmacogenomics will allow the development of tailored drugs to
treat a wide range of health problems, including cardiovascular disease, Alzheimer disease, cancer, HIV/AIDS,
and asthma.
1. This is the study of genetic variations that influence individual response to drugs?
A. Pharmacology
B. Pharmacist
C. Pharmacogenomics
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D. Gene therapy
Answer: C
Pharmacogenomics is the branch of genetics concerned with the way in which an individual's genetic attributes affect the
likely response to therapeutic drugs.___
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2. A variant form of a given gene, which may determine a trait such as having type O or type A Blood.
A. Eugenics
B. Heterozygous
C. Genetic testing
D. Allele
Answer: D
A variable version of a gene is known as an allele. Some genes exist in several distinct versions, all of which are foundat
the same genetic locus on a chromosome._______
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3. This is one of the most productive and promising applications of genetic engineering. A.
Gene therapy
B. Genetic pharmacy
C. Genetic testing
D. All of the above
Answer: __B
Genetic pharmacy is one of the most productive and promising applications of genetic engineering.______
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Instructions:
1. As an exit ticket at the end of the class period
2. Record three things you learned from the lesson.
3. Next, two things that you found interesting and that you’d like to learn more about.
4. Then, record one question you still have about the lesson.
Date: ________________
Lesson Title: Health Care and the Near Future Part 2 B. MAIN LESSON
Genetic engineering, sometimes called genetic modification, is the process of altering the DNA? in an organism’s
genome?
This may mean changing one base pair. (A-T or C-G), deleting a whole region of DNA, or introducing an
additional copy of a gene?
It may also mean extracting DNA from another organism’s genome and combining it with the DNA of that
individual.
Genetic engineering is used by scientists to enhance or modify the characteristics of an individual organism.
Genetic engineering can be applied to any organism, from a virus? to a sheep.
For example, genetic engineering can be used to produce plants that have a higher nutritional value or can
tolerate exposure to herbicides.
How does genetic engineering work?
To help explain the process of genetic engineering we have taken the example of insulin, a protein? that helps regulate
the sugar levels in our blood.
Normally insulin? is produced in the pancreas? but in people with type 1 diabetes? there is a problem with insulin
production.
People with diabetes therefore have to inject insulin to control their blood sugar levels.
Genetic engineering has been used to produce a type of insulin, very similar to our own, from yeast and bacteria?
like E. coli?
This genetically modified insulin, ‘Humulin’ was licensed for human use in 1982.
Date: ________________
Genetic Testing
Genetic testing is a type of medical test that identifies changes in chromosomes, genes, or proteins. The results of a
genetic test can confirm or rule out a suspected genetic condition or help determine a person’s chance of developing
or passing on a genetic disorder. More than 1,000 genetic tests are currently in use, and more are being developed.
Several methods can be used for genetic testing:
• Molecular genetic tests (or gene tests) study single genes or short lengths of DNA to identify variations or
mutations that lead to a genetic disorder.
• Chromosomal genetic tests analyze whole chromosomes or long lengths of DNA to see if there are large
genetic changes, such as an extra copy of a chromosome, that cause a genetic condition.
• Biochemical genetic tests study the amount or activity level of proteins; abnormalities in either can indicate
changes to the DNA that result in a genetic disorder.
Genetic testing is voluntary. Because testing has benefits as well as limitations and risks, the decision about whether
to be tested is a personal and complex one. A geneticist or genetic counselor can help by providing information about
the pros and cons of the test and discussing the social and emotional aspects of testing.
• Gene testing for the following reasons:
– Conformational diagnosis for symptomatic individual
Date: ________________
Date: ________________
abnormality._______:_______________________________________________________________________________
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3. In 2008, this act was passed to protect individuals from genetic discrimination by health insurers and employers.
A. HIPAA
B. EMTALA
C. GINA
D. BAIPA
Answer: __C
Individuals are protected from job discrimination based on genetic information under Title II of the Genetic Information
Nondiscrimination Act (GINA). Employers with 15 or more employees, including state and municipal governments, are
covered by GINA._____
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5. This is a disease that deforms red blood cells into thin, elongated sickle-shaped forms and causes anemia, cough, and
muscle cramps.
A. Sickle cell disease
B. Pernicious anemia
C. Down syndrome
D. Huntington disease
Answer: A
Sickle cell anemia is one of a group of disorders known as sickle cell disease. Sickle cell anemia is a hereditary red blood
cell condition in which the body's supply of healthy red blood cells is insufficient to transport oxygen throughout the body.
The flexible, spherical red blood cells normally flow freely across blood channels._______
Rationale:________________________________________________________________________________________
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_ C. LESSON WRAP-UP
Date: ________________
This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions, as
honest as possible, based on your own understanding.
1. What specific part of the Main Lesson for this session do you find the most confusing?
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2. What makes your answer in #1 confusing? What is the question in your mind?
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3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?
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Date: ________________
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Explain the promise of the human genome project; and,
References:
2. Understand genetic as social policy.
Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
A. LESSON PREVIEW/REVIEW
Brain Teaser: Write 3 important things they have learned from the last session.
1.
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2.
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3.
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_ B. MAIN LESSON
Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of
Energy (DOE) and the National Institutes of Health. During the early years of the HGP, the Wellcome Trust (U.K.) became
a major partner; additional contributions came from Japan, France, Germany, China, and others. Project goals were to
• identify all the approximately 20,500 genes in human DNA,
Date: ________________
• determine the sequences of the 3 billion chemical base pairs that make up human DNA,
• store this information in databases,
• improve tools for data analysis,
• transfer related technologies to the private sector, and
• address the ethical, legal, and social issues (ELSI) that may arise from the project
The term eugenics was coined in 1883 by British explorer and natural scientist Francis Galton, who, influenced by Charles
Darwin’s theory of natural selection, advocated a system that would allow “the more suitable races or strains of blood a
better chance of prevailing speedily over the less suitable.” https://www.britannica.com/science/eugenics-genetics
• Negative Eugenics
Ability to screen and prenatally test for genetic disease to eliminate genetic diseases defined
as prohibiting marriage and breeding between “defective stock”
• Positive Eugenics
Not only breeding but genetic intervention
Attempts to improve gene pool by increasing the numbers of those with positive attributes
defined as promoting the proliferation of “good stock”
Date: ________________
1. Which of the following provides a complete list of chemical letters that compose the map of a human genome?
A. Eugenics project
B. Stem cell research
C. Regenerative medicine
D. Human genome project
Answer: _D
_The Human Genome Initiative (HGP) was an international scientific research project aimed at discovering the base pairs
that make up human DNA, as well as identifying, mapping, and sequencing all of the human genome’s genes, both
physically and functionally._____
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3. Whose psychologist quoted that “For almost every behavioral trait so far investigated, from reaction time to religiosity,
an important fraction of the variation among people turns out to be associated with genetic variation.”
A. Thomas Bouchard
B. Dan Abnett
C. Dr. Fautus
D. None of the above
Answer: _A
Thomas J. Bouchard Jr. is an American psychologist best known for his behavioral genetics research on twins who were
reared separately_______
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Date: ________________
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4. The study of methods for controlling the characteristics of future human populations through selective breeding?
A. Human enhancement
B. Cryogenics
C. Eugenics
D. Genetic therapy
Answer: C
Eugenics is the practice or support of selecting marrying persons with specified desired genetic qualities in order to
improve the human species. Its goal is to alleviate human suffering by "breeding out" diseases, impairments, and other
“undesirable" traits from the human population.________
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5. As discussed in this chapter, The Republic, refers to the practice of infanticide for diseased or disabled newborns.
A. Faustus’
B. Plato’s
C. Socrates’s
D. Bauchard’s
Answer: ___B
Plato’s Republic is a Socratic discussion about justice, the order and character of the just city-state, and the good
individual, written approximately 375 BC_____
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_ C. LESSON WRAP-UP
Date: ________________
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Understand arguments for and against euthanasia; and,
References:
2. Discuss the nature of Hospice movement in the United States
and how this impact the debate regarding euthanasia.
Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
A. LESSON PREVIEW/REVIEW
Answer:
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B. MAIN LESSON
Mercy Killing
• Health care practitioner deliberately hastens death of a patient
• Practice prohibited under homicide laws
• “Consent and humanitarian motive” is never a defense under the law for murder
Date: ________________
Physician judgement
PAS is only legal if someone is mentally capable of making the choice. However, determining someone’s mental
capabilities isn’t very straightforward. One study Trusted Source found that doctors aren’t always capable of recognizing
when someone is fit to make the decision.
Ethics
• Some doctors and opponents of PAS are concerned about the ethical complications doctors could face. For more
than 2,500 years, doctors have taken the Hippocratic oath. This oath encourages doctors to care for and never harm
those under their care.
• Some argue that the Hippocratic oath supports PAS since it ends suffering and brings no more harm. On the other
hand, some debate it results in harm to the person and their loved ones, who must watch their loved one suffer.
Personal choice
“Death with dignity” is a movement that encourages legislatures to allow people to decide how they want to die. Some
people simply don’t want to go through a long dying process, often out of concern of the burden it puts on their loved
ones.
1. This care is given for people living with a serious illness to relieve pain and alleviate their suffering, example is patient
with terminal cancer? A. Rehabilitative care
B. Primary care
C. Secondary careD. Palliative care
Answer: __D
Palliative care is an interdisciplinary medical caregiving strategy focused at improving quality of life and reducing pain in
patients who are suffering from severe, life-threatening diseases.______
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2. These programs are set up to provide palliative care, abatement of pain and an environment that encourages dignity,
but they do not cure or treat intensively.
Date: ________________
A. Palliative programs
B. Hospice programs
C. Rehabilitation programs
D. None of the above
Answer: __B
Hospice care is a type of care that focuses on improving the quality of life for persons with advanced, life-limiting
illnesses..:________________________________________________________________________________________
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3. The best-known hospice in Great Britain, founded by Dr. Cicely Saunders in 1967?
A. St. Luke’s
B. St. Christopher’s
C. St. Agustin’s
D. All of the above
Answer: __B
She established St Christopher's Hospice in south west London in 1967. It is now one of many, yet it is still themarket
leader. It was a personal triumph for her, and it has been duplicated all around the world.______
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4. He is a noted ethicist and a theologian, In the situation of euthanasia he quoted that “It is harder morally to justify letting
someone die a slow and ugly death, dehumanized, than it is to justify helping him to escape from such misery.” A. Dr.
Cicely Saunders
B. Joel Feinberg
C. Christopher White
D. Joseph Fletcher
Answer: ___D
Joseph Francis Fletcher was an American academic who pioneered the subject of bioethics and established thenotion of
situational ethics in the 1960s. Fletcher was a notable academic proponent of abortion, infanticide,euthanasia, eugenics,
and cloning as possible advantages._____
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5. Euthanasia is synonymously known as which means putting a person to death painlessly or allowing them to die, as
withholding extreme medical measures a person is suffering from an incurable disease or condition? A. Mercy killing
B. Suicide
C. Homicide
D. Killing me softly
Answer: __A
Date: ________________
Mercy Killing is the death of a patient suffering from an incurable and severe condition, usually by administeringmassive
dosages of painkillers.______
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_ C. LESSON WRAP-UP
1) What was the most useful or the most meaningful thing you have learned this session?
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Brain Teaser: Enumerate the languages of DNR. Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
1. ___________ Randall Groves
Consider withholding of medical care for handicapped infants, reglect
• Exceptions
When infant chronically and irreversibly comatose
When treatment would only prolong dying When treatment would be futile, or inhumane Translated into
the language of personhood:
Infant who has no present or future potential for self-awareness or relationships can be said to have no
interests at all
Incomprehensible to provide life-extending care
Organ Donation
• Advances in technique and immunosuppressive drugs have made it possible to transplant:
Hearts
Lungs
Kidneys
Livers
Bone marrow
Skin
Corneas
Pancreases
• Survival and success rate progressively improving
• Shortage of supply
• Uniform Anatomical Gift Act
• Purely voluntary decision
• Organs may be donated by those close to individual
• Need to obtain family consent in time of grief and stress major barrier to organ procurement Volunteerism and
public education have not provided adequate supplies of donated organs
Euthanasia
Euthanasia refers to deliberately ending someone’s life, usually to relieve suffering. Doctors sometimes perform
euthanasia when it’s requested by people who have a terminal illness and are in a lot of pain.
It’s a complex process and involves weighing many factors. Local laws, someone’s physical and mental health, and their
personal beliefs and wishes all play a role.
Passive euthanasia is sometimes described as withholding or limiting life-sustaining treatments so that a person passes
more quickly. A doctor may also prescribe increasingly high doses of pain-killing medication. Overtime, the doses may
become toxic.
This makes the distinction between passive euthanasia and palliative care blurry. Palliative care focuses on keeping
people as comfortable as possible at the end of their life.
For example, a palliative care doctor might allow someone approaching death to stop taking a medication that causes
unpleasant side effects. In other cases, they might allow someone to take a much higher dose of a pain medication to
treat severe pain. This is often a standard part of good palliative care. Many don’t consider it euthanasia.
Key points
• Passive Euthanasia
1. The Baby doe regulations consider the withholding of medical care for these handicapped infants to be neglect. The
regulations provided three exceptions which are?
A. When the infant is chronically and irreversibly comatose
B. When the treatment would futile; or inhumane.
C. When treatment would only prolong dying.
D. All of the above
Answer: _D
All of the given choices are the exceptions of the baby doe regulations._____
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2. This Act was passed in the US in 1968 and has since revise in 1987 and in 2006. The act sets a regulatory framework
for the donation of organs, tissues, and other human body parts in the US?
A. Uniform Anatomical Gift Act of 2006
B. Patient Self-determination Act
C. Consumers Act
D. None of the above
Answer: ___A
The Uniform Anatomical Gift Act (UAGA) was changed in 2006 to allow the use of life support systems at or neardeath in
order to increase the number of medically appropriate organs available for transplantation._____
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3. With regards to Options for Increasing the Supply of Salvageable Organ, this option would require all competent adults
to decide and record whether they wish to become organ donors at their death.
A. Presumed consent
B. Mandated choice
C. Xenografting
D. All of the above
Answer: _B
Individuals are forced to indicate their contribution choices when performing a state-regulated duty under mandated
choice. Only after ensuring that the individual’s agreement to donate was established may physicians proceed with organ
procurement based on required choice.______
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4. Failing to revive a patient who has signed a DNR order is an example of what type of euthanasia?
A. Active euthanasia
B. Involuntary euthanasia
C. Passive euthanasia
D. All of the above
Answer: _C
When someone dies as a result of someone else's omission, this is known as passive euthanasia. Withdrawingtreatment:
for example, turning off a machine that is keeping a person alive so that they die of their sickness.Withholding treatment:
for example, withholding treatment until a person dies of their disease.______
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Instructions:
1. As an exit ticket at the end of the class period
2. Record three things you learned from the lesson.
3. Next, two things that you found interesting and that you’d like to learn more about.
4. Then, record one question you still have about the lesson.
Date: ________________
Learning Targets: Pen, paper, index card, book, and class List
At the end of the module, students will be able to:
1. Differentiate between “best interest” and “substituted”
References:
“judgment” standards as they relate to proxy decision; and,
2. Understand what DNR means and its guidelines.
Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves
A. LESSON PREVIEW/REVIEW
Brain Teaser: Write 3 important things they have learned from the last session.
1.
2.
3.
B. MAIN LESSON
Date: ________________
Informed Non-consent
• Patients who understand the nature of their conditions and the consequences of refusing
care
Court Ruling
• Acuity of patient is irrelevant to the allowance of treatment refusal
• Patient’s own perceived view of her quality of life and treatment requirements necessary to preserve it are of
paramount importance
• There is no meaningful legal distinction between mechanical life support and nasogastric feeding; both are
invasive
• Distinctions between withholding and withdrawing care are legally irrelevant
A do-not-resuscitate (DNR) order placed in a person’s medical record by a doctor informs the medical staff that
cardiopulmonary resuscitation (CPR) should not be attempted. Because CPR is not attempted, other resuscitative
measures that follow it (such as electric shocks to the heart and artificial respirations by insertion of a breathing tube) will
also be avoided. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of
life. The success rate of CPR near the end of life is extremely low.
Doctors should discuss with seriously ill patients the possibility of cardiopulmonary arrest (when the heart stops and
breathing ceases) in light of their immediate medical condition, describe CPR procedures and likely outcomes, and ask
patients about treatment preferences. If a person is incapable of making a decision about CPR, an authorized
surrogate may make the decision.
A DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted. Other treatments (for
example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided.
Depending on the person's condition, these other treatments are usually more likely to be successful than CPR.
Treatment that keeps the person free of pain and comfortable (called palliative care) should always be given.
Languages of DNR
- Code
- No code
- Slow code
- Chemical code
Date: ________________
1. Amira, a 40-year-old patient in coma has a DNR order placed in his medical chart to avoid the use of CPR. DNR
means?
A. Do Not Regurgitate
B. Do Not Revive
C. Do Not ResuscitateD. Do Not Retaliate
Answer: _C
A do not resuscitate order (DNR) is a legally enforceable order signed by a doctor at the request of a patient. Itsobjective
is to inform medical personnel that you do not wish to be resuscitated if you fall into cardiac arrest orcease breathing
unexpectedly._______
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3. Standard maintains that the decision about treatment or nontreatment must remain that of the patient, based on
the principle of autonomy. A. Parens patriae
B. Substituted judgement
C. Best-interest
D. All of the above
Answer: _B
A substituted judgment is one in which a “suitable surrogate” tries to figure out what the patient would havedesired in his
case._____
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4. The case of ___________ become the landmark decision regarding the right to informed non-consent
A. Karen Ann Quinlan case
B. Nancy Cruzan case
C. Elizabeth Bouvia case
D. Baby Doe case
Answer: _C
Elizabeth Bouvia is a prominent person in the pro-death movement. Her situation drew national attention to both this issue
and medical ethics._______
Rationale:________________________________________________________________________________________
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Date: ________________
5. This refers to the practice in a hospital or other medical center to purposely respond slowly or incompletely to a patient
in cardiac arrest, particularly in situations for which CPR is of no medical benefit.
A. No code
B. Chemical code
C. Code
D. Slow code
Answer: ___D
Slow code refers to the practice of responding slowly or incompletely to a patient in cardiac arrest in a hospital orother
medical facility, especially at cases where cardiopulmonary resuscitation (CPR) is of little medical use.____
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_ C. LESSON WRAP-UP
This strategy focuses on the assessment of your learnings after a lesson. You must answer the following questions, as
honest as possible, based on your own understanding.
1. What specific part of the Main Lesson for this session do you find the most confusing?
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2. What makes your answer in #1 confusing? What is the question in your mind?
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3. Since that is your most confusing lesson, what are the interventions that you must do to understand the topic?
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