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Healthcare: Emerging Ethical Issues

Select an emerging issue that will pose new ethical dilemmas for healthcare. For example, technology integration, innovation testing, genetic mapping, stem cell research, etc.

QUESTIONS:

1. Using APA format, analyze whether global competition affects U.S. healthcare policy?
2. For example, stem cell research in Europe but not here, how will that affect our economy and our health care options?
3. Also indicate, how the U.S. should handle licensing and liability issues for clinicians practicing telemedicine across state or national borders.

I need help with these questions for ideas and insights? Thank you.

Solution Preview

RESPONSE:

A tentative outline might look something to the effect:

I. Introduction
II. Ethics and Policies on Genetic Mapping
A. US Policies (e.g., genetic mapping, transplants- fetus, embyoinic stem cell, brain cells; research, etc.)
B. Economic and health choices Implications
C. Practice of Telemedicine across state of national borders (e.g. license and liability, etc.)
III. Conclusions (e.g. sum up main points)

Now let's look at some information for each section for you to consider.

Genetic mapping has a fairly short history. In 1990, the Human Genome Project (HGP) was initiated ito support and coordinate efforts of the National Institutes of Health (NIH) and the Department of Energy (DOE) to produce a complete genetic map of all human genes. The Ethical, Legal, and Social Implications (ELSI) Program of the HGP was charged with anticipating the social consequences of the acquisition of this knowledge and developing policies to guide its use. With 5% of the genome budget supporting ELSI activities, the ELSI Program is both the first federally supported extramural research initiative in ethical issues and the largest source of public funds for bioethics (http://www.acnp.org/G4/GN401000180/CH176.html).

There is a rising demand for genetic information. In the United States, for example, demand has led to the growth of private genetics services that are marketed directly to the public. On the other hand, in the United Kingdom, specialist genetic services have increased workloads and recognized the need for some genetics services will have to be incorporated into mainstream clinical medicine, particularly at primary care level. Genetic mapping of diseases, such as Parkinson's disease has also resulted in ethical issues related to transplants using fetal and embryonic stem cells (Kinmonth, Reinhard, Bobrow & Pauker, 1995, as cited in http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1112731).

Ethical issues that arise for genetic mapping include informed consent, justice, gender justice, privacy, confidentiality, discrimination, genetic discrimination, health-care needs, or private health insurance versus a national health service are familiar ones. For example, there are challenges to the premises of a private health insurance system presented by genetic screening. http://www.acnp.org/G4/GN401000180/CH176.html).

Genetic Mapping and Screening of Genetic Diseases

Genetic mapping for certain diseases, such as Parkinson's, diabetes, Alzheimer disease and related policies have implications for access and economics in health care. For example, with the number of cases of Parkinson's, having health policies that allow investing in Parkinson's and other neurological research will not only save millions of Americans from immense suffering; it is also an economic tool that will help fight the deficit, pay for health care reform, and strengthen the U.S. economy -- in this decade (http://www.kingwoodcable.com/martone/parkinso.htm). In the global sense, it also keeps the US competitive with its European counterparts. (see article at http://wormbook.sanger.ac.uk/chapters/www_twopointmapmarkers.2/twopointmapmarkers.html)

A national policy has yet to be developed governing population-based screening of genetic disease. For example, the debate over population-based screening for the gene for cystic fibrosis (CF) has begun (2000). However, earlier screening programs, particularly screening for the gene for sickle cell anemia in the African-American population, failed to clearly establish program goals, failed to distinguish promotion of patient autonomy from the motivation of the public health community (i.e., distinguish reproductive choices from the public health concern to decrease the incidence of the disease or the gene in the population), and led to discrimination by employers, including the military, as well as the loss of insurance. The development of the screening program for gene for Tay-Sachs disease in the Jewish community benefited from the sickle cell experience and has resulted in successful population-based screening with high community acceptance and minimal adverse effects (http://www.acnp.org/G4/GN401000180/CH176.html).

To address discrimination issues, Congress sent President Bush Anti-Genetic Discrimination Bill (2008) to sign forbidding employers and insurance companies from using genetic tests showing people are at risk of developing cancer, heart disease or other ailments to reject their job applications, promotions or health care coverage, or in setting premiums (http://www.foxnews.com/story/0,2933,354210,00.html). See the bill at http://www.ornl.gov/sci/techresources/Human_Genome/publicat/GINAMay2008.pdf and other infromation ...

Solution Summary

Referring to an emerging ethical issues (technology integration, innovation testing, genetic mapping or stem cell research), this solution responds to the questions comprehensively through discussion, research and examples. This solution provides a tentative outline and a variety of examples and resources to help the student build their paper.

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