1-Explain the legal issues of sterilization artificial insemination, and surrogacy.2-Describe the legal and moral issues of wrongful birth, wrongful life, and wrongful conception.3-Define Abortion and its classification.4-Discuss the following concepts: preservation of life with limits, euthanasia, advance directives, futility of treatment, withholding and withdrawal of treatment, and do-not-resuscitate orders.5-Discuss the purpose of an ethics committee and its consultative role in the delivery of patient care.6-Describe what AIDS is and how it is spread.7-Discuss confidentiality concerns for AIDS patients.8-Explain the importance of AIDS related education.9-Describe various forms of child abuse, how to recognize it, and reporting requirements.10-Explain why it is important to report communicable diseases, adverse drug reactions, and infectious diseasesC
Chapter 17
Legal Reporting Requirements
LEARNING OBJECTIVES
• Describe various forms of child abuse, how to
recognize it, and reporting requirements.
• Describe various forms of elder abuse, how to
recognize it, and reporting requirements.
• Discuss the importance of reporting births and
deaths.
• Explain why it is important to report communicable
diseases, adverse drug reactions, and infectious
diseases.
LEARNING OBJECTIVES – II
• Explain how and why physician incompetency is
reported.
• Understand the importance of incident reporting,
sentinel events and the purpose of “root cause
analyses.”
• Describe the elements of an effective corporate
compliance program.
Child Abuse
A child is one who has suffered intentional
serious mental, emotional, sexual, and/or
physical injury inflicted by a family or other
person responsible for the child’s care. Some
states extend the definition to include a child
suffering from starvation.
Child Abuse – II
• Reporting Child Abuse
• Detecting Abuse
– Physical Signs
• bruises
• burns
• broken bones
Child Abuse – III
• Behavioral Indicators
– diminished psychological & intellectual
functioning
– failure to thrive
– no control of aggression
– self-destructive impulses
– decreased ability to think & reason
– acting out & misbehavior
– habitual truancy
Good Faith Reporting
• Reasonable cause to believe injuries not
accidental.
• Professional not acting in bad faith to injure
another in filing an abuse report.
• Psychologist Immune from Liability
Failure to Report Child Abuse
• Psychologist
– failure to report past abuse
• Nurse
– failure to document and report
• Physician
– Text Case: Entitled to Immunity
Elder Abuse
Signs of Abuse – I
• Unexplained or unexpected death
• Development of “pressure sores“
• Heavy medication & sedation used in place of
adequate nursing staff
• Occurrence of broken bones
• Sudden emotional outbursts, agitation, or
withdrawal
• Bruises, welts, discoloration, burns, etc.
• Absence of hair and/or hemorrhaging below scalp
• Dehydration/malnourishment without illness
• Hesitation to talk openly
Elder Abuse
Signs of Abuse – II
• Implausible stories
• Unusual or inappropriate activity in bank accounts
• Signatures on checks & other written materials that
do not resemble patient’s signature
• Recent legal changes or creation of a will, when
person is incapable of making such decisions
• Missing personal belongings, including jewelry
• An untreated medical condition
• Patient unable to speak for himself or herself, or see
others, without presence of caregiver/suspected
abuser
Documenting Abuse – I
• Caregivers
– record symptoms and condition
• Witnesses
– record information provided by witnesses
• Photographs
– photograph injuries
– Preserve the evidence
– use of rape kits
Documenting Abuse – II
• Suspected abuse should be defined clearly &
objectively.
• Witnesses: Reporters of abuse must describe
statements made by others as accurately as
possible
– what actions were taken, by whom, when, where,
etc.
– Info should be included about how witnesses may
be contacted.
Documenting Abuse – III
• Photographs: It may be necessary to
photograph wounds or injuries.
– hospital emergency room or the police
department can be asked to photograph in
emergency situations.
Births & Deaths
• Reportable by statute
• Necessary to maintain accurate census records
• Suspicious Deaths
Suspicious Deaths
• Referral to medical examiner
• Violent deaths
• Criminal activity
• Medical Examiner
• Determines cause of death
• Provides information for criminal
investigation
Communicable Diseases
• Reported to protect citizens from infectious
diseases
• Reporting required by statutes
Adverse Drug Reactions
• harmful reactions that occur as a result of
administration of a drug or combination of
drugs
• Report adverse drug reactions to the FDA
– FDA https://www.accessdata.fda.gov
– FDA, 10903 New Hampshire Avenue Silver Spring,
MD 20993
– 800-332-1088 or 888-463-6332
HOSPITAL-ACQUIRED INFECTIONS
• 2006, Archives of Internal Medicine
– up to 98,000 deaths annually
• Approximately 30 states have requirements to
report infections
• 2010 PPAHCA requires acute care hospitals to
report hospital-acquired infections or be
subjected to reduction in Medicare
reimbursement.
Physician Competency
• Health Care Quality Improvement Act of 1986
– Authorizes National Practitioner Data Bank
to collect & release information on
competence & conduct of health care
practitioners.
National Practitioner
Data Bank
• Reporting requirements
• Required queries
– Medical Staff Privileges
• Who should report?
• Data bank queries
• Confidentiality of data bank information
Incident Reporting
• Hospital Incident Reports
– do not place in patient’s record
– direct reports to legal counsel to help prevent
discovery
• State Reportable Incidents
– defined by state law/regulations
• Infections
• patient injuries
• Failure to Report
JCAHO Reportable
Sentinel Events
• Events that result in an unanticipated death or major
permanent loss of function
• Sentinel Events include
– Suicide
– Unanticipated death of a full term infant
– Infant abduction
– Rape
– Hemolytic transfusion reaction
– Wrong site surgery
JCAHO Reportable
Reporting Sentinel Events
• http://jointcommission.org/
• The Joint Commission, One Renaissance
Blvd. Oakbrook Terrace, IL 60181
• Washington DC Office, 601 13th Street,
NW Suite 560 South, Washington, DC 20005
• Phone: 630-792-5800
• Fax number: 630-792-5005
Root Cause Analysis – I
A process for identifying the basic or causal
factors that underlie the variation in
performance including the occurrence or
possible occurrence of a sentinel event.
Root Cause Analysis – II
• Thorough
• Credible
• Investigation involves general & special causes
• Researching literature
• Searching for best practices
• . . . implementing & monitoring change
REVIEW QUESTIONS – I
1. What is child abuse?
2. Who should report child abuse?
3. Describe the signs of elder abuse.
4. Why was the HCQIA of 1986 enacted?
5. Describe the purpose of the National Practitioner
Data Bank.
6. What is a sentinel event?
7. Discuss the process of conducting a root-cause
analysis.
Chapter 16
Acquired Immune Deficiency
Syndrome
LEARNING OBJECTIVES
• Describe what AIDS is and how it is spread.
• Discuss confidentiality concerns for AIDS
patients.
• Describe how AIDS patients are discriminated
against.
• Explain the importance of AIDS related
education.
AIDS
• Deadliest epidemic in human history.
• Collection of specific, life-threatening,
opportunistic infections & manifestations that
are result of underlying immune deficiency.
• Caused by HIV, highly contagious blood-borne
virus is most severe form of HIV infection.
• Destroys body’s capacity to ward off bacteria
& viruses that ordinarily would be fought off
by immune system.
Spread of AIDS
• Body Fluids
– Breast Milk
• Blood transfusions
• Sexual Transmission
– Vaginal secretions
– Semen
– Partner’s Right to Know
• Healthcare Workers Transmission
Confidentiality
• Patients have a right to privacy.
• An individual’s HIV status must be kept
confidential.
• Patient information can be shared with other
health professionals
– for purposes of patient care on a need to
know basis.
Unauthorized Disclosure
• Estate of Behringer v. Med, Ctr, at Princeton
– Hospital & lab director breached duty by
allowing a surgeon’s test results to be
placed in medical record.
– Hospital should have taken reasonable
precautions to prevent disclosure.
Proper Disclosure
• Tarrant Cty. Hospital District v. Hughes
– wrongful death action alleging patient
contracted AIDS from blood transfusion
administered in hospital.
– societal interest in maintaining an effective
blood donor program did not override
plaintiff’s right to receive such information.
– court order prohibited disclosure of donors’
names to 3rd parties.
Duty & Right to Confidentiality
• Right to know when caring for patients with
highly contagious diseases.
• Times when duty to disclose out ways rights to
confidentiality.
• A prisoner has limited privacy rights.
• Prison authorities have strong interest in
preventing the spread of HIV.
Confidentiality
Sexual Partners
• Person has right to know when his or her
partner has tested positive for HIV.
• Physicians expected:
– counsel HIV-positive patient to notify
sexual partners or
– to seek help in doing so from public health
officials.
• Some states have developed informational
brochures & consent, release, & partner
notification forms.
Mandatory Testing
• U.S. District Court found routine testing of
firefighters & paramedics for AIDS virus does
not violate individual’s 4th Amendment or
constitutional privacy rights.
– caregivers high-risk group for contracting &
transmitting HIV to public.
– city has compelling interest & legal duty to
protect public from contracting virus.
• Anonymous Fireman v. Willoughby
Discrimination
• Access to Health Care
– Right to Treatment
• Education
• Employment
• Insurance Benefits
Negligence
• Administration of Wrong Blood
• Failure to Make Timely Diagnosis
• Patient Wrongly Notified She Had AIDS
• Insurance Company Fails to Disclose HIV
Status
Reporting Requirements
• AIDS is reportable communicable disease in
every state.
• Physicians & hospitals must report with
patient’s name—to government public health
authorities.
AIDS Emergency Act
• Provide emergency assistance to localities that
are disproportionately affected by HIV
epidemic & make financial assistance available
to States & other public or private nonprofit
entities to provide for development,
organization, coordination & operation of
more effective & cost efficient systems for
delivery of essential services to individuals &
families with HIV.
OSHA & AIDS
• OSHA requires health care organizations to
implement strict procedures to protect
employees against AIDS virus.
• OSHA requires strict adherence to guidelines
developed by CDC.
• Complaints investigated by OSHA can result in
issuance of fines for failure to comply with
regulatory requirements.
Protecting Caregivers – I
• Personal Protective Devices
– Gloves
– Masks
– Gowns
– Goggles
• Engineering Controls
– sharps disposal containers
– ventilation systems
Protecting Caregivers – II
• Work Practices
– hand washing
– use of needles
– safe collection, transporting & disposal of body
fluids
• Practice Universal Precautions
– infection control guidelines
– prevent contact with patient blood & body fluids
– Assume all patients infected for blood-borne
diseases such as AIDS & hepatitis B
CHAPTER REVIEW – I
1. Describe how AIDS patients are discriminated
against.
2. Discuss the privacy and confidentiality issues of HIVpositive patients.
3. Should a hospital be permitted to publish identity of
AIDS patients in order to protect other patients and
staff?
4. Is AIDS a reportable disease? Why?
5. What steps can be taken to help prevent spread of
AIDS
Chapter 15
End-of-Life Issues
LEARNING OBJECTIVES
• Discuss the human struggle to survive and the
right to autonomous decision-making.
• Describe how patient autonomy has been
impacted by case law and legislative enactments.
• Discuss the following concepts: preservation of
life with limits, euthanasia, advance directives,
futility of treatment, withholding and withdrawal
of treatment, and do-not-resuscitate orders.
LEARNING OBJECTIVES – II
• Discuss the purpose of an ethics committee
and its consultative role in the delivery of
patient care.
• Explain end-of-life issues as they relate to
autopsy, organ donations, research
experimentation, and clinical trials.
• Describe how human genetics and stem cell
research can have an impact on end-of-life
issues.
Dreams of Immortality
• Human struggle to survive
• Desire to prevent & cure illness
• Advances in medicine & power to prolong life
• Process of dying can be prolonged
• Ethical & legal issues have increased
– involving entire life span, from right to be
born to right to die
Scope of Ethical Issues
• Entire Life Span
• The Right to be Born
• The Right to Die, &
• Everything in between, e.g.,
– to choose treatment
– to refuse treatment for oneself
– to refuse treatment for another
– to limit the suffering one would endure
Ethical Dilemmas Arise
When values,
rights,
duties
& loyalties conflict.
Autonomy
• Right of a person to make one’s own decisions.
• Patient has right to accept or refuse care even
if it is beneficial to saving his or her life.
• Autonomy may be inapplicable in certain
cases
– affected by one’s disabilities, mental status,
maturity, or capacity to make decisions.
Quinlan court
Relying on: Roe v. Wade
• Announced the constitutional right to privacy
protects a patient’s right to selfdetermination.
• State’s interest did not justify interference
with her right to refuse treatment.
• Quinlan’s father was appointed her legal
guardian
Cruzan Case
• Supreme Court held that right-to-die should be
decided pursuant to state law, subject to a dueprocess liberty interest, and in keeping with state
constitutional law.
• Cruzans returned to Missouri probate court:
– Judge Charles Teel authorized physicians to
remove the feeding tubes from Nancy.
– testimony presented demonstrated clear &
convincing evidence Nancy would not have
wanted to live in a persistent vegetative state.
Legislative Response: Patient SelfDetermination Act of 1990
• Requires healthcare organizations to explain
to patients their legal right to direct their own
care
• Right to refuse medical treatment
• Right to formulate advance directives
• Right to appoint surrogate decision-maker
• Federal reimbursement requires compliance
with Act
Preservation of Life
• Medical ethics does not require patient’s life
be preserved at all cost under all
circumstances.
• Ethical integrity
– of a profession is not compromised by a
patient’s decision to forego medical care.
• Right to body integrity.
Euthanasia
• Mercy killing of hopelessly ill, injured or
incapacitated
• Active
– intentional commission of an act, such as
giving patient lethal drug
• Passive
– occurs when life-saving treatment (such as
a respirator) is withdrawn or withheld
Physician-Assisted Suicide
• Oregon’s Death with Dignity Act of 1994
– physician-assisted suicide became a legal medical
option for the terminally ill residents
• U.S. Supreme Court, in two unanimous & separate
decisions, ruled
– laws in Washington & New York prohibiting
assisted suicide are constitutional
– yet U.S. Supreme Court also ruled that states can
allow doctors to assist in suicide of their
terminally ill patients.
Advance Directives – I
• Making Preferences Known
– Obligation to make medical preferences
known to treating physician.
– Any glimmer of uncertainty as to a patient’s
desires in an emergency situation should be
resolved in favor of preserving life.
Advance Directives – II
• Living Will
• Health Care Proxy
• Determining Incapacity
• Agent’s Rights
• Durable Power of Attorney
• Guardianship
• Substituted Judgment
Futility of Treatment
• Physician recognizes effect of treatment will
be of no benefit to the patient.
• Morally, a physician has a duty to inform
patient when there is little likelihood of
success.
• Determination as to futility of medical care is a
scientific decision.
Withholding & Withdrawing
Treatment – I
• Withholding of treatment
– decision not to initiate treatment or medical
intervention for the patient.
• Withdrawal of treatment
– decision to discontinue treatment or medical
interventions for the patient.
Withholding & Withdrawing
Treatment – II
• When
– Patient in a terminal condition & there is
reasonable expectation of imminent death.
– Patient a non-cognitive state with no reasonable
possibility of regaining cognitive function.
– Restoration of cardiac function will last but for a
brief period.
DNR Orders
• DNR orders written by a physician, indicate
that in event of cardiac or respiratory arrest,
no resuscitative measures should be used to
revive patient.
Ethics Committee
• Committee offering objective counsel when
facing difficult health care issues & decisions
resource to patients, families, & staff.
• Includes wide range of community leaders.
• Analyzes ethical dilemmas, advise & educate
health care providers, patients, & families.
• Assists patients & family in coming to
consensus with options that best meet
patient’s care needs.
Ethics Committee Function
• Policy & procedure development
• Educational role
• Consultative role
• Political Advocacy
Autopsy
• Postmortem examinations to determine cause
of death.
• Add to medical knowledge.
• Necessary for criminal activity or suspicious
deaths.
• Deaths during surgery are reportable.
• Consent required.
Organ Donations – I
• Federal regulations
– hospitals to have, & implement, written
protocols regarding organ procurement.
– notification duties concerning informing
families of potential donors.
• Discretion & sensitivity in dealing with
families.
Organ Donations – II
• Education
– facilitate timely donation & transplantation
• Uniform Anatomical Gift Act
– allows a person to make a decision to
donate organs at the time of death and
allows potential donors.
Organ Donations – III
• Millions of people suffer from kidney disease,
but in 2007 there were just 64,606 kidneytransplant operations in the entire world. In
the U.S. alone, 83,000 people wait on the
official kidney-transplant list. But just 16,500
people received a kidney transplant in 2008,
while almost 5,000 died waiting for one.
—Alex Tabarrok, The Wall Street Journal,
January 8, 2010
Research, Experimentation
& Clinical Trials
• Combination of federal & state regulations
– Office of Research Integrity
• Institutional Review Board
• Informed Consent
• Duty to Warn
– Risks, benefits, alternatives
• Food & Drug Administration
Organ Human Genetics – I
• Study of inheritance as it occurs in human
beings, includes stem cell research, clinical
genetics (e.g., genetic disease markers) &
molecular genetics.
• Genetic markers are genes or DNA sequences
with a known location on a chromosome that
can be used to
– identify specific cells & diseases
– individuals & species
Organ Human Genetics – II
• Genetic Information Nondiscrimination Act of
2008 prohibits
– discrimination on the basis of genetic
information with respect to the availability
of health insurance & employment
– employers from using an individual’s
genetic information when making hiring,
firing, job placement, or promotion
decisions
STEM CELL RESEARCH
• Use of embryonic stem cells to create organs
and various body tissues.
– highly controversial, involving religious
beliefs and fears as to how far scientists
might go in their attempt to create, e.g.,
another human being.
When We Finally Know
… When we finally know we are dying,
All sentient beings are dying with us,
We start to have a burning, almost heartbreaking sense of the fragility and
preciousness of each moment and each being,
and from this can grow a deep, clear, limitless
compassion for all beings.
?Sogyal Rinpoche
REVIEW QUESTIONS – I
1. Discuss how one caregiver’s beliefs can be in
conflict with another when making end-of-life
decisions. Consider topics discussed on morality,
virtues, situational ethics, autonomy, and medical
paternalism when framing your answer.
2. Discuss the ever-expanding role of ethics
committees, including internal operational issues &
external influences that affect internal operations.
3. What are the differences between allowing a
patient to die and physician-assisted suicide?
REVIEW QUESTIONS – II
4. Examine the statement: “The inherent risk is
that society’s faith in doctors as healers
would become subverted if doctors
participate in physician-assisted suicide.“
5. Constitutionally, what gives patients the right
to self-determination?
6. Explain why you think the Schiavo case is an
example of legislating morality.
Chapter 14
Procreation and Ethical
Dilemmas
LEARNING OBJECTIVES
• Discuss the 1973 Supreme Court ruling in Roe v.
Wade and the continuing controversy over abortion.
• Describe the flow of abortion cases beginning with
Roe v. Wade, concentrating on counseling, spousal
consent, parental consent, and funding.
• Explain the legal issues of sterilization artificial
insemination, and surrogacy.
• Describe the legal and moral issues of wrongful birth,
wrongful life, and wrongful conception.
Abortion
• Premature termination of pregnancy.
• It can be classified as spontaneous or induced.
• It may occur as an incidental result of a
medical procedure or it may be an elective
decision on the part of the patient.
Section
U.S. SUPREME COURT DECISIONS
Right to Abortion
Roe v. Wade – 1973
• First Trimester
– abortion decision between woman & physician.
• Second Trimester
– state may reasonably regulate abortion
procedure.
• Third Trimester
– state may prohibit all abortions except those
deemed necessary to protect maternal life or
health.
Abortion Committee Requirement
Doe v. Bolton – 1973
• To Restrictive
• Requirements struck down
– residency
– performance of abortion by Joint Commission
approved hospital
– approval of abortion by a medical staff committee
– consultations
Abortion Funding
• Not Required for Elective Abortions
– In Beal v. Doe, 1977
– Court ruled that it is not inconsistent with the
Medicaid portion of the Social Security Act to
refuse to fund unnecessary medical services.
– Maher v. Roe
– Supreme Court voted 6 to 3 states may refuse to
spend public funds to provide non-therapeutic
abortions.
• Not Required for Therapeutic Abortions
Funding Bans
Unconstitutional in California
• If the state cannot directly prohibit a woman’s
right to obtain an abortion, may the state by
discriminatory financing indirectly nullify that
constitutional right?
• Can the state tell an indigent person that the
state will provide him with welfare benefits
only upon the condition that he join a
designated political party or subscribe to a
particular newspaper that is favored by the
government?
Funding Bans
Unconstitutional in California
• Can the state tell a poor woman that it will
pay for her needed medical care but only if
she gives up her constitutional right to choose
whether or not to have a child?
Discrimination in Funding Prohibited
Simat Corp. v. Arizona Health Care Cost Containment Sys.
• The Arizona Supreme Court in Simat Corp. v.
Arizona Health Care Cost Containment Sys., found
that the state’s constitution does not permit the
state & the Arizona Health Care Cost
Containment System to refuse to fund medically
necessary abortion procedures for pregnant
women suffering from serious illness while, at the
same time, funding such procedures for victims
of rape or incest or when the abortion was
necessary to save the woman’s life.
States May Protect Viable Fetus
Colauti v. Franklin 1979
• The Supreme Court in Colautti v. Franklin
voted 6 to 3 that states may seek to protect a
fetus that a physician has determined could
survive outside the womb. Determination of
whether a particular fetus is viable must be a
matter for judgment of the physician.
Consent – I
• Missouri: Parental Consent Statute Ruled
Unconstitutional
• Massachusetts: Parental Consent Statute
Ruled Unconstitutional
• Utah: Notifying Parent for Immature Minor
Constitutional
• Consent Not Required for Emancipated Minor
Consent – II
• Parental Notification Not Required
• Minor’s Decision to Abort Found Sufficient
• Abortion Case Returned to Lower Court
• Minor’s Decision to Abort Not Sufficient
• State Interest Not Compelling
Consent – III
• Spousal Consent Requirement
Unconstitutional
• Father of Unborn Fetus Could Not Stop
Abortion
• Spousal Consent Undue Burden
Parental Consent
Bellotti v. Baird – 1979
• Parental consent requirement struck down.
• MA statute too restrictive.
– statute as written & construed, no minor, no
matter how mature & capable of informed
decision making, could receive an abortion
without the consent of either both parents or a
superior court judge, making minor’s abortion
subject in every instance to an absolute thirdparty veto.
Parental Notification Not Req’d
Planned Parenthood v. Owens – 2000
• Colorado Parental Notification Act, Colo. Rev.
Stat. § § 12-37.5-101, et seq. (1998), which
required physician to notify parents of a minor
prior to performing an abortion upon her,
violates minor’s rights protected by the U.S.
Constitution.
• The act generally prohibited physicians from
performing abortions on an unemancipated
minor until at least 48 hours after written
notice has been delivered to minor’s parent,
guardian, or foster parent.
Immature Minors
H.L. Matheson 1981
• Statute requiring physician to notify parents of
minor, when possible, upheld.
• Parental notice does not violate constitutional
rights of immature, dependent minor.
• State may not, however, legislate a blanket unreviewable power of parents to veto their
daughter’s abortion.
Emancipated Minors
In re Anonymous – 1987
• Consent Not Required for Emancipated Minor.
Spousal Consent Not Required
Doe v. Zimmerman – 1975
• Provisions Pennsylvania Abortion Control Act
requiring written consent of the husband
unconstitutional.
• Provisions impermissibly permitted husband to
withhold his consent either because of his
interest in potential life of the fetus or for
capricious reasons.
• Although father’s interest in the fetus was
legitimate, it did not outweigh the mother’s
constitutionally protected right to an abortion.
Abortion Rights Reaffirmed
Planned Parenthood v. Casey – 1992
• Restricting Right to Abortion Affirmed
– right of women to have an abortion.
– State’s power to restrict abortions after
fetal viability.
– principle that state has legitimate interests
in protecting woman & life of fetus.
Abortion Rights Reaffirmed
Casey, con’t – 1992
• Undue burden to require spousal notification
• Not undue burden to require:
– informed consent of nature of abortion procedure
& risks involved.
– informed consent be provided before abortion
– information be provided on the fetus &
alternatives to abortion
– parental consent be given a minor seeking
abortion, providing for judicial bypass option
– 24-hour waiting period before any abortion can be
performed.
Abortion Counseling
City of Akron v. Akron Center – 1983
• Physician Counseling of Patient Upheld
– States cannot mandate what information
physicians provide abortion patients.
• Hospital deliveries
– States cannot mandate that abortions for
women over 3 months pregnant be
performed in hospital.
Prohibition Abortion Counseling
Rust Sullivan – 1991
• Regulations prohibiting abortion counseling &
referral by family planning clinics that receive
funds under Title X were held to be
constitutional.
24-Hour Waiting Period
Not Burdensome
• State may place some restrictions on
previability abortions.
• Restrictions must not impose an “undue
burden” on woman.
Incompetent Persons
• An abortion was found to have been proper
by a family court in In re Doe
– for retarded woman
– court properly chose welfare agencies as
guardian
– mother apparently had little contact with
her daughter
Viability Test Required
Webster v. Reproductive – 1989
• Statute upheld providing that no public
facilities or employees should be used to
perform abortions.
• Physicians should conduct viability tests
before performing abortion.
Partial Birth Abortion – I
• D&E Ban Constitutionally Vague
– Women’s Medical Professional Corp. v.
Voinovich
• Partial-Birth Abortion Ban Act
Unconstitutional
– Little Rock Family Planning Services v. Jegley
• Partial-Birth Abortion Statute Vague
– Planned Parenthood of Cent. N.J. v. Farmer
Partial Birth Abortion II
• Partial-Birth Abortion: Ban Unconstitutional
• 2002 Stenberg v. Carhart
– ban lacked an exception to protect the
health of the mother
• 2003: President Bush signs federal restrictions
banning late term abortions.
Partial Birth Abortion – III
• 2005 Partial-Birth Abortion Act
– 2005: Bush administration asked the Supreme
Court to review an appellate court’s decision
holding the Partial Birth Abortion Act of 2003
unconstitutional.
• 2006: U.S. Supreme Court Justices heard oral
arguments on November 8 in what may be two of
the most significant abortion rights cases in decades.
The dispute involves Congress’s ban on partial birth
abortion.
Partial Birth Abortion – IV
• Partial-Birth Abortion Act: First Federal
Restrictions
– 2006 National Abortion Federation v.
Gonzages
» ban lacked an exception to preserve
health of mother
Continuing Controversy
• Physician Concern
– Antiabortion Demonstrations
– Obstructing Access to Abortion Clinics
Abortion & Conflicting Beliefs
• Two or more ethical principles in conflict with one
another considered “ethical dilemmas.
• Morality of Abortion
– not a legal or constitutional issue
– matter of philosophy, ethics, & theology
– subject where reasonable people can, and do,
adhere to vastly divergent convictions and
principles
– Obligation to define liberty of all
– not to dictate our own moral code.
Sterilization
• Termination of the ability to produce offspring
– Elective Sterilization
– Regulation of Sterilization for Convenience
– Therapeutic Sterilization
– Involuntary/Eugenic Sterilization
Artificial Insemination
• Injection of seminal fluid into a woman to
induce pregnancy, takes place outside of the
woman’s
– Homologous arti?cial insemination
– Heterologous arti?cial insemination
– Consent Required
– Confidentiality must be maintained
Surrogacy
• Method of reproduction whereby a woman
agrees to give birth to a child she will not raise
but hand over to a contracted party
• Surrogate may be the child’s
– genetic mother
– gestational carrier
Wrongful Birth,
Life & Conception
• Wrongful Birth
• Wrongful Life
• Wrongful Conception
• Prevention of Lawsuits
REVIEW QUESTIONS – I
1. Discuss the legal and ethical issues involved in
Roe v. Wade.
2. Do you agree that individual states should be
able to place reasonable restrictions or
waiting periods? Discuss your answer.
3. Should a married woman be allowed to abort
without her husband’s consent?
4. Discuss arguments for & against partial-birth
abortions.
REVIEW QUESTIONS – II
5. Explain why you think Roe v. Wade is an
example of legislating morality.
6. Do you agree that eugenic sterilization should
be allowed? Why or why not?
7. Describe the distinctions among wrongful
birth, wrongful life, and wrongful conception.

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