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Since the family is permitted to selectively breed their kid so they can eliminate undesirable traits while preserving the desirable ones, it can be categorized as an instance of eugenics. (Perkowitz, 2017). Since only the eggs that don't exhibit any symptoms of the defective gene are to be used for fertilization, the child's human DNA was changed. The newborn was not at danger of developing Huntington's disease. It raises the likelihood that the world will become more neo-eugenic, even though it has been effective in treating the condition and lengthening life. Brave New World, a book by Aldous Huxley, avails a vision of a society that is based on eugenics
. It is based in 2540 whereby the breeding of people is done through artificial fertilization and thereafter classified as higher or lower class to sustain the dominant world state (Perkowitz, 2017). The higher classes will comprise those considered to be superior physically and intellectually thus being tasked with directing and controlling everything. Those in the lower classes will be limited thus their existence is only to facilitate the performance of menial jobs. This system is maintained via the chemical processing of human embryos and fetuses. Gattaca, a movie also depicts a genetic society. It helps in showing the consequences of editing DNA. In this setting, only those with the means can get the children they want thus giving them an early advantage over others (Perkowitz, 2017). Just like in the two scenarios, the parents can afford to give their child mental and physical advantages. The wealthy will be successful in doing away with the genes that make them susceptible to ailments preferring those that make people stronger, more intelligent, and stronger. In so doing, individualized evolution will be realized. Therefore, even though their actions are only meant to secure a better future for their kid, they still engage in genetic enhancement, which can be categorized as eugenics.
It is conventional for parents to desire a boy or a girl when they decide to have children. In so doing, many have often taken to consuming vitamins or having sex at a particular time in an attempt to influence the baby’s gender. In vitro fertilization also allows the parents to choose the baby’s sex, which gives them a higher chance of achieving this objective. Sex selection is still a contentious matter whereby different clinicians hold different opinions on the practice. Some of the critics find that it tends to upset reproduction’s natural process. Parents ought not to have such degree of control over the sex of the kid they will have. One reason is that it tends to weaken the idea of unconditional love and obligation since it enables them to make love conditional only if the child is a particular thing (Tempesta, 2016). Nevertheless, even though some claim that this is not the case, it serves as a push to a neo-eugenic society. Once humans start modifying the sex, there is no telling how far they will be willing to go including altering the height and eye color, which is fostered by the ability to preview and choose the genetic qualities of the prospective kids (Tempesta, 2016). In so doing, the world is moving closer to creating genetic haves and have-nots. The practice of choosing sex is not any different from that of selecting the eggs to undergo fertilization since they are both availed by genetic enhancement capabilities brought about by in vitro fertilization.
The mother is 32-years-old at the point of undergoing in vitro fertilization, which means that she could start showing signs when she turns thirty-five. Hence, the child will have to learn to care for the mother from a young age if her symptoms show early. In this way, a reversal of roles will be realized since she will be dependent while the young boy will have to meet these needs by adopting nurturing and supportive behaviors. Such disturbances in normal parent-child relationships make it unethical for the mother to go on to have a baby at that age owing to the adverse implications in children. The first one is that of internalizing issues such as anxiety, depressive symptoms, and somatic symptoms (Engelhardt, 2012). Also, they could externalize demeanors such as disruptive conduct and aggressiveness, self-harm, substance use, and attention-deficit disorder. Additionally, he could develop lower competency in interpersonal relationships in addition to having academic problems (Engelhardt, 2012). If such symptoms are left unresolved, his lifespan would be characterized by dysfunction.
Since the technology is available and the parents can afford these services, it is ethical for the couple to undertake genetic modification before having the child. The action can be considered to be ethical since it elicits optimal good consequences for their family. Such reasoning is arrived at because the child will be at no risk of getting HD in his adulthood in addition to ensuring that forthcoming generations do not suffer from the disease. Therefore, it brings about the maximal good compared to the alternative. Conversely, in absentia of such technology, it would be unethical to have children with full knowledge of being a carrier of the condition. The reason is that it could cause the creation of more people at risk of the disease. Some individuals that are HD carriers tend to have children thinking that a cure will be discovered in the rapidly evolving field of science and research (Quaid et al., 2010). However, such a notion may only result in the proliferation of the gene. Those that went on to have babies also got guilty feelings. Since only bad consequences are deemed to be accomplished, having the kid would be wrong.
The couple can be categorized as having acted ethically. The two maximized good implications for their household since the gene would not continue to affect future generations in addition to securing a longer and better life for their son. Their actions might also not encourage a pro-eugenic world since the practice could become regulated in the future to avoid such a scenario. Something is also considered to be ethical if it produces happiness in addition to diminishing unhappiness (Peterson, 2003). This couple desired to have a child even though the mother had a disease. When they found the solution of not passing the defective gene on, it would only be prudent that they attempt to fulfill their hearts’ desires. Also, it is not a surety that the mother would start showing signs while the boy was still young thereby leading to the kid not acquiring adverse qualities owing to a relationship disturbance. Therefore it would be wrong to withhold their happiness on this premise since she could show signs when the boy was a bit older.
Walking the Tightrope
The eighty-five-year-old widow’s autonomy is not being fully respected. Patients ought to be offered alternatives besides being allowed to make voluntary choices about their health care, even when it is life-changing. The only request by the woman that her attendants have reluctantly complied with is that of bed rest and undergoing regular repositioning. Her pain restricts her from walking, and she finds sitting in a wheelchair to be uncomfortable. These requests are misunderstood by the staff that is tasked with implementation thereby creating scenarios where her claims would experience delays before being completed. In so doing, her autonomy is not entirely respected since her chosen therapy is not liked by those attending to her even though it is her prerogative to decide her preferred mode of treatment. Additionally, her autonomy is not respected when surrogates, her son and daughter, make decisions that the medical practitioners attempt to follow without seeking her input yet she can be identified as a competent patient. According to medical standards, a patient is considered to be competent to make treatment choices if they possess an ample capacity to understand, have sufficient capability to contemplate and deliberate, possess a set of interests and apprehensions concerning the decisions, and can communicate the decision when it is made (Varelius, 2011). Within that framework, the woman has not been ruled out as not having the capacity to make rational treatment choices. Since she is still competent, then her decisions should have precedence over those of her children. Therefore, if her choice is for the pain to be managed as much as possible even though she begins drooling or becoming incapable of sitting up, then this decision should be respected. Under-medicating her leads to an infringement of her choice. Hence, the respect for her autonomy is contravened since her input is found to be annoying or it is not sought.
Having all parties, which include the patient, her children, and the doctor, sit down together would have been more efficient and ethical in efficiently controlling the pain levels that the woman was undergoing. The piecemeal approach that was adopted in the case was influential in leading to her hospitalization owing to dissenting views being held. Sitting down and discussing as a group would have allowed each party to share their experiences and outlooks on the probable course of action. Also, the implementation would have also been easier since all would have been invested in the solution reached during the meeting. In so doing, the doctor would cease receiving different directions from the parties since all would be aware of the action being taken in addition to its advantages and disadvantages relative to managing the patient’s pain. A meeting would also have been ethical since it would have allowed each party to air the decision they found to bring about optimal happiness and marginal unhappiness. The discussion would have helped in this assessment, and the best medical treatment for the patient would have been adopted.
Every patient ought to be accorded appropriate evaluation and management of pain. The fact that she was still in pain meant that she was being undertreated. This treatment method also put her at risk of liver and kidney toxicity, which if acquired would have resulted in more pain for her. Her initial pharmacologic treatment was inadequate since the tablets she took every four hours were insufficient in controlling her pain. Also, several non-steroidal anti-inflammatory drugs are usually designated as unsuitable for treating elderly individuals. However, in the case that NSAIDs are found to be the best option, doctors are always advised to adopt a start low, go slow tactic in managing pain (“AMDA Clinical Practice,” 2005). Therefore, the use of Nalfon should have been limited at the onset to allow a proper observation of how she reacted to this medication before increasing her dosage. Additionally, the comfort and wellbeing of a patient should always take precedence (“AMDA Clinical Practice,” 2005). The patient was in too much pain to walk and found the wheelchair to be uncomfortable thereby having her request bed rests and regular repositioning. However, she was tagged as a complainer, which is something that should not have happened because her comfort and wellbeing ought to have come first. This aspect is also evidence of the facility’s unpreparedness. Any barriers contravening residents’ comfort should be done away with including uncooperative staff. Hence, the pain treatment policies adopted at this facility failed to meet proper standards.
The nurse has a moral responsibility in pushing for the patient to undergo better assessment and handling of her pain. A nurse has more interactions with the patient in comparison with the doctor thereby having the former being best suited in noting that the patient is still uncomfortable and in pain. Also, a nurse is expected to communicate information concerning a resident’s pain regularly and promptly to those tasked with acting on such reports (“AMDA Clinical Practice,” 2005). Therefore, the nurse would be implementing an efficient execution of her duties in being more assertive in backing the patient’s wellbeing.
Adequate assessment of a patient is paramount since it is the foundation for clinical decision-making in addition to optimal care. Under-treatment is usually a result of the failure of doctors not conducting a proper evaluation, which can be made challenging by the fact that the woman is likely to be seen by a doctor after about two months. A physical condition ought to be done to allow for a comprehensive evaluation (Hadjistavropoulos et al., 2007). It should also be accompanied by looking at pertinent information gathered by her caregivers. Additionally, the doctor could look at self-report instruments that the patient uses, which will help in understanding what the woman is going through and the best way to assist her (Hadjistavropoulos et al., 2007). Therefore, a practical approach ought to be chosen to ensure the comfort and the well-being of the patient are safeguarded.
The utilitarianism theory states that human welfare should be maximized. In so doing, the right choice should be the one that generates optimal happiness while diminishing unhappiness (Peterson, 2003). Every patient finds happiness in getting relief from pain in their bodies. This ethical theory is thereby pertinent in the management of pain by dictating that the treatment approaches used by doctors and caregivers should be those that elicit maximal happiness in the patients. Also, they should bring about minimal discomforts for these patients. Therefore, the treatment method that causes the most pain relief for a patient should be the one that a patient is subjected to while under care.
AMDA Clinical Practice Guideline: Pain Management in ALFs. (2005). Retrieved September 25, 2017, from http://www.assistedlivingconsult.com/issues/01-03/ALC1-3_AMDAPain.pdf
Engelhardt, J. A. (2012). The Developmental Implications of Parentification: Effects on Childhood Attachment.
Hadjistavropoulos, T., Herr, K., Turk, D. C., Fine, P. G., Dworkin, R. H., Helme, R., ... & Chibnall, J. T. (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. The Clinical journal of pain, 23, S1-S43.
Quaid, K. A., Swenson, M. M., Sims, S. L., Harrison, J. M., Moskowitz, C., Stepanov, N., ... & Westphal, B. J. (2010). What were you thinking?: Individuals at risk for Huntington disease talk about having children. Journal of genetic counseling, 19(6), 606-617.
Peterson, M. (2003). From consequentialism to utilitarianism. The Journal of philosophy, 100(8), 403-415.
Perkowitz, S. (2017, April 5). How to Understand the Resurgence of Eugenics. Retrieved September 25, 2017, from https://daily.jstor.org/how-to-understand-the-resurgence-of-eugenics/
Tempesta, E. (2016, February 05). The rise of the designer baby: Parents who paid $16,500 to choose the sex of their child say the decision was a 'no-brainer' after spending years failing to conceive naturally. Retrieved September 25, 2017, from http://www.dailymail.co.uk/femail/article-3433718/The-rise-designer-baby-Parents-paid-20-000-choose-sex-child-say-decision-no-brainer-spending-years-failing-conceive-naturally.html
Varelius, J. (2011). Decision-Making Competence and Respect for Patient Autonomy.
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