Chapter 09: Ethical and Legal Issues Related to Advancing Science and Technology

Keatings: Ethical & Legal Issues in Canadian Nursing, 4th Edition

Multiple Choice

1. Which of the following technologies will have the strongest influence on future generations?

a. Gene editing b. In vitro fertilization (IVF) c. In utero surgery d. Genetic testing

ANS: A

Feedback

A Correct! Gene editing targets egg and sperm cells (germ cells), which would allow the change to be passed on to future generations. It involves making changes to the body’s basic foundation, that which drives all components of that person.

B Incorrect IVF involves fertilization and conception in a laboratory setting; manipulation of genes is not involved.

C Incorrect This will benefit the future of the individual.

D Incorrect Genetic testing identifies specific disorders; it does not make specific alterations to the gene itself.

DIF: Cognitive level: Analysis a. The gene associated with diseases such as Huntington’s chorea can be identified, and thus, the disease can be prevented. b. Genetic testing is the key to precision medicine. c. The results are shared with all family members. d. Genetic testing helps identify a person’s ancestry.

2. Which of the following is a major advantage of genetic testing?

ANS: B

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A Incorrect There is no cure for diseases such as Huntington’s chorea, raising questions as to whether one would want to know this in advance.

B Correct! Precision medicine targets therapies tailored to an individual's unique genome.

C Incorrect Other families may not want to know the information identified from genetic testing, nor might the individual want this information shared, raising other ethical issues.

D Incorrect Genetic testing focuses on a particular gene, not the person’s genome.

DIF: Cognitive level: Analysis a. Coercion and beneficence b. Informed consent and confidentiality c. Beneficence and confidentiality d. Nonmaleficence and truth telling

3. Which of the following ethical considerations are most relevant to whole genome sequencing?

ANS: B

Feedback

A Incorrect There are many benefits, but there is also the potential for harm to the person tested or to others. Coercion is addressed through rigorous approaches to informed consent.

B Correct! This technology raises major ethical issues related to informed consent specifically, ensuring that the person understands all of the potential benefits and harms. There are major implications for others because genetic relationships with other individuals may be revealed. Also, the findings would have implications for other family members.

C Incorrect There are many benefits, but there is also the potential for harm to the person tested or to others.

D Incorrect There are many benefits, but there is the potential for harm to the person tested or to others. Truth telling is involved in informed consent and confidentiality.

DIF: Cognitive level: Analysis a. The risks associated with the proposed intervention b. The stress on the parents of the infant c. The comfort level of the infant d. All are correct

4. Which of the following factors must be considered in ethical decisions regarding interventions in preterm neonates?

ANS: D Feedback

A Incorrect All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

B Incorrect All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

C Incorrect All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

D Correct! All of the above must be considered. Preterm infants have many complications, requiring a multitude of often aggressive interventions. The risks and benefits to the infant, the infant’s comfort level, and the stress on the parents must all be considered. The health care team should engage in a collaborative process with the parents and consider alternative approaches to ethical challenges that build on relationships of trust and care, rather than only focusing on the parents’ autonomy.

DIF: Cognitive level: Knowledge a. Using birth control pills b. Defining infertility as a medical condition c. Undergoing a caesarean section d. Having ultrasonography performed during pregnancy

5. Which of the following is the most significant in terms of ethical debate or potential ethical dilemmas?

ANS: B

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A Incorrect Birth control may conflict with the values of some people, but it is generally accepted as an ethical practice.

B Correct! Birth control, ultrasonography, and caesarean sections may conflict with the values of some people but are all generally accepted as ethical practices. Defining infertility as a medical condition, as opposed to a social condition, is an ethical debate. Classifying infertility as a disease requiring medical solutions (e.g., fertility treatments) would open the door for reproductive technologies to be publicly funded.

C Incorrect Caesarean sections may conflict with the values of some people, but they are generally accepted as an ethical practice.

D Incorrect Ultrasonography may conflict with the values of some people, but they are generally accepted as an ethical practice.

DIF: Cognitive level: Analysis a. The donor is usually younger than the recipient. b. Ovarian stimulation is inappropriate. c. The donor may be anonymous. d. There is the potential for abuse of the system.

6. Which of the following is the strongest argument against egg donation?

ANS: D

A Incorrect The donor is usually younger than the recipient, but this is not the concern.

B Incorrect Ovarian stimulation may be an ethical issue for some, but this is not the greatest concern.

C Incorrect The anonymity of the donors may pose an ethical dilemma to some individuals, but this is not the greatest concern.

D Correct! The strongest argument against egg donation is the ethical issue that there is the potential for abuse of the system, including the commodification of women’s reproduction. Presently, in Canada, the sale of human tissue or body parts, including eggs, is illegal.

DIF: Cognitive level: Analysis a. The health and well-being of the parents must be given the greatest priority. b. Men and women are equally affected by reproductive technology. c. Embryos must not be stored for longer than 1 year. d. Informed consent is a fundamental principle in reproductive technology.

7. Which of the following statement is reflective of the Assisted Human Reproduction Act (2004)?

ANS: D

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A Incorrect The health and well-being of the child must be given the greatest priority.

B Incorrect Women are at greater risk from the possible negative effects of reproductive technology.

C Incorrect Storage time limits for embryos vary across cryopreservation programs.

D Correct! The principle of free and informed consent must be promoted and applied as a fundamental condition of the use of human reproductive technologies.

DIF: Cognitive level: Analysis a. The option of sperm collection requires masturbation, which is a taboo. b. Transplanting ovarian tissue into an arm is unethical. c. The child may die before sperm or eggs can be used. d. Challenges associated with informed consent.

8. A pediatric patient’s cancer treatments will likely result in infertility. In this context, what is the most significant ethical issue concerning the cryopreservation of sperm or eggs for future use?

ANS: D

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A Incorrect Masturbation may be a taboo in some families or cultures, but this is not the most significant ethical issue.

B Incorrect Grafting ovarian tissue into tissue in the forearm is one method of egg retrieval.

C Incorrect There is the possibility of death in any situation, so this does not present a significant ethical issue.

D Correct! The ability to give informed consent depends on the child’s age and maturity level. Obtaining the child’s agreement or assent to the procedure may be challenging because young children may be uncomfortable with, or not completely understand, the discussion surrounding it.

DIF: Cognitive level: Application a. Men are most affected by reproductive technology. b. Couples and individuals, not the medical profession, should control the right to reproductive choice. c. The medical profession should control reproductive technology. d. Only male–female couples should pursue reproductive technology.

9. Which of the following statements is true of the feminist ethical perspective on reproductive technology?

ANS: B

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A Incorrect Women are at greater risk from the possible negative effects of reproductive technology.

B Correct! The intention of reproductive technology is to give couples or individuals the right to reproductive choice, but some feminists are concerned that in practice, the actual control will be held by men within the medical profession.

C Incorrect In the feminist view, the control should rest with the individuals and couples who might benefit from these technologies.

D Incorrect In the feminist view, both singles and couples, including same-sex couples, have the right to pursue reproductive technology.

DIF: Cognitive level: Knowledge a. Gestational surrogacy through embryo donation for couples over 50 years of age b. Commercial preconception arrangements c. Ovarian cryopreservation for premenarcheal girls d. Restricting offspring from information about sperm or egg donors until they are 18 years of age.

10. In 1995, the Government of Canada put a moratorium on which of the following reproductive practices?

ANS: B

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A Incorrect No age limit exists.

B Correct! Financial arrangements are prohibited to prevent coercion and the commodification of reproduction.

C Incorrect Although there are many ethical challenges in this area, especially related to consent, this is not prohibited.

D Incorrect Presently, donation is anonymous, but donors can elect to have their identity released to any offspring when they arrive at a specific age. This is not guaranteed.

DIF: Cognitive level: Comprehension

TRUE/FALSE

1. Predictive testing for genetic conditions or illnesses raises an individual’s awareness of risk and, thus, reduces the likelihood of related ethical issues.

ANS: F

Feedback

Correct Predictive testing may raise a number of ethical issues, including the child’s right to privacy and confidentiality, the ability of the parents to demand testing for their child, and who should have a say when genetic information will have implications for other individuals.

Incorrect This statement is false.

DIF: Cognitive level: Analysis

2. An adult patient with lymphoma has undergone autologous (self-donated) cell transplantation after a course of chemotherapy. This situation poses an ethical dilemma.

ANS: F

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Correct Autologous transplantations do not pose an ethical dilemma. There is controversy around transplanting stem cells from human embryos because it is feared that embryonic stem cell research and utilization could lead to the creation of embryos to use their stem cells for transplantation into other people.

Incorrect This statement is false.

DIF: Cognitive level: Synthesis

3. A 23-year-old female patient who is the victim of a motor vehicle accident arrives in the emergency room, where she dies as a result of her injuries. It is acceptable, at this stage, to retrieve her eggs at her husband’s request.

ANS: F

Feedback

Correct Retrieval of sperm or eggs from cadavers is prohibited, regardless of consent.

Incorrect This statement is false.

DIF: Cognitive level: Synthesis

4. A preterm infant at 24 weeks of gestation should be given comfort care only because the infant would not be considered viable.

ANS: F

Feedback

Correct The current marker of viability is now 24 weeks of gestation. However, the future of these infants is uncertain, and outcomes are difficult to predict.

Incorrect This statement is false.

DIF: Cognitive level: Synthesis

5. The Assisted Human Reproduction Act defines a fetus as “a human organism … beginning on the 57th day following fertilization … and ending at birth.”

ANS: T

Feedback

Correct This is how the Assisted Human Reproduction Act defines a fetus. During the first 56 days of its development, the organism is known as an “embryo.”

Incorrect This statement is true.

DIF: Cognitive level: Knowledge