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MEDICINE MODULE 2013

BIOETHICS AND GENETICS


LABS 4-6

LAB 4: ETHICAL ISSUES


Task 1: Look at the pictures displayed. What are these kinds of treatment? For what conditions are
they specific?
Work in pairs or small groups. Prepare a dialogue in which a patient objects to the treatment
suggested by the doctor.
Task 2: Read the text and find the synonyms for the following words:
1 make worse
2 suit
3 lengthen
4 revive
5 necessitate
6 limit
7 differ
ETHICAL ISSUES
Most ethical issues faced by doctors arise at the end of a patients life. This particularly applies to
respiratory physicians, where difficult decisions about the appropriateness of treatment and the prolongation
of life in patients with chronic underlying lung diseases may need to be made. In some situations artificial
ventilation may prolong the dying process; life has a natural end and the potential to prolong life in the
intensive care unit can sometimes cause dilemmas.
The General Medical Council (GMC) int he UK states that doctors have an obligation to respect human life,
protect the health of their patients, and put their patients best interests first. This means offering treatment
where the benefits outweigh any risks, and avoiding treatment that carry no net gain to the patient. If a
patient wishes to have a treatment that in the doctors considered view is not indicated, the doctor and
medical team are under no ethical or legal obligation to provide it (but the patients right to a second opinion
must be respected).
The decision about resuscitation and formal ventilation is never an eas one, but should ideally be taken with
the nursing staff, the patient, and their next of kin, in advance of an emergency situation. In practical terms,
this is clearly not always possible. Ideally, all decisions regarding resuscitation and the ceiling of treatment
(particularly relating to ventilation) should be documented in advance and handed over to the on-call team.
Most possible outcomes can be anticipated.

Where it is decided the treatment is not in the best interests of the patient, there is no ethical distinction
between stopping the treatment or not starting it in the first place (though the former may be more difficult
to do), and this should be used as an argument for failing to initiate the treatment in the first place.
Some clinical scenarios are more commonly encountered by the respiratory physician. COPD is the fourth
commonest cause of death in America and most patients die of respiratory failure during an exacerbation. A
commonly encountered clinical situation is where a patient with COPD is admitted with an exacerbation,
and it is type II respiratory failure. Standard treatment does not improve respiratory acidosis, so noninvasive ventilation is commenced. Before starting NIV, a decision must be clearly documented as to
whether or not NIV is the ceiling treatment. It may be if the patient has severe or end stage of OCPD.
Now answer the questions:
What can the effect of artificial ventilation sometimes be?
What can the patient ask for even if the medical team denies treatment?
When should decisions about resuscitation and formal ventilation be taken?

LAB 5: STEM CELL RESEARCH


Task 1: Make a list of developments you would like to see in medicine. Describe and evaluate your
predictions for the future.
_________________________________
_________________________________
_________________________________
Task 2: Which two adjectives in italics can you use to complete the sentence? Are they in correct
order?
a. Technology like computers has brought about structural/big/far-reaching change in the provision of
health care internationally.
b. The first face transplant represented a diplomatic/medical/real breakthrough.
c. In recent years, some very dramatic/enormous/technological advances have been made in medicine.
d. Throughout history, many important/recent/medical developments have been curtailed out of fear and
ignorance.
e. Keyhole surgery wa a(n) ingenious/modern/latest invention.
f. Society at large, not just the medical field, is undergoing a computing/complete/technological revolution.
g. A radical/whole/sudden transformation occurred in the way patients were treated.
h. Stifling constant/scientific/important innovations in medicine through lack of funding is indefensible.
i. Id like to find something tracing the constant/biological/technological evolution of medical science.
j. The government sponsored a pioneering/latest/joint initiative between the medical schools.
Task 3: Which adjectives are being described below?
a. a synonym of the word dangerous

__z________

b. being advantageous

__n_______l

c. a synonym for convincing

p_________e

d. causing harm

________f__

e. having great worth

__v_______e

f. being easy to use at any time

c_________t

g. a synonym for frightening

a_______l__

h. not being able to support sth

i__e_______

i. a synonym for damaging

d_________l

j. distasteful

o_j_______e

Now, find the synonyms from the above for the following adjectives:
compelling

helpful

incalculable

offensive

practical

risky

shocking

unjustifiable

unsafe

Task 4: Read the text. Match the sources to the extracts and find synonyms for the words highlighted
in the sentences.
A newspaper

A website for patients

A specialist website on stem-cell research

a. Scientists learnt how to grow stem cells in the laboratory after years of experimentation.
b. Stem cell treatment involves hazards as well as being harsh.
c. Professor Dhillons reaction is unambiguous when asked if the research at Edinburgh met any resistance.
d. As it is connected with the use of foetuses, the term stem cell is quite sensitive to many people.
e. Patients are given information as to when the advantages are greater than the dangers in a stem cell
transplant.
Extract 1
Stem Cell Transplant
A stem cell transplant is used to increase the chance of a cure or remission for a number of cancers and
blood disorders. It usually involves intense chemotherapy followed by an infusion of stem cells. The
treatment requires close nursing and medical care for a number of weeks. It can be a gruelling treatment and
there are risks. Your specialist can advise when the likely benefits for this procedure can outweigh the risks.
What is a stem cell transplant?
A stem cell transplant may be used so that you can have intensive high dose chemotherapy (and sometimes
radiotherapy) to kill cancerous cells. The chemotheraphy is higher than conventional chemotherapy and also
kills the stem cells in the bone marrow that would normally make blood cells. Therefore, following the
chemotheraphy, you are given back (transplanted) cells which can then make normal blood cells again.
A stem cell transplant is sometimes called a bone marrow transplant. However, stem cells can be obtained
from blood as well as from the bone marrow. So, the term stem cell transplant is now used.
Extract 2
Stem cell research is a subject almost guaranteed to prompt mixed reactions. As if to illustrate that fact, two
high-profile Scottish stem cell trials were announced this week, to very different responses. While one was
branded immoral and unethical by critics, the other was warmly welcomed as offering a potential cure for
some types of blindness.
The difference is that the former a trial in Glasgow to instert stem cells into the brains of stroke victims
relies on stem cells harvested from human embryos, which must be destroyed to enable the beginning of a
cell line.

Edinburgh uses stem cells from voluntary adult donors, harvested after their death, to treat corneal blindness.
It is the use of voluntary adult donors that makes all the difference to those with moral and ethical objections
to stem cell therapy.
Asked if he had encountered any opposition, Prof Dhillon is unequivocal. No. Because we are using tissue
thats been generously donated by adult donors after death, those issues dont arise with this type of
research.
I think the term stem cell has become rather emotive in that its linked with a number of images and issues,
both ethical and moral, associated with the use of foetuses, and this trial is not using foetal stem cells. But I
think its important for clinicians, scientists, and the public to have an open debate.
Extract 3
The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to
scientists. It has taken scientists many years of trial and error to learn to grow stem cells in the laboratory
without them spontaneously differentiating into specific cell types. For example, it took twenty years to
learn how to grow human embryonic stem cells in the laboratory following the development of conditions
for growing mouse stem cells. Therefore an important area of research is understanding is understanding the
signals in the mature organism that cause a stem cell population to proliferate and remain unspecialized until
the cells are needed for repair of a specific tissue. Such information is critical for scientists to be able to
grow large numbers of unspecialized stem cells in the laboratory for further experimentation.
Now, answer the questions:
Why is it important for scientists to understand the signals in a mature organism that cause a stem cell
population to proliferate and remain unspecialized until the cells are needed for repair of a specific tissue?
Why has the Edinburgh trial not had a negative response to its work?
What difference is mentioned between normal chemotherapy and that used in stem cell transplants?
Task 5: Heres a list of the arguments in favour and to the contrary of the stem cell therapy. Decide
which belong to which group. Which statements do you agree with?
a. Stem cell research is the breakthrough that sufferers of illnesses and paralysis have been waiting for.
b. The best way to approach the issue is to clarify how the procedure works to make people feel at ease with
stem cell research. Once it has been demystified, people are more likely to accept it.
c. Stem cell research and therapies are indefensible because they interfere with nature.
d. Many people are apprehensive about harvesting stem cells from embryos to use in any kind of treatment.
e. I can understand the faith people have in stem cell therapy, but I think it is a step too far both ethically and
scientifically.
f. Provided there are sufficient safeguards in place, stem cell research is surely a welcome development.
g. A development like stem cell research is scientifically complex and has such dangerous consequences that
it's impossible to allay people's fears.
8 Stem cell research and therapy give hope to thousands of sufferers.

LAB 6: GENETIC ENGINEERING


Task 1: Watch the video material. List the ways in which a baby can be designed.
__________________________
__________________________
__________________________
__________________________
__________________________
What are the ethical implications of designer babies?

Task 2: Prepare and perform a panel discussion on current bioethical issues, such as euthanasia,
eugenics, stem cell research, xeno-transplants, etc. At the end, arrive at structured conclusions, which
can be presented as summarizing points.