Category: Bioethics

Introduction

Paul Wolpe has addressed one of the most disputable issues in bioethics. The researcher argues that autonomy has become a panacea in solving ethical issues in the USA (Wolpe 38). The researcher reveals advantages and focuses on the disadvantages of the use of autonomy in the US bioethics. It is important to note that in the USA the principle of autonomy has overweighed the rest of the principles suggested by Beauchamp and Childress (Wolpe 41).

This shift can be explained by some cultural peculiarities of Americans. However, it is also necessary to note that this shift in priorities has proved to be misleading (Gert et al. 109). The principle of autonomy is characterized by far too many restrictions and limitations (Wolpe 55). Therefore, it can hardly be applicable in most cases. More so, it is possible to state that it has become a detriment to patient care as patients are often unwilling and incapable of making decisions that could be made only by physicians on the basis of thorough research which is backed up by the physicians experience.

Reasons for the Shift of Priorities

Principlism was articulated by Beauchamp and Childress in the late 1970s (Wolpe 41). The researchers revealed four basic principles which were to become the universal guidance for physicians. The researchers pointed out the principles of autonomy, nonmaleficence, beneficence, and justice (Wolpe 41). Notably, in the first part of the twentieth century, the medical practice was dominated by principles of nonmaleficence and beneficence.

However, in the middle of the twentieth century, the shift in priorities took place in the United States. Wolpe notes that people could easily write a modern history of America by tracing the theme of individual liberty which is a long-standing and mythologized American value (Wolpe 53). Admittedly, individual liberty is valued in any aspect of private or social life in the United States, be it politics, education, or medical care. Of course, bioethics could be no exception. Americans have always struggled for their rights, e.g. rights concerning abortion or even assisted suicide. The value of individual liberty has spread to the power of decision making.

Apart from this, Wolpe articulates another possible reason for the shift. The researcher claims that almost every development in medicine in the post-World War II period distanced the physician and the hospital from the patient and the community (Wolpe 50).

The researcher comments upon financial differences between physicians and patients. Admittedly, physicians and patients often pertain to different social classes or ethnic groups, etc. This contributes to alienation which in turn leads to bureaucracy in medical care. Highly bureaucratic practices can also be regarded as some of the factors that have led to a shift in priorities. Thus, instead of making decisions physicians are overwhelmed by various bureaucratic practices that should be complied with. These bureaucratic practices also become certain standards accepted by patients.

Many researchers state that the principle of autonomy is the most applicable in real-life settings as it is the most constitutive (Engelhardt 107). Engelhardt also claims that it is rather difficult to be objective when it comes to other principles whereas the principle of autonomy can be easy to realize (107). The researcher also argues that the principles are often incompatible. However, the principle of permission (which is another term for the principle of autonomy) can be combined with other principles, e.g. the principle of beneficence (Engelhardt 126).

The principle of autonomy is regarded as a universal principle that can help in any situation. Physicians have particular rules to follow (the rules based on the principle of autonomy) and these rules are accepted by patients. Therefore, the principle suits contemporary medical practice.

However, it is necessary to note that the major reason for the shift in priorities is still the cultural peculiarities of Americans who value individual liberty in every aspect of their lives. Many Americans believe they should have the right to make decisions which can be crucial. Many think that it is their basic right to know the truth and be able to make the necessary decision. Of course, these people disregard many important issues as they are more concerned with their liberties rather than with reasonable and thoughtful decisions. Luckily, at present principlism is being criticized by many. This criticism can become beneficial for the field of bioethics.

Is Autonomy a Detriment or Enhancement of Patient Care?

Admittedly, there are some advantages to the use of the principle of autonomy. For instance, sometimes patients should know the truth. This knowledge can help patients and physicians to make the most acceptable decision for the latter. However, it is also necessary to state that these cases should be regarded as an exclusion rather than a norm. Any other advantages of the use of the principle can hardly be found.

On the contrary, as far as disadvantages are concerned, there are quite many significant drawbacks which can even jeopardize the effectiveness of medical practices. In the first place, as has been mentioned above patients are often unable to make difficult decisions (Wolpe 55). In the majority of cases, patients feel anxiety and stress. They are often incapable of thinking critically. Besides, various diseases affect the way people perceive reality. This factor should also be taken into account as many patients decisions should be called into question.

Wolpe also reveals one of the most important factors that confirm that the use of the principle is rather a detriment than a kind of enhancement inpatient care. The researcher claims that

physicians remain the gatekeepers to most medical information in any particular clinical situation and filter that information through their own biases in any presentation of options and risks. (Wolpe 54)

The researcher sheds light upon one of the most conspicuous flaws in the use of the principle of autonomy as there is no complete autonomy. In the first place, the patient is never provided with the complete picture. The data obtained is nothing more than a decision made by the physicians. Thus, the physicians decided on the type of test to carry out, the physician is the one to diagnose, the physician also provides options to be considered by the patient. Admittedly, the patient is never fully informed as the information he/she obtains is based on the knowledge and experience of the physician.

Apart from this, even if the physician gives comprehensive information, the patient is hardly able to make the right decision. Even if the physician explains all possible outcomes of this or that decision, the patient does not have the necessary knowledge and experience to analyze the situation properly. Thus, it is possible to note that the so-called principle of autonomy presupposes a great deal of dependence as the patient has to rely on the physicians ability to diagnose as well as reveal specific information.

However, this dependence is not confined to the patients lack of knowledge. Some researchers also mention one precondition which can secure the right use of the principle. Wolpe sheds light upon the theory that patients should be matched with the physicians as the two parties should have similar backgrounds (55). In this way, physicians can be able to understand real needs of their patients. This can enable physicians to understand what can be right for the patient and what options can be suggested.

Besides, Wolpe points out that medical care in the United States has become too commercialized. This sector can easily be compared to the business sector as patient care ceased to be the primary concern of hospitals which are managed as any other business. Hospitals can be compared to numerous enterprises which are run in accordance with particular regulations and standards. However, patient care can hardly be standardized as there are far too many cases (or even the majority of cases) which are not ordinary and need specific decisions. Remarkably, the use of the principle of autonomy helps to fully standardize the system. Thus, physicians do not need to seek for the best and winning decisions as it is enough to obtain the patients consent.

The use of the principle should be regarded as a detriment. It is possible to regard the use of the principle as a way to relieve physicians of responsibility. Physicians are not responsible for outcomes of their decisions. They suggest some options and it is the patient who should take the responsibility for his/her life. This can eventually lead to really negative outcomes. Physicians can be inclined to seek for fewer options as they will not feel the responsibility for their mistakes. Admittedly, if a decision is really difficult to make, the physician would rather double-check before he/she makes the decision.

Finally, Wolpe also mentions that many Americans have different backgrounds and not all those addressing physicians are able to make any decision due to cultural peculiarities (55). Physicians should pay a lot of attention to the fact that

significant ethnic and religious subpopulations of the United States do not share a fetish for individualized autonomous decision making, believing instead in the primacy of the family in making important medical decisions. (Wolpe 55)

Admittedly, it is important to respect these people and their values as well. It is clear that there are quite many limitations to the use of the principle of autonomy. Therefore, the principle of autonomy cannot be regarded as prior to the other three principles.

Conclusion

Thus, it is possible to conclude that the four principles articulated by Beauchamp and Childress should be equally important. At least, the principle of autonomy cannot be regarded as the most important one. There are far too many disadvantages in reliance on this principle. This can even lead to various negative outcomes and decrease in quality of patient care. Such significant faults as the lack of knowledge or experience on the part of the patient can lead to numerous wrong decisions. More so, physicians can also tend to seek for fewer options as they can be relieved of responsibility. Admittedly, physicians should not be concerned with papers signed by the patient. Instead, physicians should be concerned with the principles of nonmaleficence and beneficence as their primary role is to heal.

Works Cited

Engelhardt, Hugo Tristram. The Foundation of Bioethics. New York: Oxford University Press, 1996. Print.

Gert, Bernard, Charles M. Culver, and K. Danner Clouser. Bioethics: A Systematic Approach. New York: Oxford University Press, 2006. Print.

Wolpe, Paul Root. The Triumph of Autonomy in American Bioethics: A Sociological View. Bioethics and Society: Constructing the Ethical Enterprise. Ed. Raymond DeVries and Janardian Subedi. Upper Saddle River, NJ: Prentice Hall, 1998. 38-59. Print.

The present paper aims at providing bioethical analysis world-famous case of Terri Schiavo, a patient who was artificially kept alive for more than 15 years in a vegetative state. Ms. Shiavo experienced cardiac arrest, which led to brain injury, on February 15, 1990 (Fine, 2005). As a result, the patients midbrain was able to control the vegetative functions, while the upper brain was inactive (Fine, 2005). This led to unconsciousness with open eyes, which was sustained until her death on March 31, 2005. The patients husband, Michael Schiavo, insisted that Terry was unplugged from the feeding tube, while her parents, Robert and Mary Schindler, wanted that their daughter was kept alive as long as possible. Thus, the primary stakeholders were Terri Schiavo, Michael Schiavo, Robert and Mary Schindler, the hospital (care provider), and the State of Florida (legal framework provider). The central bioethical issue is if the patient should be allowed to die if she did not give informed consent, and the opinions of stakeholders differ.

Bioethical Analysis

In a society with multiple patients values of modern pluralistic societies, it is crucial that bioethical analysis is conducted based on a comprehensive framework. The framework should take into consideration the principles of autonomy, justice, beneficence, and non-maleficence while keeping in mind the ideas of evidence-based practice and patient-centered care. Such a decision-making process (DMP) was introduced by Forte et al. (2018). The process included four comprehensive steps that could help a team of care providers make ethical decisions in complicated situations. First, the care providers should focus exclusively on the disease, which implies making the correct diagnosis and possible projections. In Ms. Schiavos case, care providers were unsure about the patients condition, as she was described as comatose, brain dead, vegetative, minimally conscious, locked in, and disabled at different times (Fine, 2005). Without a diagnosis or a relevant prognosis, stakeholders cannot adequately follow the principles of beneficence and non-maleficence.

Second, the care providers should have focused on the family members and assessed their values and beliefs. This act would be coherent with the principle of autonomy, as the relatives represent the will of the patient (Forte et al., 2018). In this case, relatives were unsure about their will. Third, the care provision team should collaborate with the team members to understand if the preferences of the stakeholders should be limited by the principles of justice (legal framework), beneficence, and non-maleficence. The legal framework provided the relatives of the patient with the opportunity to reject life-sustaining treatment if they could prove that the patient would have wanted so (Fine, 2005). Finally, a decision should be made based on the goals of care, communication between the stakeholders, and adherence to bioethics (Fine, 2005). In Ms. Schiavos case, it was decided that there was not enough evidence that unplugging her from the feeding tube would be ethical; thus, the final decision was made to continue life-sustaining treatment.

Conclusion

The decision to unplug would have been illegal and breached the principle of autonomy, as there was no evidence provided that the patient would want to be unplugged from the feeding tube. Additionally, the decision to stop life-sustaining treatment would be against the principle of non-maleficence, as it would kill the patient. Thus, care providers were sure that it could not be done. However, continuing treatment was associated with going against the principle of beneficence, as it was not beneficial for the patient. Thus, Ms. Schiavos case was complicated in terms of bioethics; however, the medical personnel made the correct choice despite the resistance of the public and Mr. Schiavo.

References

Fine, R. (2005). From Quinlan to Schiavo: Medical, ethical, and legal issues in severe brain injury. Baylor University Medical Center Proceedings, 18(4), 303-310.

Forte, D., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19(1), 78.

In medical ethics, coercion refers to any act that ignores the will of the patient in providing medical care. According to Munson (2012, p. 126), in coerced medical care, the patient receives a medical intervention, not by his or her autonomous decision, but because both the law and medical expertise have allowed the intervention to take place. Exploitation means taking the greatest advantage of or utilizing another person or group of persons where possible for a selfish intention. In medical ethics, Munson argues that exploitation in bioethics implies a situation that culminates into the utilization of a patient or persons used for study for the selfish gain of the medical body (Munson, 2012, p. 128).

Transactions involving trade in tissues and organs are a form of coercion. In medical ethics, this act should be prohibited because it mostly involves a financial incentive, thus denying the person the choice of volunteering. According to the justice principles, there is inconsistency in the ability to pay or access medical treatment, which makes the transaction more unethical. The selling of organs is always accompanied by advertisement, which also denies donors a chance to volunteer due to persuasion used. According to Munson (2012, p. 249) Donation of organs should be motivated by altruism to be truly voluntary (Munson, 2012, p. 252). Professional associations have been condemning and criminalizing buying and selling of kidneys from donors that are alive and this is evident in the news from media, which proves that organ trafficking exists between developed and developing countries. The selling and buying of organs have become a global ethical issue. The sources of the organs are usually the vulnerable and poor counties mostly in developing countries. Such donors resort to selling their organs as an alternative or the only means of supporting themselves and their families (Munson, 2012, p. 278).

From an academic perspective, selling organs should be an autonomous consideration but the reality is that there is coercion of the poor because of their desperation. The valid reason against organ trafficking is due to global injustice on segments from a vulnerable population. This is done through recruiting persons to carry out the transfer, transport, receive persons as well as harboring them waiting for the transaction to take place (Munson, 2012, p. 525). The recruited personnel use threats, force, various forms of coercion, and abduction to get the organs. Transaction of organs also involves fraud and deception, power abuse, and taking advantage of the vulnerability. Traffickers either receive or give payments and other forms of benefit to influence the consent of an individual to control another person in a way that is exploitive through the removal of organs and transportation of cells and tissues. Regarding taking the advantage of the vulnerability, age, ethnicity, and gender, social status determines the vulnerable (Munson, 2012, p. 248).

Buying and selling of organs capture many exploitive measures in soliciting commercial donors for transplants. In organ trafficking, the organ is the commodity and the priority is the financial gain for the parties involved rather than considering the wellbeing and health of the recipient and donors involved. The community that deals with international transplants should give a concerted message that it is not acceptable to exploit the vulnerable and poor in the organ markets. There should be programs to address the issue of donor safety and social benefits that meet the need of the donors (Munson, 2012, p. 536).

After God created human beings, He urged them to multiply and be fruitful. This is an obligation to actual children through Gods assigned responsibility to human beings (Munson, 2012, p. 371). Therefore, people who understand this observe procreation to pass their traits to their children. Many people attach deep significance to having children as this has overall meaning for them (Munson, 2012, p. 473). However, some people wish to have children but cannot conceive. Such desire leads to an obligation to possible children through using other means because of a deep need to fulfill what God urged human beings to do about procreation. For example, in the book of Genesis Rachel told Jacob to give her children or she dies. A person who echoes Rachaels cry in using modern technologies seeks alternative means to have children. However, technological means to obtain children are limited by ethics (Munson, 2012, p. 263).

There is no justification to obtain anything simply because one has a deep need for it. If the methods used to procreate children are harmful to other children or children brought through the method then it is immoral to employ the method. For example, it would be wrong to create children reproduced through technological means that are likely to lead to serious disease or impairment to the children. According to Robertson, substantial harm to a child refers to a situation where from the perspective of the child, life would not be worth living if his or her birth would result to harm due to the use of reproductive technologies in bringing him or her to life. He Continues by saying that devastating harm in the use of technologies arises when sufferings caused are such that it is better not to have lived at all. He says this is different from serious harm to a child, which is harm that does not make life worse than death but also includes other detriments such as physical impairments that are major, mental disability or suffering that leads to considerable pain (Munson, 2012, p. 326).

According to Robertson, reproductive technologies do not lead to harm to children born of the technologies since it is an overriding benefit for them to be born in the first place. The argument about the harm caused by technologically born children is flawed logically because Robertson and other thinkers who are like him maintain that there is a greater benefit of life for such children compared to any detriment resulting from the use of the technology.

Reference

Munson, R. (2012). Intervention and reflection: Basic issues in medical ethics (9th edition). Belmont, CA: Thomson/Wadsworth Learning.

There are many varied ethical dilemmas nurses can face in their clinical practice. Understanding the underlying philosophical concepts will help the nurse to find intelligent solutions to these issues. In the health field, increased attention to ethics is associated with the development of controversial issues, including advances in technology, as well as a decrease in health and financial resources (Butts & Rich, 2016). Understanding the role of the professional nurse in ethical decision-making helps nurses to articulate their ethical position and acquire the skills necessary to make ethical decisions. This paper aims to apply the four topics method to a challenging situation in the nursing career that required considering the ethical dimensions.

In the considered case, the patient with a terminal condition said that if he dies, he wants everything possible to be done. On the other side, the physician and the patients family have made the decision not to tell the patient that he is close to death and not to administer resuscitation if he stops breathing. In this situation, there is the ethical problem caused by the conflict of moral claims of the patients relatives and the doctor who seek to protect the patient from suffering in connection with the diagnosis, and the nurse who wants to tell the patient the truth according to his request.

Taking medical indications into account, there were no probabilities of success of any of the treatment options. This patient could not benefit from any medical or nursing care. According to the principle of beneficence and nonmaleficence, harm to the patients moral comfort could be avoided when he did not know the truth about his terminal condition (Pozgar, 2014). However, taking into account patient preferences, the principle of respect for autonomy contradicts the principle of nonmaleficence. From this viewpoint, the patient must be informed of his terminal condition, know and understand this information, and give his consent.

As for the quality of life, there were no prospects for this patient to return to normal life. In his case, there were no biases that might prejudice the evaluation of the patients quality of life. Both the physician and the relatives understood that if the person was resuscitated, most of the bodys functions would stop working and the rest of the time the patient will spend in a coma. Since he was in a terminal condition, quality-of-life assessments did not raise any questions regarding changes in treatment plans (Butts & Rich, 2016). Therefore, the doctor and the relatives decided to make sure that in obviously ambiguous situations the patient would not be saved at any cost.

What concerns contextual features, there were no professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of this patient. Neither clinicians nor family members did not have any interest in the clinical decision not to reanimate the patient. There were no financial factors that created conflicts of interest. Neither the allocation of scarce health resources nor any religious or legal issues could influence the decision. Only the patients terminal condition was the issue that forced the physician and relatives to come to such a difficult decision. The principle of justice and fairness was not violated since the benefit to the patient exceeded the scientific or public interest (Pozgar, 2014). In this case, for the terminal stage of the disease, the patient could not benefit from further treatment or resuscitation.

However, there were conflicts of interest within the hospital that affected the clinical decision. The patient was mentally capable to make any decisions on future actions. Therefore, following the principles of bioethics, the patient was told the truth about his diagnose, and he was able to decide on further interventions. This information came from the doctor with a nurse present who helped the patient understand the terminology and provide further support. The nurse acted as an advocate for the patients rights and was familiar with the rules regarding the patients right to make decisions and resolve this ethical issue. Finally, the patient has understood the situation and made a difficult decision that he will not be resuscitated.

The four topics method and the application of the principles of bioethics have shaped the decision of the nurse to tell the patient about his condition, which resulted in the process of informed consent. This is a valid process that helps to resolve an ethical dilemma when it is difficult to clearly distinguish one dominant principle. The reviewed case is the ethical dilemma where there is a clear conflict between several moral principles, and the nurse has to choose the lesser of two evils. Such situations cause moral and ethical uncertainty when it is impossible to determine which moral principles are applicable in a given case. Nurses must be able to freely discuss moral and ethical situations, even though such a dialogue will be difficult for everyone involved.

References

Butts, J. B., & Rich, K. L. (2016). Nursing ethics; Across the curriculum and into practice (4th ed.). Jones & Bartlett Learning.

Pozgar, G. D. (2014). Legal and ethical issues for health professionals (4th ed). Jones & Bartlett Learning.

This paper analyzes the quality versus quantity of longevity of life in accordance with society and bioethics. This is followed through by the analysis of Dr. Emmanuel’s “Why I Hope to Die at 75” article and a rebuttal to it from “Bioethics and Why I Hope to Live Beyond Age 75 Attaining Wisdom!” by Miguel Faria. Dr. Emanuel discusses the destructive notion of the “American Immortal” by how it imposes in supportive cost on society and how old age deprives us of living. Conversely, Miguel Faria discusses how the ideology of the “duty to die” rejects the belief of “first do no harm” while claiming the “good life” is when we age and have the time to reflect on our life. The goal is to identify which argument is logical and what policy must be done by it to balance the dilemma of technology, morality, and the cost of extended care, coupled with a reasonable healthcare system for this.

Analysis of Dr. Emmanuel’s 75 age limit In the article, “Why I Hope to Die at 75”, by Dr. Emmanuel, the argument here is that as we grow older we enter our lesser quality years and we are not immortal to death, therefore bioethics medical care should be limited to our more productive individuals. Dr. Emmanuel states “it renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived” (Emmanuel,). In other words, old age prevents us from living life. It prevents us from contributing to our society and world while altering how people experience us. Although he strongly opposes legalized euthanasia and assisted suicide, Dr. Emmanuel believes we should let nature take its course once we reach this old age instead of trying to prolong life, such as flu and pneumonia shots, vaccines, antibiotics, and other medical care. As a result, stretching out the lives of the elderly is depriving us of saving younger people because the efforts that go into living longer include extreme lifesaving medical interventions.

This “American immortal” perception only imposes an insupportable cost on society in their quest to extend their lives. Caring for the elderly is a financial burden and this consumption is not worth their contribution. To put it differently, our elders should step aside for the rising generation to free up society’s resources to support our children and allow younger workers to thrive. This includes the cost of the programs for retirees such as Medicare and social security, which is a drain on the federal government. Consequently, this spends less on the needs of the children. Due to our nature of struggling to survive, we tend to reject the belief of our “duty to die”, giving no acknowledgment to why we are here. We are already programmed to be in a routine of survival, but is it worth it at a certain age? Analysis of “Bioethics and Why I Hope to Live Beyond Age 75 Attaining Wisdom!: A Rebuttal to Dr. Ezekiel Emanuel’s 75 Age Limit” In the article “Bioethics and Why I Hope to Live Beyond Age 75 Attaining Wisdom!” by Miguel Faria alternatively the argument here is that longevity of life should be kept and that bioethics is worth this. American bioethicists argue the need to conserve medical care for limited healthcare resources. The use of government-imposed euthanasia, not only for the terminally ill but for the unproductive elderly can prevent bankruptcy for medical care. The bioethics movement revolves around the ideology of “the duty to die” while rejecting the belief of “first do no harm”. The movement is based on the population and is concerned with the conservation of resources.

This ignores the best interest of the induvial and the worth of human life. The author argues that we do not lose our creativity as we age, we just become more of an advisor with responsibilities that withhold us from creative activities. Coupled with this, though it becomes more difficult to learn as we age, we still can do it if we remain active. In a study done at the University of British Columbia, researchers found that regular aerobic exercise, the kind that gets your heart and your sweat glands pumping, appears to boost the size of the hippocampus, the brain area involved in verbal memory and learning (Godman, 2014). Furthermore, it is not feasible to confirm that the “good life” is our productive years but more so when we have the time to reflect on our lives, which happens once we have aged due to our rapidly demanding society. Moreover, there is time for fulfillment in improving society in creating a better world for our children and grandchildren. Life Is Worth Living Beyond 75 If You Adjust Your Mindset! Although I understand the many challenges faced with living beyond 75 as described by Dr. Emanuel, I do not think they are as bad as he plays them out to be. If he would look more closely into the beauty of aging instead of dreading it, he would find that along with those negatives, there are just as many positives to look forward to. Dr. Emanuel is only stuck on the physical limitations of aging such as walking, climbing stairs, standing without special equipment, or sitting for too long. He fails to look at the other picture, as we age, we are better able to appreciate life and the wisdom we have gained from it over the years. Although, Dr. Emanuel realizes the importance of mentorship, a vital role the elderly has, he devalues it as a “constriction of our ambitions and expectations”.

I believe as we age our professional ambitions involve new selfless ones. Mentoring younger colleagues are just as important as being physically productive at work. The elderly are experts at what is important from the past to carry on to the future. Moreover, Dr. Emanuel believes we become mentally deprived with age, associating it with an increase in dementia. Old age is not a cause of Alzheimer’s, scientist believe that for most people, this disease is caused by a combination of genetics, lifestyle, and environmental factors that affect the brain over time (‘Alzheimer’s disease’, 2018). We don’t have to accept the fact this is an inevitable part of aging if we simply modify our lifestyle to prevent it, such as exercising regularly, having a healthy diet, and constantly engaging our brains in learning. For example, after spending his youth as the leader of the African National Congress’s armed wing and being imprisoned for 27 years, Nelson Mandela was able to bring about unity in his 70s as an anti-Apartheid activist. Character development is something that happens to all of us as well by dealing with unexpected changes in life and from this, we mature over time. Aside from that, one thing I do agree with Dr. Emanuel on is not trading quality of life for quantity. I see why he questions the assumptions of the “American immortals” and their “maniac depression to endlessly extend life” because the notion that additional years are always better can lead to destructive expectations. Medical care, at any age, can be a trade-off between longer life and better life and it’s reasonable to question when it is appropriate to make that trade and when it is not.

I personally believe that a decision is an individual one that depends on the person’s goals. Incorporating empathetic end-of-life counseling into medical care could greatly improve our quality of life, and age should not be the only factor going into this. I don’t want to come off as an overly optimistic person because I do consider myself more of a realistic person, but I do not believe aging is as bad as people think. Each stage of life has a meaning that’s possibly to be satisfying depending on your mindset. Policy Alternative I believe the healthcare needs of older adults coping with multiple chronic conditions, which account for the majority of Medicare expenditures, are just poorly managed. Management that collaboratively engages the older patient, their family caregivers, and clinicians in identifying the patient’s needs and goals to implement that individual care plan would achieve better healthcare. As I stated earlier, it is all about the mindset of the patient and once that is identified determination of enrolling in Medicare part B can or can not be an option for the patient. Moreover, this will avoid under or over-treatment of the patient to save money on healthcare spending overall. Many elderlies buy into the fact that they are no longer useful and make little attempt to keep themselves alive and active, but then there are some older people who continue to learn and be actively involved in business or the community. The best healthcare system that could help in distinguishing this would be Taiwan’s “National Health Insurance” model. This program is like the U.S. Medicare one, yet they have the lowest administrative costs in the world thanks to technology and the country’s single insurer.

Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. This helps public health officials monitor standards to affect policy changes nationwide. This gives the government a “real-time picture” of the patient’s health patterns. This way there can be an understanding of this person’s lifestyle and goals when it comes to their health. I believe we do not have a “duty to die”, but we do have a “duty to stay alive”. If a person, regardless of age, does not want to support a duty to live, then that is no one else’s responsibility either. Conclusion In conclusion aging is inevitable but becoming old is not. Society has associated old age with being weak, fragile, and non-productive mentally and physically, making it a burden on society financially. Unfortunately, this notion has convinced many elderlies that this is a part of life and it is only right to let nature take its course, as Dr. Emanuel believes. However, these traits do not come from old age, but old age comes from these. As quoted by the great Muhammad Ali, “Age is whatever you think it is. You are as old as you think you are”. The concept of, it is your duty to die to make way for the younger generation, which Dr. Emanuel ejects out is a depressive abstraction to associate with aging. The elderly offers society something the younger generation cannot, and that is mentorship expertise. Medical care at any age is a swap between longer life and better life, and with the help of end-of-life counseling, a collaboration of engagement of the patient, family caregiver, and provider, along with Taiwan’s healthcare system we can determine when to make that swap and when not to instead of solely following the assumption of a “duty to die” once we age.

​In the Vaughn’s 3rd Ed new text concerning bioethics in bio-medical issues, principalities and cases. The texts does exploration to matters pertaining philosophy, medicine issues, social and even legal main effective bioethical issues. It does introduction to the ethical matters in the medical operations. It extents to bringing effect to through bioethics and even the moral intelligence. Vaughn’s text envelops most personal drives, moral beliefs and also the routine for evaluating them. This new edition owns several characteristics that boost bioethical issues plus the most educational forms. This editorial text shows that it is one of the highly aggravated plus issues affecting issues topics about bioethics. The educative characteristics of this text include the classic case files of the new edition of Vaughn’s text. Referencing to all the bioethical issues rose in chapters 6-10 in relation to issues in chapter 2. I stand to defend my own position on the issues raised.

​In chapter two of the Vaughn’s text, there is an amazing of backgrounds on some basic philosophical instruments. The chapter brings out vividly the moral theories in relation to bioethics. It also provides ethical ideas, theory and also some principalities. It has a very good elaborative instruction and good standard educative techniques. It consequently highlights important classical cases and legal explanations. In this chapter, touched is bioethics and moral beliefs in connection to bioethics. Theories in this chapter are used with aim to explaining how things are done, just like in science. In bioethics, moral theories have a similar duty. Moral theories have a focus on the reason why particular deeds are considered rightful. It further digs on why things are referred wrong as well as peoples bad and good features. The use of moral theories in this chapter two of the book may bring out on the reason on why some characters are said to right or wrong. The theory also elaborate to people on what certain specific characteristics make individuals good or bad. In bioethics, moral theories befits in day to day moral reasoning and beliefs of right deeds. Beginning with moral theories, it may have moral impact on moral discussions that contains both moral and non-moral premises. A moral premise contains a moral principle, rule or claim, that directly concerns use of moral beliefs.

​In chapter 5 and 6 of Vaughn’s text it talks of search on information through raiding individuals consent. In this chapter, there arises the question of what is the ethical codes position to conduction of research to people being unable to giving well codified consent. It also looks at the times placebo control can be justified. It further checks on the balance that code looks at in between the interests of science or else the society in relation to those of the human matters. It also answers the question of if there would be any need to seek the consent and research protocols. The value of the human being should take precedence over the interests of science and the society. In this chapter 5 and 6 of the Vaughn’s bioethics: principle, issues and case, the many medical code of contact questions gets answered. The chapters witness address of greater issues concerning bioethics. There must be ethics of medical research; else there could be great misuse of private information of a person.

​Relating chapter two of the book with chapter 5 and 6 of the text, there was argument that for a rationalist to compare two random treatments is a morally permissible thing. Angeli supported the idea by justifying the importance of it through his saying that investigators/researchers should be a state of equipoise. It may happen when there is thinking that one treatment may be better than another. In an argument on the legality or out of consent use of personal medical information is bring a lot of heated debates. Using ones information should directly come from their consent. They should be requested to provide the information genuinely without being tricked and have the information obtained. Sometime it may be very difficult for some people to let their bio data be used for medical research. For sure if the information will highly be hidden, there would be no medical developments and since there will be lack of grounds for research. Incase ones information is used behind their consent, the research should be sued of revealing personal information. Consent should be the center for personal information needed for research. That will prove a morally upright relationship between the information source and the researcher.

​To conclude, bioethics is one of the most basic aspects of any medical field. Medical matters being based on certain principles, cases and issues bring light to everything that has previously been mishandled. Being morally upright, having good or bad, right or wrong depicts human standards of moral contact. Respecting one’s personal information is doomed important at any cost. Researchers taking consent to use personal private information in of the best things. To have good medical services, people must be willing to release information for research.

Reference

1. Vaughn, L. (2017). Bioethics: Principles, Issues and Cases. Oxford University press, 3rd Ed, Pp. ​ ​​2 and 6-10.

Religion and science are two mutually incompatible subjects with unattackable opinions. The conflict between the two ideas have been debated for many years and continues on today. These two subjects are expansive on their ideas where faith and fact come into play when persuading someone to believe. Religion and science are two controversies that are displayed in ‘The Immortal Life of Henrietta Lacks’ by Rebecca Skloot, where Skloot presents the understanding of faith and fact in the Lacks family.

Religion plays a crucial role in the Lacks family. In the beginning of the book, Henrietta and her family both relied on religion, especially, when she started her battle with cervical cancer. They put their whole trust in God so that He can help out their family. “After leaving the hospital, she went back to life as usual” (Skloot 42). After being at the hospital for the first time, Henrietta went about living her usual life and going through the same day-to-day schedule. She wasn’t worried that her body would have gotten dysfunctional or too weak to even walk. Mainly because Henrietta didn’t understand what was going on inside her. She just thought she had to get a quick check-up, but she wasn’t aware that, in reality, cancer was spreading all over her. Due to her lack of education, it is easier for her to just believe that the Lord will take the wheel and help her through the pain. The Lacks’s family has always relied on Him for everything; even back then when Elsie was alive. Day and Hennirietta would take her to revival meetings so preachers in tents could lay hands on Elsie to heal her. They had full faith that God might one day have mercy on Elsie and sure her from her illness. As the days go by, we see the Lacks family carrying on the idea that God will take the wheel and guide them through their obstacles. Within the Lacks family, the idea of faith is a vital means of holding the clan together. Deborah and Gary are two members who deeply believe in Christianity. When Deborah and Skloot where at Gary’s house, him and Deborah started to pray to God for Rebecca to take the burden of her mother’s memory away from her. “Lord, I know you sent Miss Rebecca to help lift the burden of them cells…give them to her!…let her carry them” (Skloot 293). Deborah was exhausted and mostly frustrated about the whole situation about her mother. Gary and Deborah believe that God had sent Skloot so they could finally be removed from this affliction they’ve had for too long. Just like Gary said, “man brought nothing into this world and he’ll carry nothing out. Sometimes we care about stuff too much. We worry when there’s nothing to worry about” (Skloot 289). Gary assurse Deborah that all her frustration and anger will be taken away from her. It’s just a matter of faith. Another example in the book where the faith and religion understanding are used in favor of the Lacks family was when Deborah’s brother, Zakariyya, turns to Islam in prison, attempting to use faith to stay sane while behind bars. For the Lackses, faith means family. One of the climactic scenes in the book comes when Deborah’s husband at the time, Reverend James Pullum, calls the author onstage to tell his congregation about the book she’s working on. An outsider for much of the narrative, Rebecca feels momentarily accepted and included in this scene. Despite being an atheist herself, she understands the power that religion has for the Lacks family, and the deep meaning that it gives to their lives.

Faith and religion played a dominant role in health and healing within the African-American community, specifically, the Lacks’s family. The Lacks Family depended on religion to understand that Henrietta’s cells embodied her spirit. It is difficult for the Lacks family to understand the scientific implications of how Henrietta’s cells have been used. Deborah believes that the soul is immortal due to her finding out that her mother’s cells have been crossed with those of tobacco plants and other crucial experiments. “Can you believe they even gave her that AID virus and injected her into monkey’s?’ (Skloot 290). She refers to the cells as ‘her’, making this seem that she is referring to a person and not just any element. This makes her believe that her mother suffers when her cells are used for research. Because of Deborah’s profound beliefs, she comes to the conclusion that Henrietta’s cells still contain her spirit. It makes her believe that she holds a connection with her mother she has never obtained. Therefore, she wants to better understand the scientific aspect so she can connect the dots and and feel her mother closer every time. Deborah also believes that Henrietta’s spirit can still control anyone who messes with HeLa cells. It is therefore difficult for Deborah to grasp on the ideas of the investigations and experiments her mother’s cells have gone through. The rest of the family shares her distrust of science and the author. In the book, Skloot has an epiphany when she speaks with cousin Gray in Clover: the devoutly religious Lacks family has a different way of viewing Hennrietta’s death and immortality. “This is how it will be when the dead are raised to life. When the body is buried, it is a mortal; when raised, it will be immortal. There is, of course, a physical body, so there has to be a spiritual body” (Skloot 295). He sees her illness not as the result of rampaging cancer cells, but as something ‘man-made’ or ‘doctor-made’. Therefore he trusts that God had a personalized purpose for her. “Henrietta was chosen, Gary whispered. “And when the Lord chooses an angle to do his work, you never know what they going to come back looking like” (Skloot 295). He is another person who believes Henrietta’s spirit lives in those cells. The only difference is that her spirit came in a new form. God chose Henrietta to do His work by saving lives. Angles are chosen by God to execute His plan. The communities in Lacks Town and Turner Station use their religious beliefs to explain Henrietta’s astonishing ‘transformation’ into HeLa cells. “You’re saying HeLa is her spiritual body?’ Gary smiled and nodded…In that moment, reading those passages, I understood completely how some of the Lackses could believe, without doubt, that Henrietta had been chosen by the Lord to become an immortal being. If you believe the Bible is the literal truth, the mortality of Henrietta’s cells makes perfect sense” (Skloot 296). For a community who lacks in education, faith really comforts them knowing that there is, after all, and explanation for all this. “Of course they were growing and surviving decades after her death, of course they floated through the air, and of course they’d let the curse for diseases and been launched into space. Angels are like that. The Bible tells us though” (Skloot 296). The cells become Henrietta’s ‘resurrection body’, a chance for her to return to earth and to help humankind. The belief in the supernatural doesn’t exactly contradict scientific truth. It does help the Lacks family fill gaps in knowledge so that they can build a story about Henrietta that makes sense to them. By combining bits of science with a world of faith and superstition, they compensate for the absence of usable information from the scientific community. At the same time, it comforts them and makes them feel close to Henrietta.

On the other hand, science doesn’t play a big role in the lives of the Lacks family, but it’s a crucial topic in the laboratory. At first glance, the harvesting of cancer cells from Henrietta Lacks’ tumor seems like no big deal. She clearly doesn’t want the cancer to remain inside her. And who wouldn’t jump at the chance to help humankind simply by offering their unwanted tissues to researchers? Well, that there’s the point of contention. In ‘The Immortal Life of Henrietta Lacks’, Skloot says that ‘donating’ or ‘contributing’ tissues implies consent on the part of patient or family. It’s a basic requirement of ethical scientific research when human subjects are involved, something that we now take for granted thanks to things like the Nuremburg Code and the Helsinki Declaration. Thanks to the immortal line of cells, many medical contributions came along. The HeLa cells where an immense part of science back around the 1960’s. Outbreaks occurred during those times and doctors nor scientists could find a cure for these illnesses that spreading all over the country. With the help of the help of the immortal cells, known as HeLa cells, the scientific community was able to find a cure for a collection of outbreaks that were occurring during those times. The media knew all about the new investigations and new cures. Everyone was thrilled about the new discoveries that were made for the benefit of the country and the world around. But even though this was a monumental era, the Lackses family was way out of it. They were never informed the cells of their own mother were being used for scientific research.They knew absolutely nothing about what was going on with their mother’s cells. Science wasn’t their main priority anyway since they lacked in education. All they wanted was to understand what was going on with their mother’s cells.

Religion and science are just incompatible. Humans will be lenient more to one side than the other. The belief in the supernatural doesn’t exactly contradict scientific truth. It does help the Lacks family fill gaps in knowledge so that they can build a story about Henrietta that makes sense to them. By combining bits of science with a world of faith and superstition, they compensate for the absence of usable information from the scientific community. At the same time, it comforts them and makes them feel close to Henrietta.

My first reaction to this book was outrage. What an extremely disgraceful way for medical professionals to treat a human being. Henrietta’s story raises questions about ethics, race, and informed consent. John Hopkins University Hospital should be ashamed of themselves! There is an element of time frame that could be used to account for a practice that was status quo at the time but mostly it is just shear disregard for African Americans and their basic rights. There was a doctor/researcher that stated “those people wouldn’t understand anyway”, this shows just how much race and ethnicity played a part in this situation (Skloot, R. (2017). As an African American woman, she was considered less than and not given any respect. The informed consent that Mrs. Lacks signed was not for tissue retrieval. It was for a single operation. She was not informed of the biopsy that they had taken would be used for unjustified cell research.

Rebecca Skloot’s book shows how actions of John Hopkins affected the entire Lacks family. They did not have sufficient time to prepare for the untimely death of Henrietta. She and her family were not informed of the depth of her condition due to the lack of regard for ‘colored’ people being second class citizens at this time in history. The family were kept in a continuous state of unknowing due to the ongoing blood draws being done to the children. The children were especially affected due to being place with a sadistic aunt who abused them emotionally and physically and an uncle who abused Deborah sexually. I believe that if she had been told of the depth of her condition and treated respectfully she would have been able to arrange her children’s future lives better.

“Henrietta’s children accidently learned that their mother’s cancer cells called HeLa cells were being used in research. Henrietta’s family lived in poverty and never received any of the financial benefits” (Suzanne Mahon, 2017). There are so many different reasons to be talking about this case. As a future counselor I had a hard time reading how Henrietta had been treated. She might have survived if she had been treated with a single ounce of respect. She might have been able to have some time to prepare her family and make plans for her children. Her family would have not had to live in poverty if they had been shown justice. Justice in that way of respect, compensation and human decency.

The ACA Code of Ethics has ethical codes that address each issue I have been discussing. The first and foremost aspect is beneficence do no harm. In the case of Henrietta Lacks there were many ethical issues in my opinion, that did harm without regard for the patient. The researchers did not care for her health, much less who she even was as a person. When asked, the researcher did not even know her name. There was not consent given for research. They considered ‘colored people’ to be less than so they could do as they saw fit. Ethical code states that “C.5. Nondiscrimination Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/ partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law” (American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author). I know that the ACA code of ethics was first established in 1959 but I wish there had been some sort of consideration for Ethical code “B.1. Respecting Client Rights B.1.a. Multicultural/Diversity Considerations Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared” (American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author).

The Belmont report discusses, justice, beneficence, and respect for persons. “The lack of informed consent, or coercive, forceful influences and methods that were used to obtain consent from potential participants; this associated with impaired risk-benefit scales, unjustified research population selections have prompted international regulations to stand firm on principles advocating conscientious clinical and ethical research systems” (Preethi Shivayogi, 2013). An injustice occurs when some benefit to which a patient is entitled is denied without good reason or when some burden is imposed unduly. There was not regard for any of these aspects in the Lacks case. As I stated before there was harm done to Mrs. Lacks and her family. They have yet to be given any justice, in the form of financial reciprocity or even acknowledgement of wrong doing. Lastly, they definitely did not respect Mrs. Lacks or her family.

There are many important factors to informed consent. Informed consent is thought to be the explanation of the purpose, benefits, risks and other study information necessary to allow the participants to make an informed and voluntary decision to participate in the clinical study. It also describes the obligation of the researcher to inform the patient about personal benefits and risks a client may face in study. Respect for persons requires that patients be given the opportunity to choose what shall or shall not happen to them. Without informed consent there can be no validity of a study. We as researchers or counselors are obligated to the three components of valid informed consent: disclosure, capacity and voluntariness. If a client is not informed by disclosure, capable of consent, or doing the research voluntarily is can not be marked as valid. I do not believe that she was able to truly consent due to her health and maybe even her education level. They did not take the time to find out or even try to find out if she was capable of consent. There was no regard for harm of the patient and she was part of a vulnerable population.

Vulnerable populations are to be handled with care. There are several definitions of vulnerable populations. They are disadvantaged clients of the community. They require the utmost care, specific considerations and protections in research. The vulnerable client’s freedom and capability to protect one-self can be an issue. Decreased freewill can be an issue with clients such as prisoners, people in other institutions, like nursing homes or mental health facilities. They can have the inability to make informed choices. Vulnerable populations need attention during designing studies with unique enrollment considerations and quality examination measurements of overall safety approaches ensuing research (Preethi Shivayogi, 2013). It is of the utmost importance that we make sure that our clients fully understand what they are going to be participating in. What the harms might be, what the benefits might be, and how they have the right to quit the study at any time. They are not to be kept in the dark as Mrs. Lacks was. She had the right to know what was being done to her and what they would be doing with her cells.

In conclusion, it is in my opinion that Johns Hopkins University Hospital was ethically irresponsible in the case of Henrietta Lacks. She went to this institution for help and was taken advantage of and she was not given the respect that she deserved (Skloot, R. (2017). Her family suffered for many years with the knowledge that she was treated unfairly and this effected their wellbeing. They also were not financially compensated for the many millions of dollars that the researchers gained from her cells. John Hopkins still refuses to acknowledge or admit wrong doing to this day. This seems to me to be the ultimate sign of disrespect. This women’s cells have saved many lives and has advanced research in so many ways. She and her family deserve to be recognized for their unmeasurable contribution to science. As for me as a counselor/researcher it puts ethics and guild lines in the forefront of my mind as the most important factor for any research ever undertaken.

References

1. American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author
2. Skloot, R. (2017). The immortal life of Henrietta Lacks. Broadway Books.
3. Retrieved from on 3/8/2019 https://voice.ons.org/stories/the-story-of-henrietta-lacks-sheds-light-on-ethical-considerations-in-genetic-testing
4. Retrieved from on 3/10/2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601707/
5. Retrieved from on 3/14/2019 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863255/

Golden rice variety of rice known as Oryza sativa produced through engineering to biosynthesize beta-carotene, which is precursor of vitamin A. It is known as a biofortified culture which is genetically modified and is nutritionally rich. The nutritional valued are concerned with healthier skin, immune system, and vision. The development of golden rice was collaboration result between Peter Beyer and Ingo Potrykus research obtained in 1999 (Ye et al., 2000).

Deficiency of vitamin A is major problem of developing countries because the staple diet is mostly dependent in rice to other micronutrient poor carbohydrate foods these food show slow promise towards vitamin A. World health organization estimates about 250 million preschool children’s and affected by vitamin A deficiency which leads 2.7 million deaths. One major health effect is skin dryness and eyesight problems, low immune response, and high mortality risk infections.it is one of the major problems in developing countries (Akhtar et al., 2013).

In the current world the developing countries mostly relying on single staple crop for their energy intake. Biofortification is the aim to provide and manage health issues where the nutritional impact is seen through the composition of staple crop. The rice can be game changer in such areas where minimal change in the food production and processing and consumption can play vital role towards the health issues arising by nutritional values (Key, Ma, & Drake, 2008).

The people who support golden rice they believe it can solve the vitamin A crisis and help in the severity in health issues related to vitamin A, they can be removed or minimized by the golden rice in developing countries. While others believe the severity of vitamin A deficiency is due to unequal distribution of food over the population and there is not any role of depleting vitamin levels with the stable food rice in their daily use. The supporters believe that the golden rice project have no any concerns with profit biotech companies they believe the project has freedom to operate under human use and the technology will show its promises in developing countries.

Despite of various benefits, risks and impacts of golden rice in developing countries the innovation in biotechnology for promising the world to keep healthy individual and serving vitamin A remains constant.

Ethical Matrix

An ethical matrix is an analytical tool that helps policymakers (as individuals or groups) make logical decisions or decisions on ethical acceptability and/or appropriate regulatory controls for current or foreseen food and agriculture technologies (Mepham, Kaiser, Thorstensen, Tomkins, & Millar, 2006). The ethical matrix can be applied in several ways to assist decision- making, but all applications share some essential characteristics. The matrix is wholly based on three principles which are wellbeing where the security, health, and welfare of an individual or group are checked. Autonomy, where the people have the right to be free to choose and make their own decisions are seen and fairness where to what extent the situation is suitable for the group, is observed. The ethical problem here is the use of GM plant as food for normal people, although they are environmentally, and health friendly and dangerous concerns are not identified. The main issues that will be discussed here are highlighted, and other parts will be addressed in a broader extent. The main stakeholders in these regards are farmers, consumers, and the treated plant, and of course, the biota.

Discussion

Several ethical questions arise from the golden rice development some are related to genetically modified plants are not good, it’s not promising in the cur of disease totally. Giving the reasons for the research of golden rice, environmental, health issues are also subject to issues which is an excellent place to start an assessment. Golden rice is game changer in vitamin related deficiency and supplements. So that the developments countries the deficiency can me managed in mass manner. And shows promise in permanent way. consequential framework focus on the outcomes of the golden rice, if it shows any promise or have side effects. the clear analysis will give outcome and result about the golden rice project. Many GMO activists focus on negative consequences of farming and consuming golden rise as it has allergic and potential antibiotic resistance. The possibility that genetically modified food that can mash with plating GMO crops near non-GMO crops, unknowingly from consumer. That can lead to environmental issues. These kinds of crops create negative impact and possibly its biodiversity. Issues may arise if GMO are bred with wild species (Ogwu, 2019). There are possible socioeconomic implications that genetically modified foods have in developing countries. So, own profit companies try to back genetically modified foods which leads the fear of negative effect on small scale farmers and market balance is affected and directly the farmers are suffered who cannot go against the big biotech companies. More like golden rise keeps its promise to help millions of people who lack vitamin A and prevents millions of deaths in developing countries. In addition, golden rise can be the perfect pathfinder for enhancing genetically modified, biofortified crops to combat micronutrients in developing countries. This is the main strong point for golden rice and its use. Improvement of public health in developing countries is also one benefit from golden rice.

The debate anti GMO activist, so views are left without light, strongly blunt voices are those inhabitants of developing countries the intended got proper way to fight in correct manner fight against micronutrient and malnutrition.

Ethical Issues

Well-Being

Well-being is provided to parties like experts that may be farmers and consuming area and future generation. Golden rice maybe a good opportunity and sow promise to health, social economic benefit, causses excellent quality rice provides ne new opportunity to increase income to farmers. When evaluating the golden rice consumption impacts safety of humans and animals as well environment is regulated by agencies and experts so level of well-being is truthful and fruitful. Golden rice has a positive effect on human health, strengthening the economic status of small farmers from large agricultural businesses. Differences of opinion still persist.

Fairness

Golden rice will be a game changer in the field of medicine by transforming food into supplement by improving the qualities of rice along with nutritional value. So, the level is good for stakeholders.

Biota

The potential issues concerned with environment is the main attention now. The possibility of genetically modified crop becomes weed, and the possibility of unwanted genes being transferred to wild relatives. The displacement of related plants in wild relatives may cause loss of biodiversity which will be different form traditionally bred commercial varieties. The main threat is GM contamination that will affect traditional, conventional organic farming. Like other varieties of white rice golden rice is cultivated in monocultures which implies adverse effect on local ecosystem likely loose of ecosystem. Focusing the socio systemic branch including participation, equity, ethics and biodiversity more often pointed towards the shortcoming of golden rice.

Consumer Concern

Golden rice is approved for consumption in the Philippines and will help reduce VAD because it is high in beta-carotene. But studies show that most families are at risk of VAD, they cannot grow it themselves, and most commercial farmers cannot grow it. In many cases, an emotional reaction to golden rice was observed. The anxious reactions recycled about Green Revolution technologies and the commercialization of agriculture were not reliable for golden rice. Rice consumption is targeted at the poor, so these people act as guinea pigs, golden rice will not provide enough vitamin A, but if consumed in large quantities, it can lead to toxicity. Golden rice is an extension of the green revolution that hurts the poor.

Conclusion

Ethical problems in agriculture field and food industry in general concerns are providing quality, safety, healthy without causing any harmful effects to human, animal, and environment. Obviously, technology attribute to agriculture a great deal since its beginning especially under the highly global demand of food. Technology itself is amoral which means that it has neither a good or an evil side, the way of using it is what makes the difference. GR in this state is all good and even better and safe solution with a minimum known, measured, and proven harm. The way this project will applied and controlled may or may not change the previous ethical judgment. GR project as a GMF’s is an ethical solution have certain shortcomings in addressing consumer’s participation; it is known that often developing countries does not involve consumers in decision making of entering certain products or even opening a space for debate, the choice depends most of the times on scientific and ethical judgment of their governments, economics and scientific experts: ethically GR is likely to be in the good side of the equation of good and evil. There is several alternative to genetically modified foods under the bad conditions of the rural areas in India such as: Vitamin A pills, GR, other sources of vitamin A form local plants, breastfeeding. It is important to reconsider GMF’s by looking to the positive side of the industry and its future potentials to transform food into medicines or supplements.

References

1. Key, S., Ma, J. K. C., & Drake, P. M. (2008). Genetically Modified Plants and Human Health. Journal of the Royal Society of Medicine, 101(6), 290-298. doi:10.1258/jrsm.2008.070372
2. Mepham, B., Kaiser, M. J., Thorstensen, E., Tomkins, S., & Millar, K. (2006). Ethical Matrix Manual.
3. Ogwu, M. (2019). Lifelong Consumption of Plant-Based GM Foods: Is It Safe? (pp. 158-176).
4. Ye, X., Al-Babili, S., Klöti, A., Zhang, J., Lucca, P., Beyer, P., & Potrykus, I. (2000). Engineering the Provitamin A (β-Carotene) Biosynthetic Pathway into (Carotenoid-Free) Rice Endosperm. Science, 287(5451), 303. doi:10.1126/science.287.5451.303.

Targeted Drug Delivery

Targeted drug delivery has improved cancer therapy drastically over the decade. There has been successful development in cost-effective anticancer drugs mostly based on liposomes and polymers.

Targeted drug delivery is an important biomedical application that aims to deliver anticancer drugs to the specific site of the tumour and avoid damage to surrounding healthy cells. Currently, Iron oxide nanoparticles are the main source of magnetic materials used for the delivery of anticancer drugs to target specific areas.

Chemotherapy depends on the circulatory system to transport anticancer drugs to the tumour. There are negative side effects of this treatment such as non-specificity and toxicity of the drug, whereby the drugs attack healthy cells and organs as well as the cancerous cells. Therefore, targeted drug delivery is being developed as one alternative to chemotherapy treatment. The aim of targeted drug delivery is to direct the drug to the specific area where the tumour is located and thereby increasing the amount of drug delivered at the tumour site and reducing the side effects.

Generally, the magnetic nanoparticles are coated with a biocompatible layer, such as gold or polymers, this is done to functionalise the nanoparticles so that the anticancer drug can either be conjugated to the surface or encapsulated in the nanoparticle.The drug is released by enzyme activity or by changes in pH,temperature or osmolality.

Biosensors

A biosensor is an analytical device that is used for analysing biological samples. It converts a chemical, biological or biochemical response into an electrical signal. A biosensor contains three essential components

• The bioelement/bioreceptor are made up of enzymes, nucleic acids, antibodies, cells or tissues
• the transducer which can be electrochemical, optical, electronic, piezoelectric,pyroelectric or gravimetric and
• the electronic unit which contains the amplifier,processor and display.

Nanoparticles can also be used as bioreceptors after they are coated with a bioresponsive shell. Biosensors are utilised in many different areas including environmental, bio/pharmaceutical, food and medical industries. A typical biosensor is composed of three main parts the electronic system, which contains the signal amplifier, processor and display unit, the transducer, which converts the reaction of the sample analyte and bioreceptor into an electrical signal and a bioreceptor, which is composed of a biological substance which targets and or binds to a specific compound. The transducer used in the biosensor depends on the reaction that is generated between the sample and the bioreceptor.detect changes in light adsorption or photometric which detect changes in photon output. Piezoelectric sensors can detect changes in mass.Working principle of biosensors: is the signal transduction. The different components of a biosensor include a bio-recognition component, a biotransducer and an electronic system for the display , processor and amplifier. … The transducer measures this interaction and outputs a signal.

Bioimaging

There are different bioimaging techniques such as MRI, computed tomography (CT), positron emission tomography (PET) and ultrasound that are used for the detection and diagnosis of diseases. These techniques are non-invasive and some can produce high-resolution images of internal organs.

In cell biology, bioimaging is used to follow cellular functions, quantify ion or metabolite levels and measure interactions of molecules where they happen. Appropriate tracers, e.g., specific fluorochromes, and advanced microscopic instruments as e.g. confocal laser scanning microscopes (CLSM) are a prerequisite for most applications.

One of the great advantages of imaging is its intuitive information content; much can be learned from just a glance at the data. On the other hand, these data generally contain a very large amount of untapped information. For example, characterization of spatial phenotype heterogeneity in cells on a tissue scaffold is a critical question in tissue engineering, histopathology, and basic systems biology. However, there is currently no way to obtain such information short of using destructive and very labor intensive approaches.

Advances in Bone Tissue Engineering

Nanotechnology also has a promising role in tissue engineering.. In particular, skeletal reconstruction following bone fracture is of interest due to the increasing number of elderly people and bone fractures require bone tissue for various bone defects, ring reconstruction with tissue transplants. Bone has the capacity for regeneration, complications such as excessive bone loss impede healing, necessitating the use of bone grafts.

The invention of tissue engineering, where the main goal is to generate functional tissue, has raised the possibility of engineering bone in vitro. Over the past few researches , a wealth of progress in bone tissue engineering has been successfully achieved particularly in cell sources, developing biocompatible and biodegradable scaffolds. Designing bioreactors to improve in vitro osteogenic priming, and to identify the growth factors that can induce or promote endogenous bone and vascular development.

Nanoparticles can be combined with scaffolds to facilitate application in bone. Osteoblasts and osteoclasts have a complex interaction and their respective activity is key to bone homeostasis.Bone formation by osteoblasts can be supported by nanoparticle-based drug/growth factor delivery while osteoclast remodeling activity can be modulated by nanoparticles locally releasing specific inhibitors.

Damaged bone can also be fixed using the coral/ marine sponges due to similarity between the two. For the large-sized tissues and origins with different shapes,it is important to design a temporary support for providing spaces for cell proliferation, differentiation and growth.

NANOTECHNOLOGY FOR GENETIC ENGINEERING AND STEM CELL THERAPIES

Stem cells make them suitable for tissue engineering and organ regeneration, it is necessary to genetically engineer (or manipulate or reprogram) them. This is done with a view to generate patient-specific stem cells, make them pluripotent, for differentiation, proliferation, transdifferentiation or dedifferentiation, induce expression of signaling factors, produce transgenic animals as models of diseases, upregulate or downregulate receptor molecules on surface, amongst others.

A variety of nanovectors has been constructed which help gene transfection with their properties to be selectively internalized into target cells and high efficiencies. Nanovectors can be used both for in vivo and in vitro gene transfection are of two types- Viral vectors and non-viral vectors. Differentiated stem cells are being used to test the safety and effectiveness of new medications. Also testing drugs on human stem cells eliminates the need to test them on animals, thus reducing animal abuse.

Conclusion for stem cells research:stem cell research based on nanotechnology has obtained a lot of achievement in the field of regenerative medicine of orthopedic surgery, showing good prospects in clinical applications. But nanotechnology applied to stem cell research is still in its early stages, and there are a number of key issues to be solved.

Conclusion

Nanotechnology is a promising area of research with potential benefits in patients suffering various illnesses. Although nanoparticles are extensively studied for drug delivery and are proving to be effective in drug delivery and the diagnostic field, at least in animal models, further research is needed to prove these benefits in humans. we can conclude that:

• the advancement in nanotechnology and bioengineering is supporting tremendous efforts in improving the methods for research,
• a successful translational method of approach is making it possible to increase the number of biomarkers useful in neuro-oncology.