54 unit 1 | Professional Considerations
The Human Genome Project is dedicated to map-
ping and identifying the genetic composition of
humans. Scientists hope to identify and eradicate
many of the genetic disorders affecting individuals.
Initiated in 1990, the Human Genome Project was
projected to be a 13-year effort coordinated by the
U.S. Department of Energy and the National
Institutes of Health. However, because of swift
technological advances, in February 2001 the sci-
entists announced they had cracked the human
genetic code and accomplished the following goals
(Human Genome Project Information, 2002):
■Identified all of the genes in human DNA.
■Determined the sequences of the three billion
chemical bases that make up human DNA
■Stored this information in databases
■Developed tools for data analysis
■Addressed the ethical, legal, and social issues
that may arise from the project.
Rapid advances in the science of genetics and its
applications present new and complex ethical and
policy issues for individuals, health-care personnel,
and society. Economics come into play because,
currently, only those who can afford the technology
have access to it. Efforts need to be directed toward
creating standards that identify the uses for genetic
data and the protection of human rights and confi-
dentiality. This is truly the new frontier.
Stem Cell Use and Research
Over the last several years, issues regarding stem
cell research and stem cell transplant technology
have come to the forefront of ethical discussion.
Stem cell research shows promise in possibly curing
neurological disorders such as Parkinson’s disease,
spinal cord injury, and dementia. Questions have
been raised regarding the moral and ethical issues
of using stem cells from fetal tissue for research and
the treatment of disease. Stem cell transplants have
demonstrated success in helping cancer patients
recover and giving them a chance for survival when
traditional treatments have failed.
A new business has emerged from this technol-
ogy as companies now store fetal cord blood for
future use if needed. This blood is collected at the
time of delivery and may be used for the infant and
possibly future siblings if necessary. The cost for
this service is high, which limits its availability to
only those who can afford the process.
When faced with the prospect of a child who is
dying from a terminal illness, some parents have
resorted to conceiving a sibling in order to obtain
the stem cells for the purpose of using them to save
the first child. Nurses who work in pediatrics and
pediatric oncology units may find themselves deal-
ing with this situation. It is important for nurses to
examine their own feelings regarding these issues
and understand that, regardless of their personal
beliefs, the family is in need of sensitivity and the
best nursing care.
A primary responsibility of nursing is to help
patients and families cope with the purposes, ben-
efits, and limitations of the new technologies.
Hospice nurses and critical care nurses help
patients and their families with end-of-life deci-
sions. Nurses will need to have knowledge about
the new genetic technologies because they will fill
the roles of counselors and advisers in these areas.
Many nurses now work in the areas of in vitro fer-
tilization and genetic counseling.Professional Dilemmas
Most of this chapter has dealt with patient issues,
but ethical problems may involve leadership and
management issues as well. What do you do about
an impaired coworker? Personal loyalties often
cause conflict with professional ethics, creating an
ethical dilemma. For this reason, most nurse prac-
tice acts now address this problem and require the
reporting of impaired professionals and providing
rehabilitation for them.
Other professional dilemmas may involve
working with incompetent personnel. This may be
frustrating for both staff and management.
Regulations created to protect individuals from
unjustified loss of position and the enormous
amounts of paperwork, remediation, and time that
must be exercised to terminate an incompetent
health-care worker often make management look
the other way.
Employing institutions that provide nursing
services have an obligation to establish a process
for the reporting and handling of practices that
jeopardize patient safety (ANA, 1994). The
behaviors of incompetent staff place patients and
other staff members in jeopardy; eventually, the
incompetency may lead to legal action that may
have been avoidable if a different approach had
been taken.