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Legislating Morality

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Kate Milne

on 30 June 2014

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Transcript of Legislating Morality

Legislating Morality

Objectives
1. Describe the relationship between law and morality.

2. Compare and Contrast the arguments for and against Legislating Morality.

3. Identify areas in which Legislating Morality impacts the health care professional.

Definitions
1. leg·is·late
verb \ˈle-jəs-ˌlāt\
a. to make laws
b. to control, create, or cause (something) by making laws

2. mo·ral·i·ty
noun \mə-ˈra-lə-tē, mȯ-\
a. beliefs about what is right behavior and what is wrong behavior
b. the degree to which something is right and good : the moral goodness or badness of something
Abortion
Matthew Hafen, BS, Ashley McCarthy, RN, MS
Kathryn Milne, RN,BSN, Allison Salinder, RN,BSN

What is Morality?
Legislating Morality and Abortion
Implications
for Practice
Ensure the safe care for all women who choose to receive an abortion.
Advanced Practice Nurses can be limited by State Regulation as whether they can perform abortions.
Currently PAs and NPs provide 1st and 2nd trimester abortion care in Vermont and New Hampshire.
Depended on the State access to care can be limit.
NH Abortion Facts: http://www.guttmacher.org/pubs/sfaa/pdf/new_hampshire.pdf
Pro-Life
Moving Past
Pro-Choice or Pro-Life
Pro-Choice
This viewpoint is supported by the National Abortion Federation and NARAL Pro-Choice America.

The focus of these groups are to support women's right to choose.
References
https://www.prochoice.org/
For More Information click the following link:
Abortion. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved June 27 2014 from http://medical-dictionary.thefreedictionary.com/Pregnancy+termination

Birthmothers Ministries Inc. (2013). Types of Abortions. Retrieved from http://www.birthmothers.org/extras/types-of-abortions.htm

Brescoll, V. L., Kersh, R., & Brownell, J. D. (2008). Assessing the feasibility and impact of federal childhood obesity policies. The ANNALS of the American Academy of Political and Social Science, 615, 178-194.

Casebriefs. (2014). Washington v. Glucksberg. Retrieved from http://www.casebriefs.com/blog/law/constitutional-law/constitutional-law-keyed-to-sullivan/substantive-due-process-rise-decline-revival/washington-v-glucksberg-7/

CaseBriefSummary. (2013) Vacco v. Quill. Retrieved from http://www.casebriefsummary.com/vacco-v-quill/

Congress.gov (2013). S.1696 - Women's Health Protection Act of 2013. Retrieved from https://beta.congress.gov/bill/113th-congress/senate-bill/1696

Data and Statistics. (2014). Centers for Disease Control and Prevention. Retrieved June 27, 2014, from http://www.cdc.gov/obesity/data/index.html

Gardner, D. (2012). Quality in life and death: Can we have the conversations? Nursing economic$, 30(4), 224-227.

Geisler, Norman L.,Turek, Frank,. (1998). Legislating morality : Is it wise? is it legal? is it possible?. Minneapolis, Minn.: Bethany House Publishers.

Green, L. (2013) Should law improve morality? Criminal Law and Philosophy, 7(3), 473-494.

Hickman, S.E., Sabatino, C.P., Moss, A.H., & Wherle Nester, J. (2008). The POLST (Physician Orders for Life-Sustaining Treatment) paradigm to improve end-of-life care: Potential state legal barriers to implementation. Journal of Law, Medicine, & Ethcis, 36(1), 119-140.

Holm, S. (2003). The ethical case against stem cell research. Bioethics and Biotechnology, 12, 372-383. Retrieved from http://orca-mwe.cf.ac.uk/50047/1/Holm%202003.pdf

Kearl, M. (2013). Dickey-Wicker Amendment. Retrieved from http://embryo.asu.edu/pages/dickey-wicker-amendment

The hallmark trial of 1973 that ruled that

"States were forbidden from outlawing or regulating any aspect of abortion performed during the first trimester of pregnancy, could only enact abortion regulations reasonably related to maternal health in the second and third trimesters, and could enact abortion laws protecting the life of the fetus only in the third trimester."
What is Abortion?
Roe v. Wade
Please read the following article "Legislating Abortion Care"
http://virtualmentor.ama-assn.org/2014/04/jdsc1-1404.html
the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.

A spontaneous abortion (also called a miscarriage) occurs on its own.

An induced abortion is the intentional termination of a pregnancy and expulsion of a fetus, whether by surgery or the administration of pharmaceuticals.
Pro-Choice Legislation Initiatives
Congressional Record on Choice
Find out how members of Congress voted on
choice-related issues in 2013.
http://www.prochoiceamerica.org/government-and-you/us-government/congress.html
http://www.prochoiceamerica.org/
This viewpoint is supported by the American Life League and the National Right to Life

The focus of these groups are to preserve all human life, regardless of intent, viability, or quality-of-life concerns.
For More Information About These Organizations click the following link:
http://www.all.org/
http://www.nrlc.org/
Pro-life Legislation Initiatives
The Pain-Capable Unborn Child Protection Act (S.1670)
would
protect unborn babies

beginning at 20 weeks

The Health Care Conscience Rights Act (H.R. 940/S.1204)
would protect the rights of taxpayers and health care workers against the Obama administration’s assault on conscience and religious liberty, including the
HHS abortion-pill mandate
.

Title X Abortion Provider Prohibition Act, H.R. 61 and H.R. 217
identical bills that would
prohibit federal funding
of all abortion providers

Women's Health Protection Act of 2013
Makes the specific limitations and requirements concerning abortion services unlawful
Unsafe Abortion: Unnecessary Maternal Mortality
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709326/pdf/RIOG002002_0122.pdf
End-of-Life Issues
The Debate
Modern Medicine has become so advanced it enables patients to live longer, but is longer always better? The debate regarding end-of-life decisions is passionately disputed on both sides. Some believe preservation of life is paramount while others believe individuals should have the right to die. The question surfaces, who gets to decide such a personal matter? The patient or the government?
Legislation
Washington vs Glucksberg
In January of 1994, four physicians, three terminally ill patients, and a non-profit organization that counseled patients contemplating physician assisted suicide sued the U.S. District Court. The group stated the law which makes aiding another person with suicide a crime, violated the Fifth and Fourteenth Amendment rights. The U.S. District Court upheld its decision on the grounds that assisted suicide is not a liberty granted by Due Process of the U. S. Constitution (Casebriefs, 2014).
Vacco v. Quill
In 1997, New York state law allowed patients the right to refuse life saving treatment. Physicians argued physician assisted suicide fell within this law and it was a violation of the Equal Protection Clause in the 14th Amendment. New York state ruled against the physicians reasoning, when a patient refuses treatment he will die as a result of his illness. In the case of physician assisted suicide, the patient dies as a direct result of physician actions (CaseBriefsSummary, 2013).
Baxter v. Montana
In December of 2009, physicians argued on behalf of a terminally ill patient for his right to die. The Montana Supreme Court sited two sections in the Montana Constitution, Sec 4: Individual Dignity and Sec. 10: Right to Privacy. Stating the constitution does not prohibit the right to die. Ultimately, ruling in favor of Baxter (Montana Supreme Court, 2009).
Legislating Morality at End-of-Life
Regulating Morality: New York State
In 1985, Governor Maria Cuomo established the New York State Task Force on Life and Law.
The purpose of the task force is to create policy addressing issues involving medicine, law, and ethics.
Members from various fields including religion, law, philosophy, medicine, nursing, and bioethics volunteer on the committee.
The task force has influenced state and national legislation. Court rulings and academic journals often reference the task force.
The task force ultimately concluded physician assisted suicide should be prohibited.
Regulation Against Morality?: Oregon State
In 1997, Oregon passed the Death with Dignity Act allowing terminally ill citizens of sound mind the right to die.
Visit the site for more details and frequently asked questions:
http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/faqs.aspx#whocan
How is New Hampshire
Regulating Morality?
Implications
for Practice
Advanced Practice Registered Nurses (APRNs) must remain informed about their current state legislation regarding end-of-life regulations.
As an APRN you may not agree with the treatment the patient wants you to provide or omit. Taking time to consider your own feelings towards the matter will help prevent you from projecting your beliefs onto the patient.
Utilizing the POLST in New Hampshire will provide the APRN and patient with a future plan of action.
Current law in New Hampshire considers Physician assisted suicide a felony.
Recent legislation has passed the Physician Orders for Life-Sustaining Treatment program.
Please read the provided article introducing POLST and then watch the following video.
Open and honest communication is key when discussing end-of-life options with your patient. Read more at:
For more information visit http://www.healthynh.com/provider-orders-for-life-sustaining-treatment-polst.html
For more information visit https://www.health.ny.gov/regulations/task_force/
Please read article: http://eds.b.ebscohost.com.libproxy.unh.edu/eds/detail?sid=9fc752df-1ff4-46f7-91da-a4429fbfc31f%40sessionmgr198&vid=23&hid=115
"Morality is about right and wrong, and that's what laws put into legal form. Can you think of one law which doesn't declare one behavior right and it's opposite wrong? Truth is all laws legislate morality (even speed limits imply a moral right to life" - Dr. Frank Turek
Is Legislating Morality Constitutional?
Stem Cell Research
Ideas Concerning the Legislation of Morality
What are stem cells?
Stem cells are the body's raw materials — cells from which all other cells with specialized functions are generated. Under the right conditions in the body or a laboratory, stem cells divide to form more cells called daughter cells.

These daughter cells either become new stem cells (self-renewal) or become specialized cells (differentiation) with a more specific function, such as blood cells, brain cells, heart muscle or bone. No other cell in the body has the natural ability to generate new cell types.

Mayo Foundation for Medical Education and Research, 2014
Where do stem cells come from?

Embryonic Stem Cells
: originating from a 3-5 day old Embryo
Adult Stem Cells
: collected from bone marrow and fat
Induced Pluripotent Stem Cells
: adult stem cells that have been transformed into stem cells using genetic reprogramming.
Perinatal Stem Cells
: amniotic fluid and umbilical cord blood

Mayo Foundation for Medical Education and Research, 2014

Purpose of stem cell research
Learn more about disease development

To test new drugs and their effects on the human cell

Generation of healthy cells to replace diseased cells

-National Institute of Health, 2014
The Debate
PRO stem cell argument
:
is that derivation of human
embryonic stem cells is morally innocuous because human embryos have no moral status.
ANTI stem cell argument:

focus on the moral status of
the embryo; the life of human individuals is intrinsically valuable at all stages of life.

Holm, 2003. pg. 372, 375
View points
Embryos at the moment of conception have moral status equal to a person.
The moral status of an entity stems from its potential for experiencing a life like ours.
Moral status is tied to cognitive capacities such as consciousness and sentience, the capacity to feel joy and pain, other emotions, or the capacity to have interests and desires.
Embryos are sacred or have symbolic weight deserving of respect.
Master et al, 2011, pg. 52
History of Legislation
The Dickey-Wicker Amendment is an amendment attached to the appropriations bills for the Departments of Health and Human Services, Labor, and Education each year since 1996 restricting the use of federal funds for creating, destroying, or knowingly injuring human embryos.

The Bush administration restricted federal funding to only the human stem cell lines existing as of August 9th, 2001.

President Barack Obama has since revoked both Bush’s statement on August 9th, 2001 and his Executive Order on June 20th, 2007 supplementing the August statement.

In an Executive Order made on 9 March 2009, President Obama lifted any restriction to federally funded stem cell research imposed by the office of the President.
Kearl, 2010
Implications for Practice
The Advanced Practice Registered Nurse, APRN should be aware of the legislated permits and bans in their state of practice.
Because of the Moral dilemma stem cell research involves, the APRN should understand their own personal views, while respecting and providing for those who have opposing views.
To stay informed and up to date with medical advancement while recognizing the authenticity of the findings.
To be a patient advocate, equipped with sound clinical findings and scientific research.
Current Legislation
Resources for both sides
"[I]t is permissible to uphold social morality when the morality enforced helps constitute a valuable form of life and the ‘enforcement’ makes no or minimal use of coercion."-Joesph Raz
New York State Department of Health, 2012
January 2004 New Jersey passed a bill that permits human cloning for the purpose of developing and harvesting human stem cells.

November 2004 California created $3 Billion dollar state tax payer funded institute for stem cell research.

2006 Missouri legalized certain forms of embryonic stem cell research.

Several states have shown interest in providing their own funding; Connecticut, Florida, Illinois, Massachusetts, Missouri, New Hampshire, New York, Pennsylvania, Texas, Washington, Wisconsin.

States that have restrictions and bans on stem cell research; Arkansas, Iowa, Kansas, Louisiana, Nebraska, North Dakota, South Dakota, Virginia.

The State of New Hampshire supports embryonic stem cell research and has been urging congress to do the same. For more information please see http://votesmart.org/static/billtext/4974.htm

Wickipedia, 2013
Coalition for the advancement of Medical Research
http://alliancerm.org/
Do No Harm, the coalition of Americans for Research Ethics
http://www.stemcellresearch.org/
Stem Cell Research Center for Bioethics and Human Dignity
https://cbhd.org/category/issues/stem-cell-research
Genetics Policy Institute
http://www.genpol.org/
Adult Stem Cell Therapy
in New Hampshire
Legislating Morality and Stem Cell Research
References
Please read the following
articles:
http://orca-mwe.cf.ac.uk/50047/1/Holm%202003.pdf


https://4a638b12-a-62cb3a1a-s-sites.googlegroups.com/site/gilliancrozier/home/research/publications/Zubin%26Crozier%2CHCA%28forthcoming%29.pdf?attachauth=ANoY7cpXdlomAbC0n1J8Oe8ELfp7OOhoj04IuI0_PuSqQEil7va6Wyta923IjFSS4Haz5vb8BMHPWEogFZHr5RAmTgI-0glL_OlEIp_lTjvcwjkyZPKiQuhe5RufwL9LQWJNuGYnz3_IOn-7_hJ86pYdK2K0VnVYBNBowclC2vimvxMz-eCvhur_p4ykhUe5zKVXa-y8_6LcbJHigEJBDS4Pkh2fyozntpRMLsdTXSwiLx9Irhks4wjeQaGhbamugovlmC5KymgY2su-40bqkwWvxAsOhZirW3obt5uerrBpMydWElYiPaA%3D&attredirects=0

http://eds.a.ebscohost.com.libproxy.unh.edu/eds/pdfviewer/pdfviewer?sid=be7fa42a-a4bd-44f5-89c9-dccd315b4438%40sessionmgr4001&vid=3&hid=4113




Kass, N., Hecht, K., Paul, A., & Birnbach, K. (2014). Ethics and obesity prevention: ethical considerations in 3 approaches to reducing consumption of sugar-sweetened beverages. American Journal Of Public Health, 104(5), 787-795. doi:10.2105/AJPH.2013.301708

Kearl, M. (2013). Dickey-Wicker Amendment. Retrieved from http://embryo.asu.edu/pages/dickey-wicker-amendment

Lewis, K., & Rosenthal, M. (2011). Individual responsibility or a policy solution--cap and trade for the U.S. diet?. The New England Journal Of Medicine, 365(17), 1561-1563. doi:10.1056/NEJMp1105128

Master, Z., & Crozier, G. K. D. (2012). The ethics of moral compromise for stem cell research policy. Health Care Analysis 20(1), 50-65. Retrieved from http://search.ebscohost.com.libproxy.unh.edu/login.aspx?direct=true&db=psyh&AN=2012-03953-004&site=eds-live

Mayo Clinic (2014). Stem cells: what they are and what they do. Retrieved from http://www.mayoclinic.org/tests-procedures/stem-cell-transplant/in-depth/stem-cells/art-20048117?pg=1

Montana Supreme Court. (2009). Baxter v. Montana. Retrieved from http://www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/baxtr_v_mont_sum.authcheckdam.pdf

Miller, W. (2010). Conservatism and the Devlin-Hart debate. International Journal of Politics and Good Governance, 1(1.3), 1-20.

Napier, S. (2009). A regulatory argument against human embryonic stem cell research. Journal of Medicine & Philosophy, 34(5), 496-508. doi:10.1093/jmp/jhp036

National Abortion Federation. (2009). Legal Practice Issues. Retrieved from https://www.prochoice.org/cfc/legal_practice.html

New York State Department of Health. (2012). Task force on life and the law. Retrieved from https://www.health.ny.gov/regulations/task_force/

Oregon Health Authority. (2014). Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

The Supreme Court. (2006). Roe. Wade. retrieved from http://www.pbs.org/wnet/supremecourt/rights/landmark_roe.htm
l
Susan B. Anthony List (2012). Pro-Life Legislation retrieved from http://www.sba-list.org/legislation/pro-life

Verduin, P., Agarwal, S., & Waltman, S. (2005). Solutions to obesity: perspectives from the food industry. The American Journal Of Clinical Nutrition, 82(1 Suppl), 259S-261S.

Welcome to HEAL NH - Heal NH. (2014, January 1). Welcome to HEAL NH - Heal NH. Retrieved June 27, 2014, from http://www.healnh.org/

Westfield, S. J., Doobay, A., Hill, J., Humphreys, C., Sandil, R., & Tallman, B. (2009). The Oregon Death with Dignity Act: The right to live or the right to Die? Journal of Loss and Trauma, 14, 161-169.

Wickipedia (2013) Stem cell laws and policy in the United States. Retrieved from http://en.wikipedia.org/wiki/Stem_cell_laws_and_policy_in_the_United_States





http://eds.b.ebscohost.com.libproxy.unh.edu/eds/pdfviewer/pdfviewer?vid=3&sid=77482270-d338-4b65-8ff4-609a0fffd37f%40sessionmgr198&hid=115
Please read the following article:
http://eds.b.ebscohost.com.libproxy.unh.edu/eds/detail?vid=8&sid=9fc752df-1ff4-46f7-91da-a4429fbfc31%40sessionmgr198&hid=115&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=bch&AN=79279189
http://eds.a.ebscohost.com.libproxy.unh.edu/eds/pdfviewer/pdfviewer?vid=2&sid=f76935ac-94f2-4926-aed7-0e35ae2da3a9%40sessionmgr4003&hid=4210
Thoughts From the CDC
HEAL New Hampshire
Healthy Eating Active Living (HEAL) is a "collaborative effort of philanthropic organizations, state agencies, and community partnerships concerned about the rising obesity epidemic and its consequences."


"HEAL aims to foster implementation of healthy eating and active living interventions through a statewide infrastructure at the local community level across five sectors - schools, worksites, health care settings, food outlets, and cities/towns. The focus is on interventions that affect policy and environmental changes that result in a demonstrable impact on health and quality of life of New Hampshire residents."
Learn more at:
http://www.healnh.org/
Please listen for their proposed solutions!
Regulations on Food
What is the Issue?
What are the Facts?
One third of U.S. adults are overweight
Another third or U.S. adults are obese
Estimated annual medical cost of obesity in 2008 was $147 billion dollars
Medical costs for people who are obese were $1,429 higher than those of normal weight
Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese
In 2011-2012, 8.4% of 2- to 5-year-olds were obese compared with 17.7% of 6- to 11-year-olds and 20.5% of 12- to 19-year-olds.
62% of NH adults (ages 18 and over) are overweight
13% of NH adolescents (grades 9-12) are overweight
17% of NH children (ages 2-5) are overweight
An Interdisciplinary Approach:
Parents
Food Industry
Government
Some argue that although companies market their products directly to children, parents have the responsibility of deciding which products to purchase.

"Isn‘t making sure that children limit their consumption of fast foods the responsibility of parents?"

"Parents need to teach their children at early ages to eat healthy meals and to establish exercise routines for their families."

The Nag Study
A recent study of youth aged 12 to 18 found that:
40% asked for products they believed their parents would not approve of or buy
55% said they were successful in making their parents give in
On average the youth asked nine times before parents gave in
11% asked their parents for these products over 50 times
One out of every three trips to fast food establishments with children is the result of nagging
Proposed solutions include:
Cap and trade
Please see http://www.nejm.org/doi/full/10.1056/NEJMp1105128
Soda tax
Menu labeling
Marketing strategies
Restricting foods in schools
Restricting foods from food stamps



New York's Failed Attempt:

http://www.nytimes.com/2014/06/27/nyregion/city-loses-final-appeal-on-limiting-sales-of-large-sodas.html?_r=0
The food "industry should be committed to giving clear, consistent, and honest product claims"

"Industry should promote nutrition education at all levels, from public schools to medical schools, and enhance nutrition awareness at the consumer level."

"Industry can create new products that meet individual nutritional needs, reformulate existing products to be healthier, and provide controlled portion sizes."

"The hope is that the food industry can develop healthier products by partnering with science-based communities and the government."
Please see http://eds.a.ebscohost.com.libproxy.unh.edu/ehost/pdfviewer/pdfviewer?sid=b7329446-2bf9-4861-86e6-3be32901845b%40sessionmgr4004&vid=4&hid=4203
Should our food be regulated?
Implications for Practice
Assist in educating parents and children concerning healthy eating habits
Identify individuals at risk for obesity and offer support, refer to support groups
Encourage community efforts to educate and provide opportunities for active family activities
Advocate for the increase of physical activity at the governmental level and a reduction of unhealthy foods in schools
Support parenting styles that increase physical activity and reduce sedentary lifestyles
“Morality is a sphere in which there is a public and a private interest, often in conflict, and the problem is to reconcile the two...While every decision which a court of law makes when it balances the public against the private interest is an ad hoc decision, the cases contain statements of principle to which the court should have regard when it reaches its decision”-Patrick Devlin
"An established morality is as necessary as good government to the welfare of the society. Societies disintegrate from within more frequently then they are broken up by external pressures…History shows that the loosening of moral bonds is often the first stage of disintegration." - Patrick Devlin
Center for Disease Control and Prevention, 2014
Kass, Hecht, Paul, & Birnbach, (2014)
Kass, Hecht, Paul, & Birnbach, (2014)
Verduin, Agarwal, & Waltman, (2005)
Full transcript