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By Leanne K. Currie-McGhee

The start of existence -- the choice makers -- the top of lifestyles -- examine and improvement -- Genetic trying out and engineering -- the way forward for bioethics: stem mobile study and cloning

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43 Some insurance companies consider transplants experimental procedures. In the case of Nataline Sarkisyan, her insurer approved a liver transplant only hours before she died. To control costs and pay for needed medical care, Oregon has implemented a ranking system for services residents can receive under Medicaid. Under the system, 680 procedures are ranked according to their costs and benefits. The state legislature annually draws a line—how far down the list they will cover procedures. As of October 1, 2008, numbers 1 through 503 receive coverage.

In a 2004 study, however, two-thirds of doctors said they would ignore advance directives in cases where a patient’s prognosis remained hopeful or family members disagreed. Doctors also noted advance directives can be vague, asking for “no heroics” but not defining what that means. Some point to cases where patients have left instructions not to be put on a respirator, but doctors will violate the request if they believe the machine will only be needed for a short period of time. “It’s impossible for people to fine-tune what they want and don’t want in the way of medical care in advance,” said Alan Meisel, a professor of law and bioethics at the University of Pittsburgh.

Should they continue to let her live hooked up to machines but unaware of Julia Quinlan holds a copy of her book My Joy, My Sorrow, an account of her family's decision to remove her daughter Karen Ann Quinlan from life support in 1975. 41 42 BIOETHICS Nancy Cruzan On January 11, 1983, Nancy Cruzan lost control of her car and crashed. Before paramedics were able to restore her breathing and heartbeat, Cruzan’s brain was deprived of oxygen for several minutes. As she lay in an unconscious state, doctors inserted a feeding tube with her family’s consent.

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