Diabetes Legal and Ethical Issues

The growth and decline of philosophies and the ethical dilemmas associated with them reflect the controversy over cholesterol, whose levels have been allowed to fall to unsustainable levels, and at least in the United States, the current realization that some cholesterol is needed for several biological functions, including neurosynthesis, and that serum cholesterol levels do not need to be as tightly controlled as they have been in the past [33]. In the practice of diabetes care, an individual care plan tailored to the needs of the patient and ongoing care provided by health professionals working together could be proposed as good care (McDonald et al., 2012). A collaborative health team can not only strengthen diabetes self-care in practice, but also ensure that effective medical, preventive and health-preserving interventions take place (Von Korff et al. 1997). The above reasoning emphasizes the need to implement “the logic of care” in the nursing practice of diabetes in order to achieve improvement. There is also growing evidence that moderate hyperglycemia (e.g., >250 mg/dl) can impair cognitive function in children and adults.xviii,xix,xx Currently, there is limited data on the effects of hyperglycemia on driving. In a recent study, parents of teenage drivers estimated that hyperglycemia contributed to their children`s collisions and violations of moving vehicles, but teens attributed about a third of their accidents to hypoglycemia, but none to hyperglycemia.xxi In addition, adults with type 1 diabetes reported in a prospective study that they suffered from bothersome hyperglycemia by driving about one-sixth as often as Disruptive hypoglycemia while driving.xxii More research is needed to clarify the effects of hyperglycemia on driving safety. The ideal solution is to help healthcare facilities strengthen the overall supply of medicines, not just for diabetes and high blood pressure. Another ethical dilemma arises because the research program will include only a fraction of all patients with target diseases who visit clinics, and patients who do not participate in research studies will not have access to improved treatment. Although the cost of treating diabetes and high blood pressure is relatively low, it is highly unlikely that a research program would be able to bear the cost of treating a large number of non-study participants, and a commitment to this would make the research unprofitable. Moral tensions in nursing practice may also be due to the different understanding of the disease and the different demands of diabetes care for healthcare professionals and patients. Patients are more likely to focus on the consequences and impact on their daily lives, while healthcare professionals pay more attention to medical treatment and economics (Hörnsten et al. 2004).

Although healthcare professionals pay a lot of attention to the best interests of patients, they generally have to take clinical and moral responsibility towards patients. For this reason, responsibility for care is determined not only by considering patients` rights and respecting their freedom, but also by addressing the broader health needs of individuals and the community (Thompson et al., 2006). Using these strict criteria, the limited (ten) Pub Med articles generated between 1996 and 2015 included a variety of ethical and legal issues. There were three peer-reviewed articles on the ethics of prevention and screening, including newborn screening [9-11], three articles on research ethics [12-14] and one on hematopoietic stem cell transplants [15], on driving [16], on the need for cardiovascular prevention [17] and on the ethics of a particular drug study [18]. Articles that were highly aligned via Google Scholar for the same time interval also addressed ethical or qualitative issues and elderly care [19], consumer protection [19,20], diabetes and fertility [21]. In a subsequent prospective study xvi, in which drivers with type 1 diabetes were explicitly recruited to have none (N = 22) driving accidents >1 (N = 16) in the past two years, it was confirmed that +History drivers had greater insulin sensitivity during euglycemia and performed worse during hypoglycemia and had less response to counter-regulatory adrenaline. In addition, participants in the history + had fewer functional hypoglycemic symptoms. When these two groups were compared in neuropsychological testsxvii, both in euglycemia and mild hypoglycemia, +history factors showed slower information processing speed and lower working memory. Harsch and alxii surveyed 450 patients with type 1 and type 2 diabetes. Symptomatic hypoglycemia in driving ranged from 0.02 to 0.63 events per year, or between 0.19 and 8.26 per 100,000 kilometres travelled.