Medical Ethics

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Textbook:

Intervention and Reflection: Basic Issues in Bioethics 10th Edition edited by Ronald Munson and Ian Lague (Note: earlier editions of the book will not work for this assignment, since the material is changed and updated a great deal from one edition to the next.)

 

1. Children and Informed Consent

·       Introductory material (7-20, 36-39)

·       “The Dilemma of Jehovah’s Witness Children Who Need Blood to Survive” by Anita Catlin (85-89)

1. Read the following decision scenarios (starting on page 109) and answer the questions listed:

·       Decision scenario 1 (questions 1, 2, & 3)

·       Decision scenario 2 (questions 1, 4, & 5)

·       Decision scenario 4 (questions 1 & 3)

·       Decision scenario 5 (questions 1 & 3)

2. Look at the cases on p. 17-20 and 36-38. What do you think should have been done in these cases? Why?
3. Consider the following three views (a) The state should override parents’ medical decisions about their children when those decisions are not in the child’s best interest, (b) The state should only override parents’ medical decisions about children when the child is going to be severely harmed, and (c) The state should never override parents’ medical decisions about their children. Which of these do you agree with most? Why?

 

2. Genetic Interventions: A New Eugenics?

·       Introductory material (244-258, 280-296)

·       “Procreative Beneficence: Why We Should Select the Best Children” by Julian Savulescu (315-321)

·       “The Case Against Perfection” by Michael J. Sandel (321-327)

1. Read the following decision scenarios (starting on p. 345) and answer the questions listed.

·       Decision Scenario 2 (questions 1, 2, 3, & 4)

·       Decision Scenario 3 (questions 2, 3, & 4)

·       Decision Scenario 5 (question 4)

·       Decision Scenario 7 (questions 1, 2, 3, & 5)

2. Do you agree more with Savulescu or Sandel’s position? Why?

 

3. Human Reproductive Cloning

·       Introductory material (355-357, 361-366)

·       “The Wisdom of Repugnance” by Leon Kass (410-415)

·       “The Ethics of Human Reproductive Cloning” by Carson Strong (416-420)

 

1)    Consider the following case (taken from the National Bioethics Advisory Commission on cloning): A couple wishes to have children, but both adults are carriers of a lethal recessive gene. Rather than risk the one in four chance of conceiving a child who will suffer a short and painful existence, the couple considers the alternatives: to forgo rearing children; to adopt; to use prenatal diagnosis and selective abortion; to use donor gametes free of the recessive trait; or to use the cells of one of the adults and attempt to clone a child. To avoid donor gametes and selective abortion, while maintaining a genetic tie to their child, they opt for cloning.Do you think there is anything wrong with cloning a child in this case?

 

2)    Do you agree with Kass that revulsion or emotional repugnance regarding something usually indicates that thing is morally wrong? Why or why not?

 

 

3)    Kass argues that there is something important and profound about reproduction through sex and that reproduction that does not take place in the context of sex is dehumanizing. Do you agree? Why or why not?

 

4)    Do you think a cloned child would have psychological, emotional, or social problems because he or she was not genetically unique? Would these problem be any different from the issues identical twins face? Why or why not?

 

 

5)    Do you think allowing cloning would likely lead to a “slippery slope,” perhaps resulting in designer babies or racist policies? Why or why not?

 

6)    Strong argues that people should have the freedom to make their own choices about reproduction as long as there not compelling moral reasons to object to their choices. Do you agree with this? Why or why not?

 

 

7)    With many new reproductive technologies (artificial insemination, egg and sperm donation, in vitro fertilization, etc.) there was a great deal of public concern when the technology was introduced, and then much more acceptance as the technology became commonplace. Do you think the moral concerns about cloning are substantially different from those about other reproductive technologies? Is cloning something that people simply need more time to get used to, or are there moral issues associated with it that cannot be overcome? Why or why not?

 

8)    If human cloning could be done safely, would you support it in some circumstances? Why or why not?

 

4. The Ashley Treatment

·       “The ‘Ashley Treatment’” by Ashley’s Mom and Dad (538-542)

·       “The Ashley Treatment: Best Interests, Convenience, and Parental Decision-Making” by S. Matthew Liao, Julian Savulescu, and Mark Sheehan

1. What do you think of Ashley’s parents’ claim that the Ashley Treatment is justified because it will improve the quality of Ashley’s life?

2. What do you think of Ashley’s parents’ claim that only those caring for severely disabled children can fully understand the decisions they are making?

3. Under what circumstances is it justifiable to medically stop or promote a child’s growth? (Note that this used to sometimes be done to keep girls shorter, and is now sometimes done to make both boys and girls taller. In both cases the reasons for the treatment are frequently social, not medical). Is medical treatment that affects height any different from, say, surgery to address a cleft palate, or surgery to remove a large, obvious, birthmark?

4. What do you think of the argument that Ashley’s disadvantage is socially constructed? In other words, is the problem mainly that there are not enough resources available to care for children like Ashley? If more resources were available, would the Ashley treatment be unnecessary?

5. Do you agree or disagree with Liao, Savulescu, and Sheehan’s claim that while growth attenuation may be justified, hysterectomy and breast bud removal are not justified in Ashley’s case? Which parts of the Ashley treatment would you support? Why?

 

5. Impaired Infants, Euthanasia, and Physician-Assisted Death

·       Introductory material (515- 531, 565-592)

·       “The Groningen Protocol: The Why and the What” by James Lemuel Smith (534-538)

·       “Active and Passive Euthanasia” by James Rachels (594-598)

·       “The Wrongfulness of Euthanasia” by J. Gay-Williams (602-604)

1. What is the difference between physician-assisted suicide and euthanasia?

2. Read the decision scenarios starting on p. 623 and answer the following questions.

·       Decision Scenario 1 (question 1)

·       Decision Scenario 2 (questions 1 & 2)

·       Decision Scenario 3 (questions 1 & 2)

3. Has Rachels convinced you that there is no clear moral distinction between active and passive euthanasia? Why or why not? Has he convinced you that sometimes killing someone is morally preferable to letting them die? Why or why not?

4. What do you think is the strongest of Gay-Williams’s arguments against euthanasia? Why?

5. Read the decision scenarios starting on p. 559 and answer the following questions.

·       Decision Scenario 1 (questions 1 & 3)

·       Decision Scenario 2 (questions 1 & 4)

·       Decision Scenario 3 (question 3)

6. Would you support the use of the Groningen Protocol in Bente Hindriks’s case (p. 515)? Why or why not?

7. Would you support a law allowing either physician-assisted suicide or euthanasia in Minnesota? Why or why not?

 

6. Organ Transplants and Scarce Medical Resources

·       Introductory material (629-642, 644-648)

·       “Alcoholics and Liver Transplantation” by Carl Cohen, Martin Benjamin, and the Ethics and Social Impact Committee of the Transplant and Health Policy Center; Ann Arbor; Michigan (658-662)

·       “The Case for Allowing Kidney Sales” by Janet Radcliffe-Richards et. al. (663-666)

1. Read the following decisions scenarios (starting on page 675) and answer the questions listed:

Decision Scenario 1 (questions 1, 3, & 4)

Decision Scenario 5 (questions 1, 2, 3, & 4)

Decision Scenario 6 (question 3)

2. Should “social worth” criteria ever be used to decide who gets an organ (see p. 644-647)? Why or why not? How should we allocate organs if there are not enough for everyone?

3. What should be done about the shortage of organs for transplant? Have Radcliffe-Richards et. al convinced you that allowing kidney sales is a good idea?

 

7. The Affordable Care Act

·       Introductory material (681-698)

1. Read the Robert Ingram case (p. 681). Could this still happen today?  Does the Affordable Care Act (Obamacare) eliminate this sort of case? Why or why not? What, if anything, should be done about situations like Ingram’s?

2. The United States spends more on health care than any other country in the world. However, we rank approximately 42th in life expectancy and approximately 55th in infant mortality (CIA statistics). Why do you think this is the case? What, if anything, should be done about it?

3. Do you think people have a right to health care? Why or why not?

4. What do you think are the biggest barriers to moving to a universal government-run health care system (like Medicare but for all ages) in the United States? Are there ways of addressing these barriers?

5. Make lists of the pros and cons of a free market health care system, a universal government-run system, and the Affordable Care Act.

6. Are you in favor of the Affordable Care Act? Why or why not? If you are not in favor of such a system, what (if anything) do you think should be done to alleviate the problem of people with inadequate health insurance?

 

8. Medicine in a Pluralistic Society

·       Introductory material (746-755, 759-765)

·       “The Dangers of Difference: The Legacy of the Tuskegee Syphilis Study” by Patricia King (795-798)

·       “Sex Beyond the Karyotype” by Alice Dreger (818-824)

·       “Who is Disabled? Defining Disability” by Susan Wendell (824-830)

1.    Read the following decision scenarios and answer the questions listed (starting on p. 836).

·       Decision Scenario 1 (questions 1 & 3)

·       Decision Scenario 4 (questions 1, 2, & 3)

·       Decision Scenario 5 (question 1)

 

2. Do you think it would be possible for a situation like the Tuskegee study to happen in the United States today? Why or why not?

3. What do you think of King’s claim that the history of racism makes it dangerous to emphasize racial differences in medicine, and that we should presume people are the same unless we have good reason to believe they are different?

4. What do you think of Dreger’s claim that “Any attempt to divide people neatly into two sex types is ultimately a social action, not a scientific (or natural) one.”? How important is it to clearly divide people into “male” and “female”?

 

5. Do you agree with Wendell’s claim that disability is contextual? Do you think, for example, that deafness should be categorized as a disability?

 

9. The Challenge of Global Bioethics

·       Introductory material (858-860)

·       “The Distribution of Biomedical Research Resources and International Justice” by David B. Resnik

1)    Read Decision Scenario 1 on p. 894 and answer questions 1 and 2.

2)    Is it important to consider medical resource allocation on a worldwide level, or should we focus on this question at a national or even local level? Why?

3)    Some people argue that we have greater responsibilities to those closer to us. So, for example, we have greater responsibilities to family members than to friends, greater responsibilities to friends than to acquaintances, and greater responsibilities to acquaintances than to strangers. Can this argument be used to show that Resnik is wrong, and people should use their resources mainly to improve the lives of those in their own communities rather than trying to help people across the world? Why or why not? Does it matter if resources are unevenly distributed, so some communities have many more of them than others?

 

 

 

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