PHIL 434 Medical Ethics Midterm.docx

PHIL 434 Medical Ethics Midterm.docx - PHIL 434 Medical...

This preview shows page 1 out of 9 pages.

Unformatted text preview: PHIL 434 Medical Ethics Midterm Exam REMINDER: DO NOT USE EITHER OF THE RELATIVISM THEORIES OR DIVINE COMMAND. 1) A married couple wishes to have a child; however, the 32-year-old mother knows that she is a carrier for Huntington's disease (HD). HD is a genetic disorder that begins showing signs at anywhere from 35-45 years of age. Its symptoms begin with slow loss of muscle control and end in loss of speech, large muscle spasms, disorientation and emotional outbursts. After 15-20 years of symptoms HD ends in death. HD is a dominant disorder which means that her child will have a 50% chance of contracting the disorder. Feeling that risking their baby's health would be irresponsible; the couple decides to use in vitro fertilization to fertilize several of the wife's eggs. Several eggs are harvested, and using special technology, only eggs that do not have the defective gene are kept to be fertilized. The physician then fertilizes a single egg, and transfers the embryo to the mother. Approximately 9 months later, the couple gives birth to a boy who does not carry the gene for the disorder. Questions for Case 1: A. Is this a case of eugenics? "Eugenics" is defined as "the hereditary improvement of the human race controlled by selective breeding" (dictionary.com) Yes, this is a case of eugenics although it can be considered a modern, “acceptable” version of eugenics that deals with treatment of disease and not creation of a superior population or eradication of a certain group. B. Would it be acceptable for the parents to select for sex as well, or should they only select an embryo that does not have HD? How would this be different? No, it would be unacceptable for the parents to choose the sex of the baby as this is not considered treatment of disease, but a fulfilment of their own selfish desires. If the parents also had been known carriers of sex chromosomal abnormalities, then it would be acceptable since it is treatment of disease. Since the wife is a carrier of Huntington’s Disease which affects both men and woman, choosing the sex of the baby can be considered gender discrimination and trait selection. C. Is it ethical for this couple to have a baby when the mother could begin showings signs of HD when the baby is just a few years old? Under autonomy, the parents have the right to choose the best outcome for themselves and their unborn child under their own circumstances. Seeing as though the couple appears to be well educated on options regarding gene testing, it is more than likely the wife was also tested to see if the gene was inherited. Even if the wife was not previously tested to see whether she inherited the gene, the latest onset of symptoms for HD is 80 years old meaning the wife could live another 50 years before onset of the disorder ( ). D. With this technology possible, would it be ethical for this couple to have a child without genetically ensuring it would not have the disease? What if we did not have this technology, would it be ethical for a known carrier to have a child? (If not, how far should this carry? a carrier for cystic fibrosis (which is recessive)? Any decision made for the child by the parents can be considered acting out of autonomy and in their right to personal life decisions if it does not bring intentional harm. This type of technology is expensive and might not be an option for the parents, so they decide to conceive naturally and because there is a 50% possibility the parents might want to take the chance. There might be religious factors that discourage a couple to engage in genetic testing and ultimately cannot be forced by guilt or by law. If we label declining genetic testing for Huntington Disease as unethical, then we could say the same for children born with any genetic abnormality. Under our rights we have the option to privacy which includes, making the best decision for ourselves and our families. E. Weighing everything we have discussed, do you believe the couple acted ethically? By which theory (ies) is this ethical? There may be more than one so defend how you would use this theory to make it ethical. I do believe the couple acted ethically and within their right to autonomy, as they believed in vitro fertilization would provide the best possible scenario for both themselves and their child. This can fall under rule utilitarianism which says an action is right if it conforms to the rules and results in the greatest good. By United Nations standards, eugenics for the use of disease treatment is acceptable and not considered a moral infringement. Additionally, by the social contract theory their rights are protected under the Constitution which protects self-government and privacy. 2) You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. Questions for Case 2: A. Should we completely discount this treatment as useless, or could there be something gained from it? Explain. “Cao Gio” is a Vietnam tradition that by American standards can be considered a home remedy. Although the treatment by American healthcare standards can be classified as useless, the doctor must still be culturally sensitive to the family’s belief by not downplaying the tradition. B. When should a physician step in to stop a cultural practice? (If you answer "when it harms the child" remember that there is some pain in many of our medical procedures, for example, having one’s tonsils removed so your explanation has to have more than just that) The physician should interfere when the tradition causes irreversible side effects, such as the case with female circumcision. Additionally, if the parent seems unfit despite cultural influence, the physician should interfere the ensure the child is safe. C. Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Why or why not? Yes, the physician should be concerned with alienating the mother, because she might not take her son to the emergency room again. A physician’s role is to treat and guide their patients to the best possible health treatments. This does not involve judgement or making them feel guilty about their choice of care due to religious or cultural influence. Additionally, the patient could also tell other friends or family members, isolating a whole group who might one day need real medical attention. D. Do you think that the physician should report the mother? Support your decision (either pro or con), using Kant’s Ethical theory? I do not believe the physician should report the mother to CPS because her actions were done out of good intentions and not to intentionally bring harm to the child. Reporting the mother to CPS might send the child to foster care and prevent the mother from making future attempts to bring her son to the emergency room or a traditional doctor. For instance, in California which has a high instance of “coining” cases, California child abuse services does not consider the practice a danger to the child, but understands it is a cultural tradition usually performed by a trained practitioner ( ). 3) A woman was diagnosed with motor neurone disease (the same disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing. Questions for Case 3: A. Does she have a right to make this choice, especially in view of the fact that she will be dead in a short while (say six hours)? Is this choice an extension of her autonomy? Explain. I do believe the patient has the right to choose death with dignity as an extension of her autonomy. At the time of her request, the patient was in full mental capacity and was conscious of her decisions. The action of providing the patient with pain medication was not voluntary euthanasia, but can be considered palliative care. We do not know if patient was in hospice care at the time of this scenario, where it is very normal for patients to receive morphine for pain relief and is considered, “crisis intervention”. If the patient decides to choose pain relief within six hours of death or one year of death, she is in protected under her right to privacy. B. Is the short amount of time she has to live ethically relevant? Is there an ethical difference between her dying in 6 hours and dying in a week? What about a year, and how do you draw this distinction? What would support or not support such a difference ethically? The patient has been diagnosed with a terminal illness and can make end of life decisions at her own request if she is within the full mental capacity. Ultimately, it is up to the patient to make decisions for the type of pain relief she desires or if she chooses to end her life with dignity. I don’t believe there is ethical relevancy to how much time the patient has to live. The patient could have a terminal illness which causes excruciating, unbearable pain and should be able to decide the best pain reliever or choose end their life through lethal medications if they feel they cannot handle the pain. C. Is the right for a patient's self-determination powerful enough to create obligations on the part of others to aid her so that she can exercise her rights? She clearly cannot kill herself. She can't move, but should someone be FORCED to help her, or to find someone to help her? Why or why not? In this scenario, the patient is asking for relief of pain which she should have help with. If the patient requested death with dignity it would be considered illegal for the physician or anyone else to administer deadly medications to the patient in states such as Oregon. No one can be forced to provide lethal medication and can object to the request by the patient. There are currently no laws that allow a physician or even family members to actively assist suicide to a terminally ill or physically incapacitated patient. Choosing to do so could result in conviction of murder and jail time. D. Should the money used to care for this woman be taken into account when she is being helped? Do you think that legalizing euthanasia could create conflicts of interest for the patient/ or the doctor? Will people feel that they need to end their lives earlier to save money? What evidence, if any, exists to support this claim? No, money should not be taken into consideration when it comes to human life, because it would cause injustice for people who cannot afford healthcare. For instance, if a doctor were to treat an unconscious patient that enters the emergency room based off how much money they have in their pocket, lower income families would suffer greatly from this unethical treatment. I do not believe legalizing euthanasia would create conflict if it monitored with laws. In Oregon, statistics show financial implications were not a major factor when people chose to end their life with dignity and there have not been issues related to patients feeling pressured to end their life through lethal medications. E. If you were the physician, what would you do? Note: if you would pass her off to another doctor knowing he or she would do it, does this free you from you ethical obligations? How would you apply care ethics to this scenario in support or against what you would do? If I were the physician I would respect the patients right to choose the pain relief of their choice. In medicine, there will always be decisions patients make we do not agree with but, we must put our personal feelings aside and provide the best care while adhering to the patient’s wishes. Additionally, I would provide the patient with additional choices that might she might not know are available to her, to ensure she is aware of all options. In care ethics, relationships are based off our feelings for another and in this case a doctor cares to provide the most comfortable treatment for their patient. 4) A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter’s death). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence; the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars. Questions for Case 4: A. Do you believe that the physician’s actions can be justified in any way? Is there an ethical theory that could support this decision? Explain why or why not. Unfortunately, the actions of the physician cannot be justified. If he or she felt the patient was not in her correct state of mind, a psychological evaluation should have been ordered and documented. If there were no evidence to prove the patient was not able to make conscious healthcare related decisions, then there was no justification for going against the patients will. Under beneficence the physician is acting out of providing the best treatment for the patient diagnosed with a 50/50 chance of survival and could possibly be a supportive argument for his or her actions, but there is no evidence found to claim the patient was not competent. B. Is there anything else that they could have done? If the physician was concerned regarding the patient having a lifesaving surgery, then they should have consulted with the next of kin. There might be other emotional factors that are causing the patient to opt out of surgery, such as not being able to take care of herself once she is discharged. The physician should have conferred with someone the patient trusts to encourage her to undergo the surgery, instead of pressuring the patient. Additionally, other options should have been provided to the patient such as plastic surgeon to cover the scar if that was important to her. C. Is it ever right to take away someone's autonomy? (For example, would a court order make the physician’s decisions ethical?) How could we ethically do so? Use virtue ethics to support or deny this? The only justification for taking away someone’s autonomy is when they do not have the competence to make health care related issues or are a danger to themselves. For instance, some states have laws that require “72-hour holds” for people who are having mental breakdowns and threaten to harm themselves or others. Certain criteria must be met and a fourteen-day extension may be permitted in some cases, but the patient still has the right to be released after the hold has exhausted. Moreover, if a person is transported to the emergency room lifeless and unresponsive, a doctor has the right to determine the best treatment for the patient while he or she is incapacitated and there is no next of kin. Virtue ethics would judge the subject based off how they live their life, or decision they make and not the value of human life or the vow doctors provide care in the best interest of the patient. D. What would you do if you were one of the health care workers? Using Act Utilitarianism how would you support what you would/would not do in this scenario? If I were one of the health care workers I would have consulted with a family member regarding the patient’s decision to decline surgery. If the family intervention did not work, I would attempt to show the patient pictures of successful scar reconstruction in hopes of changing her mind. Ultimately, the patient has the right to self-determination including declining lifesaving medical procedures and the decision must be respected. I would try my best to provide professional medical advice without inputting my opinion regarding her choice. In act utilitarianism, the choice is good if it brings happiness to most those involved. In this case, if the women, family and physicians feel this is the best option for the patient then, it is a good decision. 5) Twenty-nine-year-old Janet and her husband Jack were driving home from her ob-gyn appointment when tragedy struck. Another driver, elderly and distracted by an incoming text message, ran a red light and T-boned Janet and Jack’s Mini-Cooper. Both young people sustained severe injuries. Jack died enroute to the hospital. Janet survives, having escaped injury except to her head; but that was unfortunately massive. Her physicians now say, a month after the accident, that the prognosis is grim. The best one could hope for—or perhaps the worst—is continuation for some time in a persistent vegetative state. Just before leaving the doctor’s office, Janet had sent a jubilant text message to her parents. “Guess what?! We’re pregnant!!! ” Janet had thought about mortality in advance of this accident. She is, or was, a nurse. She had gone to continuing education workshops about end of life care and advance care planning. Janet then had completed her own advance directives some months ago, naming Jack as her primary agent and durable power of attorney for healthcare decisions. She named her parents as secondary agents. Janet also had completed, with notarized signature, a healthcare treatment directive. Among her directives was a clear, handwritten statement about life prolongation if she were, somehow, “to end up in anything like PVS, from which I am not apt to recover.” Janet had written that, in such a condition, “I do NOT want my life to be extended by means of medically assisted nutrition and hydration, ventilator, or other life support.” With Jack gone, treatment decisions are left up to Janet’s parents. They both are thoughtful people, healthcare professionals also, who take very seriously their difficult responsibility of acting as surrogates on Janet’s behalf. After consulting her physicians, other family members, and even their priest, a decision is made to stop everything except palliative care. Janet’s parents had received a copy of their daughter’s advance directives, and they have determined that this is what she would have wanted, what in fact she had conveyed with such tragic prescience. Plans are made to transfer Janet to a hospice unit in another part of the hospital. It would take place the fol...
View Full Document

  • Fall '18
  • Physician, attending physician, Residency

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern