The backwards math

BME 419
Jennifer J. Kang-Mieler
1
BME 419: Ethics and case discussion
Ethics Case #1: The backwards math
Jay’s boss is an acknowledged expert in the field of catalysis. Jay is the leader of a group that has
been charged with developing a new catalyst system, and the search has narrowed to two
possibilities, Catalyst ‘A’ and Catalyst ‘B’. The boss is certain that the best choice is ‘A’, but he
directs that tests be run on both, ‘just for the record.’ Owing to inexperienced help, the tests take
longer than expected and the results show that ‘B’ is the preferred material. The engineers
question the validity of the tests, but because of the project’s timetable, there is no time to repeat
the series. The boss, therefore, directs Jay to work the math backwards and come up with phony
data to substantiate the choice of Catalyst ‘A’, a choice that all of the engineers in the group,
including Jay, agree with. Jay writes the report.
Š If you were Jay, what would you have done? Would you have written the report?
Š If you had refused to write the report, how could you have justified this refusal since you,
along with all of the others on the team, felt that the test data was invalid and there was
not time to duplicate the test? Is it not likely that experience is a better guide than one set
of questionable test data? If yes, does this impact on the ethical nature of the dilemma?
Š Would it have been a good idea to write the report and also write a memo saying that you
were being directed to do something which was unethical? If you did this, would it be
done just to cover you if you are found out? Would that make what you did any more
ethical than it would have been without the memo?
Š How about an alternative — writing the report, but not signing it? Is this a satisfactory
solution to your ethical dilemma?
Š Is this a case in which you would become an “internal” whistleblower by going over your
boss’ head and reporting that you had been asked to write a false report?
-BBEfofgoo@@@@a@zh —
BME 419
Jennifer J. Kang-Mieler
2
Ethics Case #2: Uncertain medical treatment
You are the surgeon at a private hospital called in on a case concerning a heart defect in a
newborn with trisomy 18, a congenital condition in which a person has a third chromosome #18.
The infant is likely to die in a matter of days from heart failure if not treated, but it is a very
expensive operation that is not guaranteed to work. Trisomy 18 has several symptoms, including
mental retardation. One of the complications is almost always fatal by the age of about 10, and
90% die by the age of one. The parents are aware of these statistics. The parents are uninsured
and have 2 other children.
Š What is your action? Why?
¾ Perform the surgery
¾ Counsel the parents about the prognosis with and without surgery, and let them decide
¾ Tell the parents that you are not willing to do the surgery, but they may wish to get a
second opinion
¾ Tell the parents there is nothing you can do about the heart problem
offset
BME 419
Jennifer J. Kang-Mieler
3
Ethics Case #3: Savior siblings
My Sister’s Keeper, a bestselling novel by Jodi Picoult (also a movie), poses many ethical issues,
specifically on pre-implantation genetic diagnosis, “designer babies,” savior siblings, and child
vs. parent autonomy. Please watch the movie.
My Sister’s Keeper is the story of Anna Fitzgerald, a “designer baby,” who was genetically
designed, conceived, and born to be a perfect genetic match for her older sister, Kate, who
suffers from a rare childhood leukemia. At birth, Anna donates umbilical cord blood to Kate, but
as Anna grows up she donates more blood, marrow, and stem cells to her sister to keep her alive.
When Anna is 13, her sister enters renal failure and her parents expect Anna to donate a kidney
to her sister. In response, Anna enlists the help of an attorney to sue her parents for the rights to
her own body. The story follows the family’s struggles as Anna sues for medical emancipation
from her parents.
Š Imagine you are the mother: while Kate is dying, you discover that Anna refuses to give
Kate the last possible life-saving treatment. How would you react? How would you try to
keep your family together?
Š Do you think it is ethical to design and conceive a child that meets specific genetic
requirements?
¾ If so, is PGD ethical in all cases? (prevent miscarriages, prevent inheritable
genetic diseases, sex selection for social reasons, etc)
¾ If not, do you believe there should be specific exceptions – such as saving another
person’s life – or is this just a “slippery slope”?
Š Knowing what you now know about PGD, do you agree with the parent’s choice to
“design” Anna to save Kate?
¾ Is it ethically ok to screen embryos for desired genetic traits, and reject the
“undesired” embryos?
Š Do you think the parents went too far in their concern for Kate by making Anna a savior
for Kate? When is it too far to save one child by using the body of another? By taking
umbilical cord blood? Bone marrow transplants? Kidney donation? After Anna has
spoken up in opposition to any further use of her body?
together
BME 419
Jennifer J. Kang-Mieler
4
Ethics Case #4: Placebos for addiction withdrawal
Seventy-four-year-old Mrs. Abrahma had been getting the prescription filled for years. She had
a malignancy of the colon 4 years previously. An operation had corrected the problem, but in the
emotional and physical distress that followed, Mrs. Abraham had a terrible time sleeping. She
had received a prescription from her internist, Dr. Raymond Siemens for Seconal® to help her
sleep and continued taking them to the point at which she could not sleep without them. Her
physician, after several months, realized that he had caused her to become addicted and felt that
it was his duty to help her break her habit. He had arrange with the pharmacist to take Seconal®
capsules and gradually replace more and more of the active ingredient, until some months later
she was on pure lactose packaged in the distinctive Seconal® capsules. She still claimed,
however, that she could not sleep without her sleeping pills.
Dr. Siemens firmly believed that it was in his patient’s best interest, but he felt uncomfortable
about the placebo prescription he was writing. He was concerned about the potential legal
implications of lack of informed consent. (He surely had not informed his patient of the
treatment strategy and the risks and benefits of the “drug” he was now prescribing.)
Furthermore, he was asking the pharmacist to mislabel the prescription, placing the drug name
on the prescription label when, in fact, it contained nothing but inert lactose. He was concerned
about the fact that Mrs. Abraham was paying monthly for the prescription that contained no
active ingredients. The charge was modest, barely covering the cost of the capsules’ ingredients
which were being discarded, surely not compensating the pharmacist for the extra time involved
in emptying the capsules and refilling them. But most of all he was concerned about whether he
was being dishonest. Do placebo prescription such as Mrs. Abrahma’s involving lying and, if so,
are they morally wrong?
Š Is avoiding the truth any different morally than telling an outright lie?
Š How can the physician know what the consequences will be?
Š Can the problem be avoided by referring the patient to another physician for disclosure?
Š What is the nature of the duty to be honest?
fifth
BME 419
Jennifer J. Kang-Mieler
5
Ethics Case #5: The Nazis at the heart of the worst drug scandal of all time
Read the attached article by Roger Williams with Jonathan Stone from Newsweek Sept 17, 2012.
Š What is thalidomide? What was the primary use in 1950s? Why did they think it was safe
for pregnant women to use?
Š What should have been done to prevent this?
Š What do you think Chemie Grünenthal should have done? Do you think it was
appropriate to hire Nazis scientists? What about the US companies/government?
Š What can we do to prevent similar situations?
BIG

 

BME 419
Jennifer J. Kang-Mieler
6
Ethics Case #6: The Immortal Life of Henrietta Lacks by Rebecca Skloot
1. Start by summarizing the history of Henrietta Lacks’s tissue cells. Who did what with the cells,
when, where and for what purpose? Who benefited, scientifically, medically, and monetarily?
2. What are the specific issues raised in the book—legally and ethically? Talk about the 1980s
John Moore case: the appeal court decision and its reversal by the California Supreme Court.
3. Follow-up to Question #2: Should patient consent be required to store and distribute their
tissue for research? Should doctors disclose their financial interests? Would this make any
difference in achieving fairness? Or is this not a matter of fairness or an ethical issue to begin
with?
4. Were you bothered when researcher Robert Stevenson tells author Skloot that “scientists don’t
like to think of HeLa cells as being little bits of Henrietta because it’s much easier to do science
when you dissociate your materials from the people they come from”? Is that an ugly outfall of
scientific research…or is it normal, perhaps necessary, for a scientist to distance him/herself? If
“yes” to the last part of that question, what about research on animals…especially for research on
cosmetics?
5. Is race an issue in this story? Would things have been different had Henrietta been a middle
class white woman rather than a poor African American woman? Consider both the taking of the
cell sample without her knowledge, let alone consent… and the questions it is raising 60 years
later when society is more open about racial injustice?
6. What did you learn from reading The Immortal Life of Henrietta Lacks? What surprised you
the most? What disturbed you the most?
7. What role did the deferential attitude toward doctors in the early 20th century play in the
interaction between Henrietta and her family and Johns Hopkins? How has that attitude toward
doctors changed over the decades? Do patients’ socioeconomic differences affect the relationship
today?
8. What did you learn about “informed consent”? What does it mean or does not mean? What
does it meant to you?
9. One of the issues the book addresses is patient privacy. Henrietta completely lost hers long
before the book was published, but also did not get the fame her daughter, Deborah, thought she
so richly deserved. Why does Deborah want fame for Henrietta?
10. What kind of impact do we have with new research or technology in our society? Is this
always good thing? How do we know that we are making a positive/negative impact?
t_@–z@f_





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