Ethical ????

s
Will more technological advancements
cause more ethical problems?

• Yes

• No
 Autonomy
• 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.
• Do you believe that the physician's actions can
be justified in any way?
• Is there anything else that they could have
done?
• Is it ever right to take away someone's
autonomy? (Would a court order make the
physicians' decisions ethical?)
• What would you do if you were one of the
health care workers?
 Euthanasia
• 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.
• 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?
• 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?
• There are two types of surrogacy. One type
involves a surrogate mother who uses her
own egg and carries the baby for someone
else. The other type is a "gestational
surrogacy" in which the mother has no genetic
tie to the child she carries. In the case
presented, a gestational surrogate is used.
• A woman, after a bout with uterine cancer had a hysterectomy
(surgical removal of the uterus). Before, its removal, however, she
had several eggs removed for possible fertilization in the future.
Now married, the woman wishes to have a child with her husband.
Obviously she cannot bear the child herself, so the couple utilizes a
company to find a surrogate mother for them. The husband's sperm
is used to fertilize one of the wife's eggs, and is implanted in the
surrogate mother. The couple pays all of the woman's pregnancy-
related expenses and an extra $18,000 as compensation for her
surrogacy. After all expenses are taken into account the couple pays
the woman approximately $31,000 and the agency approximately
$5,000. Though the surrogate passed stringent mental testing to
ensure she was competent to carry another couple's child, after
carrying the pregnancy to term, the surrogate says that she has
become too attached to "her" child to give it up to the couple. A
legal battle ensues.
• http://ww.scu.edu/ethics/publications/submit
ted/cirone/medical-ethics.html
• Baby K, as she came to be known, was born with a severe neurological condition
known as anencephaly. In affect, she was born with both cerebral hemispheres
missing from her brain, which means that her greatest potential would be shy of
ever producing a single, fundamental thought. Her mother, insisted that Fairfax
Hospital provide Baby K whatever treatment was necessary to keep her alive as
long as possible, as most anencephaly cases failed to survive for more than a few
hours, days or weeks at best. Fairfax, in Falls Church, VA provided the standard
treatment for Baby K’s condition and obliged her mother’s insistence for
aggressive respiratory treatment when needed. The cause of death can commonly
be linked to the fact that the single brain stem cannot support normal respiratory
functioning. The hospital staff did what they could to keep Baby K and her mother
as happy as possible and awaited the infant’s unavoidable death.But Baby K
proved to be a survivor. At sixteen months she was stable at an extended care
facility that provided her constant attention and total care. The hospital was still
obliged to provide the respiratory treatment needed for her survival, at her
mother’s continual insistence, although the physicians believed that further
respiratory intervention would be futile. Eventually, Fairfax sought a ruling from
the federal district court that would allow them to refuse the aggressive
respiratory treatment that kept Baby K alive. Although their case was overturned
in court, Fairfax appealed the decision at the U.S. Court of Appeals. Again their
position that Baby K’s quality of life was not sufficient to mandate the treatments
she was receiving, was not supported due to the 1986 Federal Emergency Medical
Treatment and Active Labor Act. This law required hospitals to provide the type of
treatment that Baby K needed as long as she needed it. Although the law was not
originally intended for cases like Baby K’s, it was instead passed to keep private
hospitals from "dumping" emergency cases without insurance to public facilities,
the courts perceived that they could not support the hospitals request to deny life
saving treatment to Baby K, despite the fact that she was incapable of anything
more than existing in a void of nothingness.
 Cultural Beliefs vs. Western Medicine
• 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
• Should we completely discount this treatment as
useless, or could there be something gained from
it?
• When should a physician step in to stop a cultural
practice? (If someone answers "when it harms
the child" remind that person that there is some
pain in many of our medical procedures, for
example, having one's tonsils removed)
• Should the physician be concerned about
alienating the mother and other people of her
ethnicity from modern medicine?
• Do you think that the physician should report the
mother?
• Baby Owens was born at 11:30 pm to Dr. Owens and her husband, Philip at
Midwestern Hospital. The proud parents didn’t remain proud very long as their
first meeting with the child showed that something was terribly wrong. The baby’s
misshapen head and aloof look in those strangely shaped eyes had all the
earmarks of Down syndrome and neither Dr. Owen nor her husband were
prepared to accept a baby of such shortcomings into their home, their family or
their lives. They verbally announced their feelings to the staff that had taken care
of Dr. Owen during the birth and any attempt to console them was futile. Their
minds were made up. To add insult to injury, Baby Owens was hiding a deeper
secret. She was born with a sealed patch in her small intestine, also known as
duodenal atresia. Although the condition is lethal if left untreated, as the baby
would not be able to eat, a relatively minor surgical intervention could correct the
problem and Baby Owens would grow into a normal healthy child, at least as
normal and healthy as a Down baby can be. In all honesty, the physicians had no
way to determine the extent of Baby Owens’ mental retardation, but it made no
difference to the Owens’s, severe or mild, their baby would be ultimately retarded
and that was one condition they just could not accept. Dr. Owens informed Dr.
Ziner, her attending physician, that she and her husband would not authorize the
surgery needed to save Baby Owens’ life. According to Dr. Owens, "It wouldn’t be
fair to the other children to raise them with a mongoloid. It would take all of our
time, and we wouldn’t be able to give David, Sean and Melinda the love and
attention they need." (Munson, Intervention and Reflection – 144) Despite Dr.
Ziner’s objections, Dr. Owens remained firm in her and her husband’s decision to
allow Baby Owen to die of starvation by denying her the life-saving surgery. The
hospital’s legal and medical representative got together to discuss their position on
the matter.
• What action, if any, should they take to prevent the death of an
otherwise physically health child? In previous matters when a
parent’s religious belief conflicted with a necessary surgery on a
child, the hospital had received court orders mandating the surgery,
regardless of the parents’ wishes. But was this case different? Was
the fact that the baby was mentally handicapped a spin that would
allow her death? The hospital decided that they had no reason to
force the parents to authorize the operation and subsequently, be
forced to take home a baby that they didn’t want. The official
position of Midwestern Hospital was that they could not perform
an operation on an infant without parental consent.
• Twelve days later, Baby Owens died of starvation in an isolated
room away from the other patients. Although many on the staff
were appalled by the hospital’s position to allow the death of an
otherwise healthy baby, they were not allowed to intervene in the
baby’s slow, lingering death. The most they were permitted was to
apply drops of water her lips and throat in an attempt to ease her
suffering.