Discussion Board #8

Here is a list of a few things to consider when deciding if an action is ethical:

1. If you perform this act, have you followed relevant laws, and kept within your company’s policy?
2. Will this act promote a win-win situation for as many of the involved individuals as possible?
3. How would you feel if the act was publicized in the newspaper or went viral on the internet?
4. Would you want your family to know?
5. If you perform this act, can you look at yourself in the mirror?

(Instructors can evenly distribute scenarios to class, or the students could be given an option to choose one).

Read your assigned or chosen scenario.  Read through and briefly answer the questions in your scenario.  Consider how the situation should be handled from a legal and ethical standpoint. What are the ramifications if the situation is not handled properly?

Case One:
A woman was diagnosed with motor neuron disease (the same disease that Stephen Hawking had) 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 neuron 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 One:

1. 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? Why or why not?
2. 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?
3. 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?
4. Should the money used to care for this woman be taken into account when she is being helped? Do you think that legalizing Doctor Assisted Death 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-to not be a burden on their families?
5. 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?

Case Two:

A 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 Two:

1. Is this a case of eugenics? “Eugenics” is defined as “the hereditary improvement of the human race controlled by selective breeding” (dictionary.com)
2. 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?
3. 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?
4. 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)? )
5. Weighing everything we have discussed, do you believe the couple acted ethically ?

Case 3:
A mother brings her son into the emergency room during an asthma attack. Though both of his parents work, they cannot afford medical insurance for themselves or him. They also earn too much money to qualify for state or federal aid. He is treated for his asthma attack at the hospital and he and his mother leave. Two weeks later, they return to the hospital in a virtually identical scenario.

Questions for Case 3:

1. Do you think that this boy is receiving adequate care? Shouldn’t he be able to see a primary care physician before his condition becomes so acute that he must visit the ER?
2. Should everyone be entitled to a basic “minimum of health care”… or to the exact same health care?
3. Do you think that health care is a right? If so, are we forced to honor this right?
4. (If you answered “yes” to the above question) Is this right relative or universal? Does this right exist because of the wealth of the United States, or is it applicable everywhere? Is health care a luxury to be enjoyed by those who can afford it?
5. (If you answered “no” to the above question)
6. Does having less or no money entitle a person to less or lower quality health care?

Responses can be typed in Microsoft Word and then pasted into the IvyLearn discussion board, or simply type it in the Discussion Board.   Click “reply” to start your own entry/post in the discussion board, then click “post” to submit the response.  This is due by Wednesday at midnight. Make sure you reply to at least two other class members posts by Sunday at midnight. Your replies need to be at least 3-4 sentences in length. For example, indicate whether you agree or disagree with their opinion, have something in common or made a connection to their posting. Replies must be respectful and well thought out.  Be sure your peer responses further the discussion in some way and do not just simply state whether you agree or disagree.