Cases

Question 1

Christiaan Barnard

Answer 1

-Christiaan Barnard was the first doctor to carry out a heart transplant. He had practiced on dogs and had done a great deal of research. He waited for the heart to stop beating before transplanting and therefore the heart was taken from a deceased human donor.

Question 2

Christiaan Barnard: Fidelity, teleology, deontology, utilitarianism, locust of authority, informed consent, veracity

Answer 2

• Fidelity- The doctor was not loyal to his patient in that he was prioritizing his own success rather than the patients
• Veracity- The doctor was not honest about the success rate of the procedure
• Teleology- The doctor was more concerned about the outcome (being the first successful doctor to perform a heart transplant) than the patients safety
• Informed consent- Because the doctor fabricated the numbers for success rate, the patient did not have a full understanding of the procedure
• *Locust of Authority-
• *Deontology-
• *Utilitarianism-

Question 3

Barney Clark

Answer 3

The first artificial heart transplant. The patient had signed the consent without understanding. He asked for the heart to be taken out and was refused. He survived for three months.

Question 4

Barney Clark: autonomy, veracity, informed consent

Answer 4

• Autonomy- The patient has the right to make choices about his health care at any point of time. He had the right to withdraw his consent at any point.
• Veracity- The doctors were not truthful about the procedure and consequences
• Informed consent- The patient was not fully aware of all the risks of the procedure before consenting

Question 5

Baby fae

Answer 5

Baby Fae was given a heart transplant with a baboon’s heart. The procedure was rushed (performed two days after approval) and not all information was obtained (the hearts were not matches). The family was not provided with all the information necessary in order to give consent.

Question 6

Baby fae: informed consent, teleology, fidelity

Answer 6

• Informed consent- The risks of the procedure were not explained to baby faes family and therefore they could not give their informed consent
• Teleology- the procedure was rushed because the doctor was only concerned with his own success in the procedure
• Fidelity- the doctor was not faithful to his patient in that he was only concerned about his own benefit

Question 7

Dr. Kevorkian

Answer 7

Dr. Kevorkian administered a lethal injection to his patient that was suffering. He was known to give patients their right to die through lethal injection (physician assisted suicide)

Question 8

Dr. Kevorkian: non-maleficence, beneficence, autonomy, informed consent, fidelity, veracity, ethical dilemma, locus of authority, moral distress

Answer 8

• Non-maleficence- The doctor did cause harm to his patient in that he assisted in their suicides
• Beneficence- The doctor believed that he was taking away their pain and was acting in the best interest of the patient
• Autonomy- The patient has the right to make their own decisions about their life and the doctor is fighting for what they want
• *Informed consent- The patient knew the risks of the procedures (death)
• Fidelity- The doctor was being faithful to the patient’s wishes and let them die with dignity
• Veracity- The doctor was truthful about the procedure
• Ethical dilemma- decision to live or die
• Locus of authority- Does the patient get to decide to die naturally or end their suffering
• Moral distress- physician assisted suicide can conflict with morals

Question 9

Assisted suicide: Karen Quinlan

Answer 9

Karen was in a vegetative state due to drugs and alcohol. The parents decided to pull the plug, but doctors refused. She was eventually taken off.

Question 10

assisted suicide: karen quinlan: paternalism, autonomy, teleology, deontology

Answer 10

• Paternalism- The doctors denied her right to remove life support and took control of the situation
• Autonomy- The family had no power to make decisions regarding Karen’s care
• Teleology- The parents were focused on the outcome of ending their daughters suffering
• Deontology- The health care team was focused on prolonging her life

Question 11

assisted suicide: terri shiavo

Answer 11

Terri had anorexia which led to heart attack and anoxia -> leading to brain damage and coma. Terris husband wanted to remove her feeding tube based off private conversations regarding Terris wishes; however, her parents didn’t even believe she was in a vegetative state. Terris tube was eventually removed after intense fighting.

Question 12

assisted suicide: terri shiavo: locus of authority

Answer 12

-Locus of Authority- Who has the right to make decisions about Terris care? -> her parents or her husband who knows what she would want

Question 13

assisted suicide: grace lee

Answer 13

Grace was put on a ventilator and was tube fed due to a progressing brain tumor. Her parents wanted to keep her alive for religious reasons even though Grace was competent enough to make her own decisions. She eventually changed her mind and decided to live.

Question 14

assisted suicide: grace lee: autonomy, locus of authority

Answer 14

• Autonomy- Grace had no autonomy over her own situation at first
• Locus of authority- Grace’s parents were making decisions about her care even though grace was competent enough to make her own decisions

Question 15

Jahi McMath

Answer 15

Jahi had her tonsils removed and was declared brain dead after a mishap. California did not want to use resources on her because she was brain dead. New Jersey took her in.

Question 16

Jahi McMath: paternalism, distributive justice

Answer 16

• Paternalism- Paternalism was strong in this case in that California was not even going to give her a chance once she was declared brain dead.
• Distributive justice- California did not want to use their resources on Jahi because they thought it would be of better use for other patients.

Question 17

elizabeth bouvia

Answer 17

Elizabeth Bouvia has progressing cerebral palsy that was debilitating. The hospital refused to let her die upon her request. She tried to starve herself to death and they put in a feeding tube. Because it was so painful for her to die she chose to live.

Question 18

elizabeth bouvia- paternalism

Answer 18

-Paternalism- The doctors refused to let her die upon her own request. They forced a feeding tube upon her.

Question 19

mayor koch/joyce brown

Answer 19

Joyce Brown was a professional homeless woman. She was the first participant in a program to take the homeless off the streets. She refused treatment however they admitted her anyway.

Question 20

mayor koch/joyce brown: autonomy, informed consent, locus of authority, veracity, moral distress

Answer 20

• Autonomy- Autonomy was upheld in this because they let Joyce go back onto the streets and gave her her right to refuse treatment
• Informed consent- Joyce was being given medications and treated without her consent.
• Locus of Authority- The Mayor and Joyce were fighting over the power of the choices made about her health care
• Veracity- They were not honest to Joyce about giving her medication.
• Moral distress

Question 21

the Ashely treatment

Answer 21

Ashely was born with brain defects that would cause her brain to stop growing but her body would continue to grow. Her parents chose to stunt her growth in order to make it easier for them to care for her. They removed her breasts, closed her growth plates, and did a hysterectomy.

Question 22

the ashely treatment: locus of authority

Answer 22

-Locus of authority- who should be in charge of Ashley’s treatment? -> her parents, herself, or the health care team

Question 23

baby jane doe

Answer 23

Baby Jane Doe had spina bifida, hydrocephalus, and microcephaly. Surgery would increase life expectancy but would cause many possible symptoms. Patients refused the treatment due to risks. Without the surgery Baby Jane Doe was expected to die, so people thought the surgery was her right to life. Baby Jane Doe ended up surviving and the spina bifida healed itself.

Question 24

baby jane doe: Veracity

Answer 24

-Veracity- Veracity was upheld in this case. The parents were given all the information they needed and made an informed decision

Question 25

telemedicine: fidelity, confidentiality, privacy, beneficence, autonomy, paternalism, informed consent, veracity, deontology, teleology

Answer 25

- *Fidelity*- Telemedicine decreases quality and therefore decreases fidelity. Telemedicine makes the relationship between the provider and patients less personal and there is less trust - Confidentiality- ethical obligation to keep patient information private - Privacy- governed by law - Beneficence- - Autonomy - Paternalism - Informed consent- Informed consent is required during a telemedicine call. “Do you consent to using this technology during this telemedicine visit” - Veracity- People are more likely to lie over telemedicine - Deontology- Process is prioritized, telemedicine can cause misdiagnosis and less trust. Seeing the patient is better because there is more attention to process. - Teleology- At least we are seeing the patient. Prioritized the outcome that the patient was seen.

Question 26

nancy wexler

Answer 26

Nancy Wexler tried to find the cure for Huntington's Disease. 50/50 chance of inheriting the disease. She discovered tested for specific genetic markers for diseases

Question 27

nancy wexler: teleology, deontology, ethical dilemma, beneficence, distributive justice

Answer 27

-Distributive justice- testing is costly and sarce and the question of who should be tested comes into play Beneficence- Huntingtons is unavoidable and there is no cure. Testing cures anxieties of getting it in your 30s-40s -Ethical dilemma- some insurance companies or employers may discriminate against people with genetic diseases -*Teleology*- The ultimate goal was to find the cure for huntingtons and testing methods. -*Deontology*- They felt that it was their duty to find the cure/testing because they knew the pain of huntington's disease -> the process was questionable because they were going to other countries that felt like Americans were intruding on their countries

Question 28

baby lousie

Answer 28

The first ever IVF procedure. There was a fallopian tube blockage so Ms. Brown could not get pregnant. They combined the egg and sperm. The parents were never told that there was never a successful IVF. People speculated because the doctors are playing god

Question 29

baby lousie: teleology, deontology, confidentiality, moral distress, veracity, fidelity, autonomy

Answer 29

- *Teleology*- the doctor didn't tell the parents there wasn't a successful previous IVF, all he cared about was a successful outcome - Autonomy- The parents had the right to decide if they wanted to have an artificial fertilization - Fidelity- The doctor was loyal to the patient's wishes - Veracity- the doctor was not truthful about there being previous successful IVFs in the past - Confidentiality- There information was heavily disputed in the religious community - Moral distress- Are test tube babies immoral and go against the natural laws of life? This process can lead to people making designer babies - *Deontology*- There were trials beforehand, duty to follow protocol, is this ethical, is science going too far -> wasn't really seen here

Question 30

baby m

Answer 30

Two families one being a surrogate (mary beth whitehead) and one being the family (elizabeth stern). The family gets too involved in the surrogates' care. She feels violated. The surrogate decides she wants to keep the baby. She is granted her wish.

Question 31

baby m: fidelity, veracity, beneficence, autonomy, confidentiality, deontology, teleology

Answer 31

-Fidelity- consent form was not upheld Informed consent -Veracity- Mary beth whitehead lied about giving the baby to the sterns -Beneficence- mary wanted to give the gift of life away to stern -Autonomy- Baby can't give consent to who they want their guardian to be at birth -Confidentiality- Elizabeth Stern called Marys doctor demanding information -*Deontology*- is science going too far, is this ethical -*Teleology*- the Stern family just wanted a baby because she was developing MS (means justify the ends)

Question 32

Henrietta lacks

Answer 32

Henrietta was diagnosed with cervical cancer she gave her cells over but did not consent to research on her cells. Lacks died her cells were found to still be alive and were used for cultures (immortal cells, HeLa cells). They eventually made a deal with the Lacks family to continue research with the family's consent on decisions.

Question 33

henrietta lacks: locus of authority, ethical dilemma, confidentiality, moral distress, autonomy, informed consent, paternalism, beneficence, nonmaleficence, veracity, teleology, deontology, fidelity

Answer 33

- Locus of authority- cells were taken without her consent and researched - Ethical dilemma- Lacks family felt violated and wanted the research to stop but some family thought the research was doing a good thing for humanity - Confidentiality- family felt like the research would expose their information - Moral distress- The family knew the research would benefit humanity but their DNA sequences would be public to the whole world - *Autonomy*- Henrietta nor the family were given power to decide if her cells could be used for research - Informed consent- family was not given proper knowledge about the use of her cells and henrietta was not informed that she was going to be infertile from the tissue collection - Paternalism- Health care team used the cells collected in research because they thought they were benefiting humanity - Beneficence- no physical harm was done to subject because had already passed during the biopsy - Nonmaleficence- physician removed harm by removing the cancerous tumor with hopes of prolonging her life - Veracity- physicians were not truthful because they didn't inform the family of the research of the sterilization - Teleology- scientific advancement was the greater good - Deontology- lacks family did not want their DNA available for global use and the duty of the health care team was not upheld regarding consent - Fidelity- violated patients fidelity