Bioethics 302

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Test #1

Exam Due Date:

Exam Instructions:

  1. Please answer all three of the questions below.  Be sure to answer each sub-question.
  • Each answer should be approximately 600 words per answer, sometimes longer.  Your total test should be between 1800-2100 words.
  • Cite the sources for any quotes in your test or in any instances where it is not clear which author you are paraphrasing.  You may use in-text citations (Gawande, 123) without a full citation sheet for this test. Only use course materials for this test, including notes from class and the article provided for Question 1.
  • Test questions should be answered by you alone. You may review any class readings with class member, but carefully avoid discussing the test questions. If I find too many similarities between any two persons’ answers, I retain the right to test them further.
  • Remember that this test is graded, in part, on the quality of the reasons you give in explaining and supporting your answers.  Think carefully about your answers and explain them clearly and thoroughly (though keep the word count in mind).
  • Please submit your test by clicking on the title of this test under “Tests” on Blackboard and attaching your document in the box that opens.  

Exam Questions:

  1. Organ transplantation for alcohol related end-stage liver disease – an ethics analysis

In the U.S., human organ transplantation takes place in medical centers that have registered with the federal government as places that can receive and offer human organs. Regarding all organs, the need is far greater than the supply. Organdonor.gov says that 17 people a day die in the U.S. currently waiting for an organ. In 2021, about 11,500 people were on a waiting list for a liver.  That year, about 9000 liver transplants were performed. Some people died of liver disease who never made it on the list.  Genetic conditions, Hepatitis C and other diseases can cause End Stage Liver Disease (ESLD), but a significant amount of ESLD is due to the significant use of alcohol over time. There is a recent uptick in cases of younger people with alcohol related ESLD (ARESLD), but most often, destruction of the liver requires heavy drinking over many years.

Most transplant centers in the U.S. require patients with ARESLD to demonstrate 6 months of sobriety before being placed on a waiting list for a liver.  Excessive use of alcohol after transplantation can ruin a transplanted liver. Since 2011, however, several studies have shown that 6 months is not a good test of sobriety after receiving a liver: some with ARESLD who didn’t have to wait the 6 months performed very well later. Transplant centers are now asking themselves whether to remove the 6-month waiting period and allow those with ARESLD to compete with others equally for liver transplantation. Usually, let’s say, those on a waiting list for a liver are ranked by need (how dire their condition is without the transplant), their general ability to care for the new liver, and their time on the list.  “Competing equally” means removing the 6 month sobriety test for those with ARESLD, but they would still need to show they have support and can care for the new liver, just like others.

Please use the Utilitarian and Kantian ethical principles to analyze whether, on average, it would be ethical for a transplant center in the U.S. to allow those with ARESLD to compete equally with others on a waiting list for a new liver.  If you like, you can perform this analysis with the information given here on the test. Feel free to consult the article below from 2021 by NPR on this topic:

https://www.npr.org/sections/health-shots/2021/10/10/1041867003/in-the-quest-for-a-liver-transplant-patients-are-segregated-by-prior-alcohol-use

In your analysis:

  1. Please state the Kantian and Utilitarian principles that you will use in your analysis. You may include a few details that help to clarify the principles if you wish.
  2. Using Kant’s principles, how would a Kantian respond to the ethics of allowing those with ARESLD to compete with others for liver transplantation without the 6 month restriction?  Consider what elements of the case would interest a Kantian? What judgment would a Kantian make?  Why do you think so?  Please explain in detail, using the 1st or 2nd version of the Categorical Imperative, or both versions.
  3. Using the Utilitarian ethical principle, what judgment would a Utilitarian make about the ethics of the case above?  Why do you think so? 

I will not grade you on the factual accuracy of your statements in this analysis, but rather, on your ethical reasoning. I’m happy to answer any questions.  

  • Read the following case and answer all of the questions below.

Imagine that you have a 75-year-old female patient, Mrs. Smith, who has been recently diagnosed with breast cancer.  As an oncologist, Mrs. Smith was referred to you, and you are meeting with her to discuss treatment options. You have found that Mrs. Smith is unwilling to discuss her options, however.  Earlier, a tumor in Mrs. Smith’s breast had been biopsied, and her primary care physician informed her that it was malignant.  It is your job to discuss surgery and other treatment options with her. You will be her surgeon, and you will be in charge of her ongoing treatment as well. This is a sample of your dialog:

Doctor:   I know a diagnosis of cancer can be scary, but you are healthy for your age, and you have options.  I need to make sure that you understand—

Mrs. Smith:  Do whatever you have to do to fix me, doctor.  I don’t care about the options, and I won’t understand all of your medical jargon anyway. Just make me well.

Doctor:  You’ll understand these options.  We’re going to do everything we can to make you well.  We’ll get rid of the tumor, but some women like to preserve part of their breasts if they can, and I think—

Mrs. Smith:  You know best, Doctor.  I’ll sign whatever you want.

Doctor:  I know, but I need to tell you—

Mrs. Smith: (Interrupts again) Please doctor!  I trust you.  Just tell me what I should do, and I’ll do it.  

Let’s say that you believe a lumpectomy (surgical removal of the tumor) followed by radiation treatment is a good course of treatment in such cases. Some women prefer to have a mastectomy to lessen the chance that the cancer will return.  You are comfortable with the lumpectomy in this case, and you tell her so.  Mrs. Smith is not interested when you try to explain the risks and benefits of the treatment, and you give up.  When she is given the forms to consent to the lumpectomy, she signs them quickly without reading them.

Questions:

  1. As far as you can tell, given your course materials, did Mrs. Smith give informed consent for her surgery?  Explain.
  • Do you believe your actions (the doctor’s actions) were respectful of Mrs. Smith’s autonomy?  Why or why not?   In answering this question, please do the following:
  • Consider what you believe “respect for patient autonomy” means in medical contexts.  Explain what you mean, and relate it to this case.
  • Use a case (or two) to explain what you mean by “respect for patient autonomy” in medicine.  You may compare your case to Mrs. Smith’s case.
  • Refer to at least two of your class readings in explaining your answer.
  • Do you believe that your actions (the doctor’s actions) were ethical in this case?    Please explain. Do you have any suggestions for providing more ethical care for this patient, if you believe improvement is possible?
  • In “Disclosures of Misattributed Paternity”, Ross argues in favor of the disclosure of misattributed paternity to both parents, not only the mother.  She offers a variety of arguments in favor of this thesis.  Many of her arguments relate to the professional duties of a genetic counselor.  Consider the case of a husband and wife who seek genetic testing and counseling regarding their first child who has a condition their doctor suspects is genetic. Specifically focusing on the professional ethical duties of the counselor, should the counselor disclose misattributed paternity results to both parents in such a case if relevant? 

In answering this question:

  1. Describe in detail two of the best ethical reasons for believing that genetic counselors have an ethical duty to disclose misattributed paternity to both parents. 
    1. What are two of the best ethical reasons against medical professionals – genetic counselors in this case – having a duty to disclose misattributed paternity to both parents?  Focus on professional ethical duties, please.
    1. Last, but not least (!), what do you think?  Choose one central reason, pro or con, regarding this debate and defend it in a paragraph.  In defending your reason, imagine someone who would disagree with it.  Offer supporting points for your reason that would speak to the main concerns of an opponent.  Think critically and use an example if it’s helpful for you.

Additional Points:

  • In parts (a) and (b), you may use reasons that are from Lainie Ross’ reading.  Please go beyond her reasons in your final paragraph.  
  • In each point that you make, consider how it is relevant for ethics.
  • Apply what you have learned about the ethical duties of medical professionals in your response.