Herb Leventer Med Ethics midterm

Nadya Suleman

- Was artificially inseminated with 6 embryos, when one split into twins, resulting in 8 embryos - physicians criticized this since she she already had 2 disabled children from a different pregnancy. They said that the implantation could result in more disabled children and was deemed unethical - children depended on public assistance - Suleman ended up in rehab to treat an addiction to Xanax (Chapter 5)

The first heart transplant

-Christiaan Barnard, a South African surgeon, secretly decided to try to transplant a human heart (on Louis Washansky). Louis agreed to it. Barnard was waiting anxiously for a heart because Washy was about to die -While this happened, Denise Darvall was in a car crash. Barnard told her father that she was dead and he agreed to let them use the heart. (Her heart had stopped beating). Father had said 'if you can't save her you can use her organs', but Barnard killed her to use her organs. He did the operation while the girls heart was still beating- instead of waiting for her heart to stop, he had injected potassium into her heart to paralyze it so she could me called technically dead. -Harvard therefore created the Harvard Criteria of Brain Dead which requires the entire brain to be non-functioning before organs can be removed. -Washy had a few bad days then a few good then he was really downhill and about to die and Barnard forced him onto a respirator even though he refused. -Later on Barnard did an actual success on Philip Blaiberg -Barnard was fame-seeking and gross -While this was going on, Shumway (in California) was waiting to try his first heart transplant but waiting for a donor because California had strict rules about who is brain dead --> he was much more ethical about it. -Many cardiac surgeons criticized heart transplants because of terrible death rates. (Chapter 10)

-Barney Clark's artificial heart

-DeVries operated on Clark. When he woke up he wasn't so good, had lost a lot of memory. Then he started having many seizures and kept losing more memory. Things looked up but than a ton of really bad kept happening. After 112 days he died. -Differences in opinion if this was one of the boldest experiments ever or if it failed to prove its worth and it also was too expensive and painful. -They came to realize that an artificial heart would need to be flawless and subject to no breakdowns, or else when patients would leave hospital they'd immediately die. (Chapter 10)

HIV prevention in Africa

-Gave some people the drug (AZT) to not transfer HIV to babies and some a placebo-but those kids got the HIV! They knew that AZT worked already, as it was already proven in North America, but they tested it in Africa to see if they were given a smaller dose would it be as effective-but smaller dose is basically keeping away full treatment! They chose a very vulnerable population for this-black, female, poor, illiterate, victims of sexually transmitted diseases, and without other available treatment. -They asked for it-should that matter? -They got consent, but some say the women understood whereas others don't really think they understood. -Some say that if they didn't do this the babies would've been infected anyway and also this would save thousands of babies afterwards -Officials claim that they also would give the African women the dosage needed once they figured it out -In the US this definitely wouldn't fly-should a doctor follow different ethical standards depending on what country he's in? -Utilitarianism and public health ethics vs. Kant (and his belief that ethics aren't local but universal). (Chapter 9)

Bucharest Early Intervention Project

-In Romania abortion was illegal which led to too many kids, so they did research by putting half in foster homes and kept half in orphanages -This is bad because those that were the control group (in orphanages) could have been helped by intervention. -Visiting evaluators couldn't touch children and were told to leave the room if they started crying so they wouldn't influence. -Similar to tuskegee study: -Vulnerable, poor subjects who couldn't leave. -Run by prestigious organizations -Claimed that the subjects wouldn't have gotten treatment otherwise -Substantial evidence already existed that extreme deprivation harmed the developing human brain -Also did they have to leave them in the control group for 12 years? It was obvious it wasn't doing good for them already. Were they mere means (anit-Kant!)? (Chapter 9)

Marion Sims

-Invented gynecology. He was the first to study these areas. He was criticized because he did it in ways like rushing in after sex to collect from the woman. -He experimented on black women slaves that he owned. -Many argue that the statue of him should be taken down for doing these experiments and specifically on the minority. -He opened the first women's hospital in the U.S. He was ostracized because why can't women just go to normal hospitals. Then he said that a big focus would be on breast cancer, and the doctors even more said women aren't going to want to go to a hospital like that bc they'll maybe catch it and all. He got the funds though (bc rich lady had breast cancer so he treated her) and made the hospital. -He started a women's hospital in a male chauvinistic society-he can't be that bad! -But then again he did work on these slave women-he did ask permission, but let's be real-they couldn't really say no anyway. -We don't blame the men for being chauvinistic because that was the norm→ do we blame sims for using slavery when that was the norm? He wasn't any worse than the norms. He didn't let this even affect his medical work-he treated both black and white women. -He worked on them without anesthesia. -But even after anesthesia was created almost NOBODY used it because it had a danger of death, so he felt that they shouldn't go through that option of death for a procedure that wouldn't cause death. He also didn't use anesthesia on white women → not a racist action, rather a medical one. -He figured out the cure to fistula (closing the opening that makes people leak urine because of labor)-it took many experiments for him to do this though - he wrote in his book that the women asked him to keep trying after he kept failing, but we don't know. (From what Professor said on First time organ surgeries day)

Is medical research on humans ethical?

-It seems that all medical research on humans would be unethical because obviously if it's being experimented on then the doctor doesn't know if any intervention will work-someone needs to take a chance of being harmed or getting an unintended side effect in order for medicine to progress - all research is in conflict with the physician's obligation of "Do no harm". -So once we're doing experiments, the ethical questions are "who should go first?" And "how should subjects be recruited?" -Now informed consent and minimal harm are in act from the Nuremberg Trials. (Chapter 9 handout)

links between embryonic and reproductive cloning

-Kass: "any opponent of the manufacture of cloned embryos must also oppose the creation of cloned human embryos" 1. bec reproductive cloning is evil, we shouldn't fund anything that would help us do it 2. if rep cloning is just a tool to make a baby then we should investigate ways to create such a tool (ch 6)

The Tuskegee Study

-Syphilis was really bad. -There was a lot of racism so physicians saw syphilis as a natural consequence of low character in blacks. -The great depression hit also around that time. -So doctors studied many men that had syphilis, a sexually transmitted infection, but didn't know it. (Some didn't have syphilis). -To get them to go through painful experimentation, the researchers told them they had "bad blood". -They were given placebos and even after the disease became treatable with penicillin they still didn't receive it. -The study was meant to last 6 months and really whole lives. Terrible stuff. ETHICS: -In the study, participants didn't know that they were in a study lasting their whole lives, they didn't know what syphilis even was, and they didn't know that they weren't being treated with drugs that were available. (So no informed consent, but this was before that was an idea, but still there was "Do no harm" and do ethics need to be written out for them to be kept?) -They only did this study on blacks-coincidence? You could argue that they thought it manifested itself in different ways based on the different races, but then you would need to also have a study of the white people -Kampmeier (head of Tuskegee study) argues the patients would have been worse off without the study, receiving no treatment. But this can't be proven because you don't know what would've happened without the study. It's true most probably they wouldn't have gotten the medication, but the possible treatment of applying heavy metals which they could've done on their own wasn't told to them. -Once penicillin came out should they have been told about it? Kampmeier claimed that it wouldn't have helped them because it's only for people with primary syphilis, but others argue that it still would have been beneficial for at last 12.5% of the subjects. -Many argue that if no harm can be proven then nothing unethical had been done (Utilitarianism/consequentialism). -But we can argue this from a more kantian side of things, focused on motives, or a virtue effects side, focused on character of researchers, by saying that it's not just the consequences that shows whether or not something is ethical. They used them as mere means-not okay! Not only did they not have good will, but they had ill will. -Caused families harm too because didn't know they had syphilis. (Chapter 9)

Nazi medical research and Joseph Mengele Physicians' defense at the Nuremberg trials

-Terrible things were done by Mengele and other German physicians during the Holocaust. -Justified their actions saying that because the people were going to die anyway they might as well experiment on them and make their bodies useful. Nuremberg trials-They defended themselves saying they were just following orders and they'd experimented to solve medical problems of war (and that it was no different than research done in America on captives). (Chapter 9)

Nuremberg Code

-The 10 principles that were created for what is considered ethical experimentation. -Most important principle is that people, even prisoners or inmates, should freely consent to participating in any experiment. (Chapter 9)

Why are the ethics of surgery different than the ethics of medicine?

-There are often things that come up that the surgeon needs to make a spur of the moment decision without getting consent-they need to be more decisive, aggressive, and fast. -This devaluing of patient autonomy can potentially cross the line (like how Barnard ignored Washy's request to not be on a ventilator). (Chapter 10)

Rios Case

-frozen embryos created via IVF -question if embryos could be destroyed -Committee votes to freeze until they're adopted but they never were, so they froze to deterioration (ch 6)

How is medical prevention controversial?

1) opting out of certain things becomes very controversial (ex, vaccination) especially when group benefits are involved 2) some medical intervention isn't meant to cure (ex, abortion)

Good Reasoning in BioEthics must include...

1. Give reasons that are relevant to the position, attack any misconceptions, provide evidence for the position, give explicit justified conclusions, and logically consistent. 2. Universalization of decisions, it needs to apply to everyone. 3. Impartiality, our decisions can not be based on our own interests, everyone must be treated the same. It is on someone is a certain decision to carry the onus, burden, of proof, if he cannot disclose good reasons, his position is unjustified. 4. Reasonableness, meaning being open to other positions, able to see faults in own position, not 'attacking a straw man' meaning not attacking the weakest point in opposing position, and being in search of truth. 5. Civility, don't attack the person, just argue the ideas. (ch.1)

Argument against giving organs to sickest patients

1. People are waiting longer, get sicker, and end up needing multiple operations when they would otherwise need one. 2. Personal responsibility for health - unfair to others down the line who took care of their bodies and therefore are not now as sick (Chapter 11)

Reproductive Cloning ethical problems

1. spindle problem- genetic defects/cells don't divide properly--> birth defects if birth at all 2. biological inequality-parents will clone from genomes of people who have good traits-this is making hierarchies. Some may argue, however, that it's unfair to have a child be born lesser than he could otherwise be through cloning. 3. good of the child-Most discussions on cloning beg two important questions: they assume bad motives on the part of the parents or scientists, and they assume the child would be harmed by knowing he or she was created this way. refute: But a child created this way would know he was wanted by his parents! Also he'll be chosen from a good genome-is being automatically physically good a bad thing? (ch 6)

Pros of reproductive cloning

1. stronger genetic connection- 100% of parent genes and more legal ramifications 2. only way to have one's own baby vs adopt 3. increase liberty of one who wants to clone! 4. Rawlsian argument for cloning and choice- ppl not just permitted to improve the genes of their future children, but are obligated to do so bec it's wrong to choose lives for future people that makes them worse off than they otherwise could've lived. (ch 6)

The "God Committee"

Aka Admissions and Policy Committee Gave out scarce resource of dialysis machines based on what they deemed to be the "social worth" of the patient, defined by whose life best met standards of their middle class community. Committee was made up of 7 members representing the community (ex: lawyer, gov. official, etc). They worked anonymously and never met the patients. - Goes against idea of seeing everyone as valuable and worthy of being saved - Congress offered to pay for machines to save everyone to avoid the issue of deciding order of treatment, but can't do this for rare resources like kidneys and other organs (Chapter 11)

What are the conditions that need to be met in order for an American to be allowed to end his own life?

Americans agree that included in the autonomy of mentally competent people is the right to end their own lives, however, it is not agreed upon how this applies to people who lack mental competence (ex, comatose) (chapter 3)

ART

Assisted Reproduction Technology [currently in the US more then 60,000 newborns per year are born through ART, of which only about 3,000 were IVF's] (chapter 5)

Cheryl Chase

Became leading advocate for intersex people and argued that everyone should know his or her true origins and make his or her own decisions about their gender or sexuality. Born with ambiguous genitalia and was first sexed as a boy, but after 18 months and with an unusual appearance, doctors decided to make her a girl. Cheryl's life refuted Money's claim that professionals can assign gender with happy results. Cheryl never felt completely male or female, like some other intersex people - she lived between genders. Argument: what harms the intersex child most is the attitude that the child suffers from something shameful that should be hidden, and that the child should be told the truth and allowed to choose which gender they want to be. The parents should embrace the child as he/she is and not be ashamed. (Chapter 13)

Is if harmful for IVF to result in multiple gestations?

Because the fetus's are placed into the mothers womb in a unnatural way, an IVF which results in more than one fetus being inserted into the womb may be dangerous because there is less food available for the fetus's. However, it is known that in natural births, when there is more then one fetus in the womb there is less food to go around which usually results in premature babies and there is 3 times more of a chance to have a severely handicapped birth. The probability of the outcome of each child is based on how many fetus's it is sharing a womb with. Although IVF of multiple fetus's in one chance is dangerous, one may argue that there is no difference between that and a natural pregnancy of more then one fetus. Should society really get to mandate how many IVF fetus's are ethical if there is no mandate against natural pregnancies? (Chapter 5)

What is disease?

Boorse explains that disease is an objective category that doesn't depend on what culture you're in. He defines disease as any departure from statistically normal body functioning that is detrimental to the individual-AKA people who deviate from the norm and it deviates in a way that can be negative

David Reimer

Bruce and Brian Reimer were twin boys who, at 8 months old, both suffered from penis infections and were recommended to have circumcisions. The doctor messed up with Bruce's operation, burning off his entire penis as a result. David's parents went to Johns Hopkins Hospital in Baltimore to be helped by psychologist Dr. John Money, who recommended a surgical sex change, from male to female. Money had a theory that nurture, not nature, determines gender identity and sexual orientation, and he wanted to use this case to prove it, using a human who was born male, raised as a female, and lived happily as an adult female. The experiment was even better because he had an identical twin, who was being raised as a boy. Bruce was renamed Brenda and given estrogen shots. However, even as a young child, Brenda resented being a girl and refused to act like one - she wanted to act like a boy, just as Brian was allowed to. Money, however, lied about Brenda being happy as a girl and claimed that her successful gender reassignment validated his theory. He claimed that anyone can be raised as either gender and be happy as a gender reassigned adult. Money forced the twins to see him privately yearly for therapy sessions to try to push Brenda into femininity and to make Brenda self-identify as a female. At 14 years old, Brenda was finally told the truth and immediately decided to live as a boy - he changed his name to David, started to dress as a boy, and started to take testosterone injections. He eventually went public to refute Money's claims, as Money had been using the false reports about his happiness as Brenda to change other children. But his twin brother died of a drug overdose, after claiming to neglect during his childhood for being the "normal one", he lost the money he made off of a book written about him, and his wife left him, and all of these things drove him to commit suicide at the age of 38. (Chapter 13)

Karen Quinlan

Comatose and Brain dead: - feeding tubes were the only thing preventing her from starving to death and was dependent on ventalator - physicians didn't want to remove the tubes because 1) they equated it to euthanasia (at that time murder) 2) they feared the family may later change their minds and sue - because Karen never wrote her wishes down the court ruled they couldn't pull the plug - in 1976 the court decided that the family can choose to pull the plug (-> however, the doctors weened her off life support leaving her alive in a vegetative state for another 10 years) (chapter 3)

Terri Schiavo

Comatose because of anoxia: - kept alive by a feeding tube (similar to Cruzan) - had a husband who was considered her legal guardian - after many attempts to improve her condition, her husband signed a "DNR" but her parents did not want this. They brought it to court and tried to have him removed as guardian but ultimately lost. - after 8 years the husband won the appeal and her tube was removed. (Chapter 3)

Utilitarian approach to distribution of scarce resources

Decide based on who would get the most years out of a given machine or organ -Ex: it is likely that an alcoholic would ruin a kidney, so they wouldn't give it to him, not because his drinking makes it immoral but because the kidney would have a short life span Chapter 11

Fetal dex controversy

Dr. Maria New gave this drug to pregnant women with CAH fetuses daily to prevent the development of ambiguous genitalia and lead the child, as an adult, to show typical gender behavior (more than an untreated child would- an untreated CAH female generally acts tomboyish and attracted to other females). Ethical issues raised: 1. Why is it necessary to normalize CAH females? What's wrong with being a masculinized female? Must medicine be used to normalize every deviance? 2. Is it even safe? It was somewhat experimental, which is wrong to do without IRB approval. 3. Was there possible long-term harm? For women who received fetal dex in utero, we won't really know until their lives are over. 4. CAH and intersex teenagers should get to make their own decisions later on how they want to be, not have decisions made for them at birth. (Traditionalist reply: it will be too late because by then, the "gender identity gate" will be closed) - This treatment appears to work and prevents all CAH-linked birth defects in women. In 2010, federal regulators upheld Dr. New's research on fetal dex, thereby absolving her of any charges of unethical behavior. (Chapter 13)

"Even if only a single abnormal baby is born, Dr. Edwards would have a terrible guilt on his shoulders"

Dr. Robert Edwards was the inventor of IVF. From this quote it seems to place all the blame of defects in IVF on Dr. Edwards. Many doctors were/are opposed to IVF since there is no way to guarantee or check for certain if the IVF baby has a defect. Dan Callahan, a bioethicist, says that the first case of IVF was unethical since no one could guarantee the outcome. However, it can be argued that these critics overlooked the fact that birth can have a guaranteed outcome. There is only a slightly higher risk of defects. (chapter 5)

ESLD vs ARESLD

ESLD = End-stage liver disease - liver destruction ARESLD = Alcohol-related end-stage liver disease - most common --Debate as to whether patients with ARESLD should get liver transplants, based on the argument whether alcoholism is a disease or a chosen behavior (Chapter 11)

Ernie Crowfeather

Famous case considered by the God Committee - Criminal, received dialysis for 30 months but refused to follow the regimen, drank, imposed childlike needs on the Taff, turned down further therapy and died. Turns out Scribner had gone around the committee in order to get dialysis for him. (Chapter 11)

"the real choice is between accidental or random reproduction and rationally willed or chosen production... Laboratory reproduction is radically human compared to conception by ordinary heterosexual intercourse. it is willed, chosen, purposed, and controlled, and surely those are among the traits that distinguish Homo sapiens from other animals"

Fletcher argues that not only is IVF ethical, but, in some ways it is the better way to conceive a child since there is choice, will, and want. Some couples who conceive a child are not looking to become pregnant, and that, he says is more harmful to an embryo-person then being placed into a womb by IVF.

Argument for choosing a gender at birth

For a normal development, a child must have a clear gender identity. People have a hard time accepting a child with ambiguous genitalia or mixed reproductive organs, and these children will have a hard time socially without a clear gender. If the person is heterosexual, people will interpret the lack of a clear gender as evidence of a homosexual orientation. And these people don't need to know about their problems at birth - if these problems can be corrected at birth, the adult can live and function normally. Plus, surgeons and parents do the best they can and decided that it was a social emergency at birth for the child to lack gender - wrong to second guess them years later. (Chapter 13)

Mickey Mantle

Former baseball star, had been alcoholic for decades and was diagnosed with ESLD and a tumor on his liver. Went on the UNOS waiting list for a liver transplant and got one two days later. Many felt that his celebrity status got him to the top of the list, and the transplant team was also criticized because of his liver cancer and alcoholism - they felt he didn't even deserve it. Decreased public trust in UNOS. (Chapter 11)

Gender identity vs gender role vs biological sex

Gender identity = how one sees oneself and behaves as a male, female, or in-between Gender role = how one acts in public or how the public expects one to act as a male, female, or in-between Biological sex = determined by chromosomes (Chapter 13)

Robert Casey

Governor of Pennsylvania, got a combined liver-heart transplant seemingly within 10 hours of being put on the list, even though many other candidates were ahead of him. Later claimed he had been on the list for a year. Was defended by the transplant program saying that he was the only one who needed both a liver and a heart. UNOS then revised criteria to say that a candidate must be at the top of one of the lists for single organs (which Casey had not been) in addition to his place on any list for two transplants. (Chapter 11)

Nancy Cruzan

Heart restarted after accident but no brain activity: - difference between Cruz and Quinlan was that Quinlan's case was about pulling the ventilator while Cruzan's was about pulling the feeding tube - Cruz's parents did not think that think that someone dependent on a feeding tube is "owed" food forever - because Cruz left no wishes before she died (no "clear and convincing evidence") the court did not allow the tube to be pulled - after Cruzan's friend testified that this would be what she would want, the court allowed the tube to be pulled (chapter 3)

HLHS

Hypoplastic left heart syndrome

Non-heart-beating organ transplantation - process, problems, and resulting decision

In 1993, the University of Pittsburgh Medical Center figured out how to obtain organs from patients who were declared dead by loss of cardiac function - they managed death in the group of patients whose cause of death had not damaged the organ and in which case the family has signed a DNR order. They remove the respirator, breathing stops, they wait 2 minutes to see if breathing resumes, declare the patient dead, administer a drug to maximize the health of the organs to be transplanted, and remove his organs. This patient is called a non-heart-beating cadaver donor (NHBCD). Problem: The only way to know if the changes in the person's breathing are irreversible is to start CPR, but in this case, CPR is explicitly declined, so if the family has not consented for this process to be done, the staff may be charged with accelerating death to harvest organs. Kantian objection: not treating the patient as an "end in himself" Claim that the drug administered to the patient hastens death - declined by surgeons using this protocol Result: Decision is made case-by-case whether or not to administer the drugs and wait 5 minutes instead of 2 (Chapter 11)

Ad Hominem ("To the man")

In an argument, attacking the person rather than the position. this is a fallacy in ethical debates. (ch.1)

Prenatal listing

In the early 1990s, candidates for neonatal heart transplants were being identified prenatally and then placed on waiting lists while still fetuses. This would give them an advantage because time accumulated on a waiting list gives a candidate extra points. - This was made possible by the ability to diagnose HLHS in utero, but this early diagnosis wan't uniformly distributed throughout the US, so this prenatal listing was unfair to other babies who weren't diagnosed until birth. Also, fetuses with HLHS remain relatively safe while in the womb, while HLHS babies are at great risk after birth. -UNOS changed its policy in 1992 and put fetuses on a separate list from babies. UNOS also decided to locate a heart to a fetus only when no baby could use it. (Chapter 11)

Ad Populum

Just because everyone does something does not give it sound reasoning to do it, does not make it ethical. (ch.1)

Living donors - what are they and what are possible issues?

Letting people volunteer to have surgeons risk harm on them to benefit another. Alternative to cadaveric transplantation. Some have died, some donors have later required kidney transplants, some have become severely disabled The transplant team focuses on the sick recipient of the organ, not the donor, plus they don't get paid (and actually lose money) for caring for the donor. *Savior sibling = child conceived as a resource for another sibling (Chapter 11)

Mandated choice vs Required request vs Presumed consent

Mandated choice requires adults to indicate whether they want to be organ donors (on driver's license) --most American states require this choice Required request requires someone at a hospital as a relative upon admission of a patient - Even without a signed donor card, a family can still choose to donate the organs of a brain-dead relative. And even if a brain-dead patient has a signed card but the family refuses, surgeons generally won't take the organs (fear lawsuits/bad publicity). Presumed consent = anyone who has not declined to be a donor in writing to a national agency is presumed to be a donor (policy is followed in many European countries) Opt-out policy=need to decide NOT to be a donor, opt-in policy=need to consent TO be a donor (Chapter 11)

End State Renal Disease Act (ESRDA)

Mandated the federal government to pay got a dialysis machine for any American who needed one - Brought about soon after Shep Glazer dialyzed himself before Congress, disconnected a tube from the machine, let his blood flow onto the floor, and told them that if they didn't fun more machines, that blood would be on their hands. - story may be somewhat exaggerated - Also brought about because of concerns that too much money was being spent on space and the war in Vietnam and not enough on dying patients who could potentially be saved. - Ended need for the God Committee - Created too quickly and set a bad precedent, as other groups then lobbied for similar coverage. - Became one of the most expensive medical programs in North America - Under this act, Congress also reimbursed kidney transplants (Chapter 11)

Ethicist (Ethics of Care) approach to distribution of scarce resources

Might think it's appropriate to give preferences to certain people -Ex: Alcoholic baseball legend whose fame made them part of many people's lives (Chapter 11)

Multiple listing

Patients get themselves work-ups at multiple transplant centers to get onto multiple transplant lists. Unfair because this favors wealthier people who can get time off of work, can afford to travel, and have generous medical plans. Much more likely to be selected this way. -Steve Jobs used this method, and, having the money to get himself worked up in Tennessee, he became the sickest patient on that hospital's list and got the transplant. - In 1990, NY banned multiple listing. Some patients argued that this denied their right to contract for medical care. (Chapter 11)

Retransplantation

Patients often need second or third transplants, as it's likely for them to reject a transplanted organ. But shouldn't patients get a second organ only when everyone has had a chance at one? - UNOS treats all patients waiting for transplants as first time patients -- not so good because they're less likely to survive than first-transplant patients, as they're sicker. - Utilitarian approach: no transplants, need to gain maximal years per organ (Chapter 11)

Is the autonomy of the embryo in question since it did not choose to be the "subject of an experiment"?

Paul Ramsey suggests that that because the embryo did not give consent to be artificially created and then inseminated, they may not have wanted to be the result of the "selfish" act of their parents. He would call these babies "test-tube babies" and accuse the parents and doctors of "playing G-d". His main complaint was that this was wrong to the embryo - person. However, Joseph Fletcher argues that its more of an argument against naturally created babies since at least an IVF pregnancy was planned, where as a natural pregnancy 50% of the time is unplanned and sometimes unwanted. This all seems to assume that a fertilized egg is considered a person with interests and rights which most people and legal systems deny. (chapter 5)

Transgender

People who feel they live in the body of the wrong gender and as teenagers seek hormones and surgery to change to the right gender. Ethical question: should parents support such irreversible changes before children know who they really are, and when they are subject to all kinds of peer pressure? (Chapter 13)

Rule of rescue

Refers to giving scarce medical resources to an identified patient, rather than to equally deserving but anonymous people. Often done using the media when patients need organ transplants (to obtain funds for patients) - Unjust way to distribute organs because the media favors more attractive people. Also, this makes journalists the deciders of life for many people in choosing whether or not to cover the story. And, for every identifiable person saved, many other anonymous patients are lost. - Originally used by Dr. Belding Scribner, who took a patient to a newspaper convention to lobby publicly for more dialysis machines, meanwhile telling reporters about the God Committee. This led to widespread news coverage in the coming years regarding the fact that decisions had to be made to choose who would be the one to get a dialysis machine and live. This had been Scribner's angle all along - to get publicity over the issue. This began the education of the American public about ethical problems in medicine, and so began the field of medical ethics. (Chapter 11)

Kate Gosselin

Similar to the Suleman Case - received artificial inseminataion which resulted in sextuplets - One child was sent to a special needs children school (Chapter 5)

Slippery Slope

Slippery Slope arguments see society as a teetering ball perched atop a slope, braced by wedges, preventing it's descent. our basic moral principles are those wedges. "Without X, the society will fail in Y way". One change snowball into larger problems, this is because there is a fine line drawn between right and wrong in some cases. (ch.1)

Base Line Harm

Something is worse off then it was prior to the act -> therefore, if something isn't born yet then there is no such act (chapter 5)

Hemodialysis/dialysis

Substitutes for kidneys; patients in renal failure must undergo dialysis for several hours, multiple times a week; doesn't cure renal failure and leaves patients tired and cranky, very expensive. Most patients can only get off dialysis with a kidney transplant. First hemodialysis machine was invented by Willem Kolff, and combined with a shunt created by Belding Scribner, this became a sort of artificial kidney. Problem = which patients should be served first? (Chapter 11)

Louise Brown

The first known child of IVF - Was carried to term - was a result of her mother not being able to carry a child after damage to her fallopian tube (Chapter 5)

Belmont Report

The four main medical ethics principles that were presented are autonomy, maleficence, beneficence and justice. usually autonomy trumps all. (ch.1)

Patient abandonment

The idea of being forced by UNOS to allow a patient (who they personally know and have worked with for a while) to die after rejecting an organ But why should an identified patient take priority over a new patient? Plus, this would favor more charismatic, friendly, or attractive patients, who can easily form relationships or be preferred by the transplant teams (if they were allowed to select who got the new organ). (Chapter 11)

What is Ethics?

There are 2 common ways in deciding what is right or wrong: 1) from the "top down" -> imposing a general theory on the particular situation 2) from the bottom to top-- that we're starting from the facts of the particular case at issue, to see if there is a situation similar to it where we have already agreed on the correct solution.

"The probability of an impaired baby varies with the number of embryos allowed to gestate... if six are implanted, one is almost certain to be born with cerebral palsy or blindness. Unfortunately the chance of having any baby at all with ART also varies directly with the number of embryos implanted. Hence the ethical dilemma"

There are those which argue that because multiple births can result in defects in babies, there should be a system in place monitoring how many embryos are allowed to be inserted during IVF (chapter 5)

Post Hoc, Ergo Propter Hoc ("After this, therefore, because of this")

This occurs when causality is confused with temporal priority. Just because something happened before doesn't mean that it caused it. (ch.1)

Organ-utilitarians

Those who see justice as creating the greatest years of life per donated organ - Under this view, UNOS should give first-time patients priority over transplanted patients. (Chapter 11)

UNOS

United Network for Organ Sharing - created by congress in 1987, created a points system, combining medical need, ability to follow the anti-rejection drug regiment, probability of living longest with the transplant, time on the waiting list, etc - In 2000, Congress changed it so that the sickest always come first (inefficient because they'll likely die soonest) ---- Even though the best way to get the most use out of an organ would be to give it to a moderately sick person who's just experiencing organ failure, many people rejected this system because the person waited on the list for years and deserve the chance at life. (Chapter 11)

Vegetative State

Used to describe a type of deep unconsciousness that, if one persists for a few months, is usually irreversible. (Some bodily functions do work [as in the case of Karen Quinlan] which would cause a family to believe that their loved one is not in PVS) (chapter 3)

Helga Wanglie

Was in PVS for 8 months: - kept alive by a feeding tube and ventilator - doctors wanted to remove tubes while her husband did not want to ***this brought upon the question of if relatives of a patient can force medical officials to continue care [case ended when Wanglie died]

Appeal to Authority

When citing an authority, it must be relevant to the argument. (ch.1)

Futile vs. non - futile care

at what point is medical care considered futile - "not worth it" [ex, Schivo Case - after years of treatment to reverse Terri's condition, neurologists concluded that medical care will no longer be affective] (Chapter 3)

embryo slippery slope

claim: embryos may be regarded as mere commodities for research which will further erode our respect 1. conceptual ss: if trivial reason justify experimenting on embryos pre 14 days, then they'll justify experimenting on fetuses 2. empirical ss: acceptance of deaths of embryos will generalize to accept death of fetuses (ch 6)

Indeterminancy

we don't know exactly when personhood begins, so we should treat embryos as though they're people. (ch 6)

IVF

"In Vitro fertilization" Also known as test tube conception

What are some ethical issues in first-time organ surgeries?

-The desire to be first and famous tends to get in the way and it's not right- Shumway had really set the grounds, but was being ethical so he didn't do the first heart transplant yet Barnard did just because he wanted to and gets all the credit. -We never mention 2nd or 3rd or anything. -We also don't mention that messed up tries that came first -Media and all makes us do crazy things -People were trying to hoard organ and not share them with other surgeons, so they made it that physicians who declare a potential donor brain-dead can't be on the surgical transplant team. -In most first-time surgeries the quality of life for patients has been poor. Either there was death or there were MANY medical issues following. The antirejection drugs cause many side effects. However, without these drugs patients are likely to die soon after because of the body's rejection of the organ. -For the years that they didn't have cyclosporine (antirejection drug) the organ receivers had bad results-but then again where would we be today without those trials? -The media portrays things as great but they really aren't. -Some see it as negative that doctors always want to be a "first" so they try all these things -Others say how else are we going to advance in surgery if they don't try new things?! -We know that these firsts led to thousands of people's lives being saved today -There's also that line of transplants that need to happen for life and the ones that can happen for cosmetic reasons-the line might get blurred and all fall under 'therapeutic surgery'. -Right now the consensus is that face transplants should be done only in cases of lack of physical function like not being able to eat of speak. There are too many risks for just an attempt to improve appearance. -Is the immense cost of these things worth it? Would that money be better off going to prevent smoking, promote exercise, and things of the sort to create healthier hearts? -Saving bad organs shows the rule of rescue-our society cares more about saving an identifiable life than preventing future deaths from heart failure -Are the patients of first time transplants really informed enough? Patients were incorrectly told that the transplant would be a permanent cure, so they didn't really give consent because maybe knowing the aftermath they'd have objected. -Yes they give "informed consent" but are they really in the mental state that they really consent? Do they understand the ins and outs? -The hope is that they understand the risk of cancer from the antirejection drugs -Surgeons mislead and lie about the chances of success and ignore the poor quality of life that comes after. They're doing it for media fame→ they see patients as means to an end for them→ against Kantian ethics. -2 more ethical complications exist for the first heart transplants- -Technically to get a heart transplant, the person's original heart needs to be removed. However, this is technically killing them. In order to do that there needs to be a "reasonable" chance of benefiting them. But 90/100 of the first transplants died within weeks so that doesn't seem so reasonable. 50/50 would be more likely. -The heart becomes less viable the longer it's without blood, so surgeons want to take out organs as quickly as possible after the donor's death. This could run into issues, so the "brain death" criteria. (Chapter 10)

What is fiduciary obligation?

Doctors must act in the interest of their patients as opposed to themselves. (The main question which stems from this is can doctors refuse to treat someone?)

embryo reductio ad absurdum

if embryo=person.. - woman should conceive as many kids as possible so as not to waste eggs... -ivf saved embryos, plan B pill, etc are killing ppl (ch 6)

Should cloning embryos be linked to reproductive cloning, or should the 2 issues be kept separate?

The 2 should be kept separate. consist of totally different ethical problems

PVS

persistent/permanent vegetative state (chapter 3)

If cloning babies were safe, how might it create more inequality in society?

"In a single swoop, particular families single-mindedly devoted to raising their genetic stature could biologically outdistance normal humans over a few generations. It would endanger social justice and be much harder to undo bec written into biology. non-superior genes would find it hard to compete.

Intersex

"People with developmental sex disorders" Generally born because of deviations in anatomical development of the fetus and because of exposure during fetal gestation to hormones and chemicals. These children can be born with ambiguous genitalia, partially formed sex organs, microorgans, or organs of both sexes (hermaphrodites). (Chapter 13)

Bonnie Steinbock

"interest view": having moral status is limited to beings who have interests, ie being able to desire something, ie not pain -embryos have moral value but not moral status, ie they're worth being worried abt and cared for but have no desires (ch 6)

Argument regarding conjoined twins and intersex people

(With intersex children, parents generally decide gender at birth, and with conjoined twins, most parents consider such births an emergency and ask children to normalize conjoined twins into singletons, even at the cost of killing both children) Alice Dreger and Cheryl Chase argued that: 1. Physicians and families should wait until the child can decide for itself what gender it wants to be 2. Physicians should help families understand that a child with intersex can be happy with an ambiguous gender 3. If physicians and families guess wrong about gender, intersex children can be irreversibly harmed 4. Such crises at birth about gender are socially constructed and mediated by ignorance and fear **The American Academy of Pediatrics disagreed, and in 2000, it wrote that such a child constitutes a social emergency - sexing a child at birth can hopefully prevent later medical harms as well as a stable gender identity. However, in 2006 they decided to no longer consider the birth of an intersex baby to be a surgical emergency, and few surgeons would take a decision lightly to sex a child at birth, especially against its biological gender. (Chapter 13)

pros to embryo research

*libertarians: do what you want with your body! -experiments provide ppl w medicine -use to grow own organs to avoid transplant rejection -eventually MOOT- stem cells w/o destroying human embryos (ch 6)

Isabelle Dinoire

-First time partial face transplant patient. The doctor, Dr. Maria Siemionow, was really ethical about it, emphasizing first do no harm. (Chapter 10)

Embryo: Potential for Personhood

-scientists: pre 14 days, embryo not human, no feel pain -conservative: already human from conception bec has potential to become a person (ch 6)

Three recommendations about sex reassignment surgery (by Prof. Kenneth Kipnis and Milton Diamond)

1. Ban surgical assignment of gender without consent of the patient and until evidence-based medicine proves that such surgery helps more than it harms. 2. Do not restart such surgery until comprehensive look-back studies show how and when benefits of such surgery can be obtained. 3. Undo the deceptions by past physicians to living patients about such surgeries imposed on them as infants. Tell them the truth. - Parents need completely informed consent about possible harmful results before agreeing to this surgery to be done on their children, such as ending ability to have children, conflicting with feeling of true gender identity, etc - Hard to know long-term effects because so many children aren't told the truth about what happened. Another problem with the secrecy is that in specific cases, a couple will come to an infertility clinic to learn that they can't get pregnant because the wife is a biological male. (Chapter 13)

Congenital Adrenal Hyperplasia (CAH)

Most common cause of intersex. It's a genetic disease affecting the adrenal glands, and these babies lack a certain enzyme during fetal development, and therefore females with CAH tend to have ambiguous genitalia. (Chapter 13)

Cloning Misconceptions

1. myths--> false! -cloning doesn't reproduce existing ppl nor drones -Kass: prejudice ppl will treat clones as less-than-human, refute: all couples weary of prejudice ppl who may mistreat their children 2. religious christian: against will of Gd, refute: source in Bible? prev med discoveries show change isn't against Gd's will 3. Right to unique genetic identity, refute: twins, genes= identity? 4. unnatural and perverse, refute: natural=best? unnatural= bad motive? 5. right to an open future- parents disappointed if child doesn't turn out how they calculate, refute: parents should always take *Kantian* approach and view child as end in himself, never force wills/ideals on their children (ch 6)

Tu Quoque

2 wrongs don't make a right! (ch.1)

Does ART produce monsters? (babies with harmful birth defects)

2% of normal births have defects where as 4% of IVF births do However, this is where the question comes in. Yes, it is true that pregnancies resulting from IVF do lead to more birth defects, but that is also the result of pregnancies at a later point in a woman's life. We don't seem to be discouraging the 40 year old from getting pregnant, so why are we discouraging one who can only get pregnant through IVF? (chapter 5)

Mandate Reduction

The concept of destroying other eggs once one egg is already implanted in the uterus (this would stop multiple gestations) (chapter 5)

Kantian approach to distribution of scarce resources

Don't establish distinguishing criteria - decide through a random selection (impersonal/impartial lottery) Worked based off of a person's choices and don't treat those who brought about the condition onto themselves - Nicholas Rescher combines these two criteria saying that the second should be used to eliminate the unworthy and then from there do a lottery (Chapter 11)

David Ozar

embryos not ppl, but more than inanimate objects -scientists should be legally signed to treat embryos w respect to avoid slippery slope of devaluing other human lives -banning them from being bought and sold to medical school research (ch 6)

What is medicine?

A profession, in which individuals care for and heal the sick. It is a socially constructed position, meaning that each society has a different interpretation of the implication and expectations.

Comatose

A sleep like state in which there are minimal/no working bodily functions and there is severe irreversible brain damage (After a few months in a coma bodily functions [even simple ones such as pupil reaction to light] shut down and the patient is declared brain dead) (chapter 3)

Cadavers

Brain-dead patients

Embryos Valuable from Conception

pope: conception/embryo= human, can't be exploited for any purpose.

"Uniformed Determination Act"

proposed in 1981: "An individual who sustained either: 1) irreversible cessation of circulatory and respiratory functions 2) irreversible cessation of all functions of the entire brain, including the brain stem [brain is "dead"]. A determination of death must be made in accordance with acceptable medical standards" Rabbi Bleich: opposed the New York establishment of this law without the clause of accommodations to religious or moral obligation [ this allowed people to only choose the first definition] (Chapter 3)

"the dignity of the embryo begins to collapse into the dignity of the cell"

slippery slope to claim embryo's relevance as potential personhood because technically every cell is the equivalent of an embryo bec we can engineer any cell in the body to become a person (ch 6)

Abnomal Harm

there is a world "norm" and when a fetus is not up to that level of norm people need to do what they can in order to help the fetus reach that level of norm (chapter 5)

top-down vs bottom-up decisions

top-down decisions: imposing a general theory on a situation to make a decision. like, utilitarianism, kantianism or ethics of care. bottom-up decision: using the facts of a particular case to see if there is previous case, giving the decision a precedent to base it off of. this is also called causity, common-law or case-based ethics. however, this is not practical because every case is too multi-faceted. (ch.1)

How has the discovery of IPS cells altered the landscape of the debate about research on human embryos?

we can get cells for research without destroying embryos, still embryonic stem cells may be better for some purposes. New discovery weakens the punch of many arguments against embryo use (ch 6)