The purpose of this assignment is to give you a chance to work out your own views about the issues raised by a case study involving an ethical dilemma and, more generally, to practice the procedure for analyzing ethical dilemmas. This assignment requires you to prepare a written analysis of a case you choose in which you develop then defend your own ethical analysis.

Your case analysis should be written in essay format and be approximately 1200-2400 words in length (about 5-10 max. typed double-spaced pages).   The papers are due no later than 12:30 pm,  Thursday November 13.

Read the cases that are attached. Tell me by email which you would like to use for your paper. Be sure to list your first, second, and third choices.  Each case will be assigned to at least 4 and no more than 6 students in the class.  I will assign the cases based on your preference and the date of your email to me. If you don't send me your preferences by 9 pm, Wednesday, October 4, I will pick a case for you.

While your paper will be you own independent work, it is often very useful to discuss your case with a small group of students who are considering the same problem.  This gives you the opportunity to consider different aspects of the case and to hear different positions you might not otherwise consider.  I will provide some time in class for you to do this, but you may also want to continue the discussion outside class.  Remember however, that your position need not agree, and often will not agree, with that of others with whom you discuss the case.

In preparing your paper, organize your report using the outline given below.
 

Outline for your paper

In analyzing an ethical problem and describing your position, you need to systematically reason to a rationally defensible, moral judgment using ethical principles and moral rules.  Use the following steps in analyzing your case and preparing your paper:

 1.  Summarize the case
 2.  Identify the salient issues, facts, and conceptual ambiguities
 3.  Outline the reasonable options for action
 4.  Choose an ethical principle and develop ethical arguments for and against each option
 5.  Evaluate these arguments
 6.  Make a decision of the most ethical course of action

The detailed outline below is intended to suggest the important points that should be covered in your analysis.  You are not required to respond to every point, but use the general six point structure of the outline.  Be sure to identify each section of your paper by labeling it with one of  the six bold face headings below.  Remember, your paper should be in essay form not in outline form.
 

The Case

    -Briefly summarize the important points and the decision that needs to made.

Issues

   - What is the most significant moral or ethical issue raised by the case?
      Are there other significant moral issues that deserve consideration? What?

   -  What essential facts are known?  What, if any, facts important to the issues
      raised are not known? (If such facts are determinable, attempt to find
     answers from external sources.  If they are not, make reasonable
     assumptions.  (Note: Describe your findings or assumptions about the facts
    that are not given in the case in the Options section rather than here.)

  -  Are there any conceptual issues--such as what a key concept means or
     whether it applies?  If so, what are they and  why are they relevant to this
    case?

   - Who are the major stakeholders--individuals whose interest could
     reasonably be affected by the decision made in the case--and how might they
     be affected?  Which of the stakeholders deserves the most consideration?  Why?

   -  Does technology play a role in the case?  If so, how?  Has this changed recently?

Options

   -  Resolve the factual issues that are not given in the case description.  These
     may involve questions about technology, medicine, safety, the law or
     other issues. Use research to resolve those that are determinable.  Make
     plausible assumptions--and state them clearly--about factual issues that
     cannot be determined.

  -  Describe each option that you believe could reasonably be taken.
     In some cases, these may only include those explicitly suggested in the
     case description.  However, in most cases you will think of other alternative
     actions that are reasonable or even preferable.  (Simply describe rather
     than evaluate the options in this section.)

Ethical Arguments

    -  Identify one of the four moral standards discussed by Harris (Rule Egoism,
       Natural Law, Utilitarianism, and Respect for Persons)  that you believe
       can be appropriately applied to this case.

    - Describe the essential ideas of the theory and its pertinence to the case.

    - Using this theory, give the arguments for and against each of the
      alternative actions (options) that you identified.  You must include as one
      of these alternatives the action that you will later recommend be taken.
      (Note: Defer evaluating these arguments until the next section.)

Evaluating the arguments

    - Based on the theory you chose, evaluate the arguments you developed  for each
      option.  Which arguments should be considered most important, which
      seem moderately important or of only minor importance?

    - Are there any factual assumptions or unresolved conceptual issues that
       that are critical to the case?

   -  Does aapplying this theory tend to yield converging or diverging judgments
      about what action ought to be taken?

    - Consider similar or related situations to those in this case where there is
      reasonable consensus about what action is ethically appropriate.

Decision

    - Decide which of the options you would recommend or judge to be ethically
      the best way to deal with the issues presented in this case.

    - Defend your decision by a brief summary of the arguments that you
      believe are most compelling including their relationship to the moral
      theory you have selected.

    - Present the strongest arguments that a critic of your position might try to
      use to argue against it using other ethical reasons or another ethical theory.
      Then, present a rebuttal or counter argument in defense of your decision.

    - Could you personally live with this decision?

    -  Compare what your initial “gut” reaction was to this case  when you first
       read it  (and what you “instinctively” felt was the right thing to do)  to
       the final decision you reached after applying the moral theories and
       completing the analysis.
 

How I will evaluate your paper

The object of this assignment is to lay out and logically defend a particular decision about a controversial case.  It is important that you take a position, and answer both the explicit and implicit moral questions raised.  Do so even if you are unsure about what you really think is ethically best.  I will evaluate your paper according to how well you articulate and argue for a moral judgment about the case using known facts, reasonable assumptions, and relevant ethical principles not whether I agree personally with your particular ethical judgment.

Your paper will be evaluated on a scale of 0-100. Each section of your paper (except The Case section)  will contribute 18% of your grade.  Your overall presentation quality--writing craftsmanship and absence of errors -- will contribute 10% to the total grade.
 

Oral Report

In addition to the written paper, you need to prepare an oral summary (3 minutes maximum) of your case to present to the class.  Briefly describe the case, the options you considered, which you choose, and the ethical reasons for your choice.  These reports will be given the same day that the written report is due.
 

                                                                                                                                                                    last revised 7/17/00

Read these  cases.  By 9 pm Wednesday, Oct. 4, send me an email listing your first, second and third choice preferences for the case you would like to analyze.
 
 

Renada Patterson talked with her father for the first time when she was thirteen years old when he called her from prison to offer his kidney.  Renada, born with only one kidney--an unhealthy one-- had been on dialysis for seven years unable to go to school, stay with friends, or dream too far in the future.  Renada's father, David, who is serving a 12 year prison sentence in California for burglary and drug convictions, had abandoned her when she was a baby.  When he called out of the blue and offered her one of his own kidneys, all was forgiven.  For two years, Renada lived as a healthy girl for the first time in her life.  Then her kidney--her father's kidney--began to fail.

She needs a new kidney again just to survive.  Neither her mother nor any other relative is eligible to be a donor.  The current waiting period in California for a donated kidney is about four years.  But her father, due to be in prison for another three years, wants to give his daughter the one kidney he has left now.  If he does, it would mean a painful life of medical treatment with daily dialysis for him with his existence constantly threatened and his life span almost certainly shortened.  It would also mean that the state would have to pay at least $40,000 a year for his dialysis while in prison.

If the father is allowed to make this sacrifice, it would be the first time that a live kidney transplant from someone who has only one kidney has ever been approved. There is some question whether Renada's body would even accept another kidney from her father.

Should the father be permitted to donate his only kidney to his daughter?  Should the fact that he is in prison be a consideration? What advice would you give the medical ethics committee that is considering whether or not to approve the procedure?
 
 

The Whitmans, a married couple, have an 11 year old child who suffers from cystic fibrosis, an incurable fatal disease that results in frequent infections and difficulty breathing.  The couple wants to determine the risk of having another child with this disorder.

Because CF is a recessive disorder, a child usually must inherit the CF gene from both parents to get the disease.  A child with just one CF gene does not contract the disease but is a carrier with the potential to pass the trait on to the next generation.

The DNA test reveals that Melissa, the mother of the child carries the CF trait.  However, her husband, George, does not.  In fact, the DNA test shows that George is not the biological father of the child.

The test results significantly decrease this couple's chance of having another child with CF.  But the test has put the counselor in a very difficult situation.  What should the counselor tell the couple?  Should she tell them about the non-paternity findings?  Should the mother be told privately?  If so, is the center colluding with the mother to withhold information from the husband?   If he asks, how can the counselor respond to questions from the husband about the "good results"?   Should she try to do this without revealing the true paternity of the child?

In addition, the counselor must make another difficult decision.  The biological father of the child carries the mutant CF gene but he did not contact the genetics center and has no knowledge that the tests were conducted.  Should the genetic counselor attempt to learn the identity of this man and call him to tell him about his risk in having children who could have CF?

Assume you are the counselor, what we would you do?
 
 

Sarah Johnson, 52 years old, lies in a coma in the hospital as the result of an automobile accident. Before the accident, she was an avid hiker and mountain climber. She had just begun arrangements to leave her job as a stockbroker in order to open a training center where teen-agers could learn basic mountain climbing skills. Her only living relative is her son Anthony who is 21 years old. Sarah divorced many years ago and has no brothers or sisters.

The year before the accident Sarah signed a Living Will and legal power of attorney in which she designated her son Anthony as her "health care representative," empowering him to make all heath care decisions for her in the event she became physically or mentally unable to do so. In the Living Will she stated : "there are circumstances in which I would not want my life to be prolonged by further medical treatment…. I recognize that this is likely to hasten my death". One such circumstance she specifically identified was " total and irreversible loss of consciousness". A second circumstance she identified, was "having an incurable and irreversible condition which may not be terminal but which would require life-long confinement to a bed or wheel-chair without a significant capacity to care for myself."

The physician in charge of Sara Johnson's case informs Anthony that there is a 90% chance that his mother will never regain consciousness and will most likely die within a week.  If extraordinary medical efforts are taken, there is a 10% chance that she could come out of the coma in 2-3 months but would most likely have severe speech and hearing disabilities, only minimal use of her arms, and probably be paralyzed from the waist down.

Because there is a 10% chance Sarah could come out of the coma, the physician wants to take extraordinary measures to keep her alive. Sarah's very close long-time friend, Marilyn Turner, supports the physician's decision. She was opposed to the Living Will arrangements from the beginning.  Anthony knows that there is money available to pay for the medical treatment. Health insurance will pay part of the bill, and the remainder can be covered from the sale of a major portion of his mother's stock's.  If these extraordinary medical steps are not initiated within the next 48 hours, Sarah will die.  Anthony is the sole beneficiary in the event of his mother's death.

Just before the accident there had been  tension between Sarah and Anthony about money. He had dropped out of college and asked his mother to help him buy a franchise for a fast food store in partnership with a friend. His mother  refused and told him that unless he returned to college, she would not give him any financial help. Marilyn Turner and Sarah's other friends know about this dispute.

Tony loves his mother very much. While the inheritance would clearly be to his benefit, he wants to do the right thing and certainly does not want his actions to appear as greedy or selfish to others.

What should Anthony do?
 
 

RU-486 is a controversial drug that is now widely used in France to terminate pregnancies. The FDA has blocked the use of this drug for this purpose in the United States.

 When used alone,  RU-486 can prevent pregnancy  by interfering with the implantation of fertilized eggs in the uterus by binding tightly to the progesterone receptors in cells. When used together with another drug, prostoglandin,  RU-486 can terminate a pregnancy by stimulating the changing of the endometrial lining of the uterus, thus provoking a rejection of the embryo

As a society we have approved the use of other forms of birth control that function in much the same way as RU-486. Hormone regulating birth control devices (e.g. The Pill) use progesterone and estrogen to masquerade a "pseudo" pregnancy and thus prevent implantation of the embryo. The intrauterine device (IUD) may act stimulate the rejection of an Implanted embryo by irritating the endometrial  lining of the uterus. Further, there are no legal restrictions on removal of the embryo by induced abortion is by dilation and aspiration in the first trimester of pregnancy.

RU-486 could be approved in the United States for non-abortion purposes.   It has shown potential usefulness in dilating the cervix to help avoid cesarean sections and aiding in the delivery of a fetus that has died in utero. It is effective in the treatment of certain cancers that contain progesterone receptors including some breast and ovarian cancers. It has also been used to treat endometriosis (the third leading cause of infertility in the United States), Cushing's syndrome (a hormonal disorder in both men and women that is currently responding to the removal of the adrenal glands), some ulcers, hypertension, obesity, and osteoporosis.

Should RU-486 be approved as an abortifacient in the United States? Why or why not? If your mother has a type of breast cancer that could be best treated with RU-486 and you could bring this drug illegally into the United States, what would you do?  Would your decision change if you believed your younger sister might use the drug to terminate an unwanted pregnancy?
 
 

Jeff and Marta Scorza , a husband and his pregnant wife, seek genetic counseling and IVF (in vitro fertilization).  Each carries one flawed copy of the gene responsible for achondroplasia; thus both are dwarfs.  They, and other family members, make up the famous circus act "The Tumbling Scorzas" which has been a successful tradition for three generations.

The counselor explains that genetic testing can determine whether a fertilized egg has inherited the achondroplasia mutation.  In the discussion, the couple informs the counselor that they want to avoid at all costs having a child that carries two mutant genes.  That is not surprising, since children born with two such genes rarely survive beyond infancy.  The couple had had such a child, a boy who died at 6 months after birth who was never able to leave the hospital because of the need for constant intensive medical treatment.  It was a heart-breaking experience that the Scorzas never want to face again.

But, in addition, they say, they want a baby who is heterozygous for the achondroplasia trait.  Such a child inherits a flawed gene from one parent and a healthy gene from the other parent.  That genetic combination means the child will be a dwarf just like the parents.

The parents say they want any fertilized egg that does not inherit one copy of the mutant gene destroyed.  They only want the clinic to implant fertilized eggs that carry one mutated gene back into the woman’s uterus so that they can be certain that their child will be a dwarf.  They fervently believe that they can be better parents to a child  who has the same condition they have.  They also want a child who can help them carry on the family tradition of the " Tumbling Scorzas".

You are the director of the fertility clinic.  Should the fertility center perform the testing, egg selection, and IVF under these circumstances?

Some things to  consider include the fact that achondroplasia is a fairly serious disorder.  The bones can be abnormal in structure sometimes requiring the use of a wheel chair.  Yet many dwarfs live long, healthy lives and don’t regard their condition as a disability.  In addition, some couples with achondroplasia worry about the problems involved in raising a normal-sized child.

There are no legal restrictions that would prohibit this procedure.
 

Jack and Diane had struggled hard to make it through college at the College of New Jersey. Both had taken out student loans and worked full time to make it through. The hard work paid off when Jack got his first electrical engineering job at a large computer company in Philadelphia making $35,000 a year. Diane graduated with a degree in child development and started a little day care center in their new suburban home outside Houston. She was able to supplement their income with earnings of $10,000 per year from the day care center at their home.

Things were going so well they decided to make an addition to the family, and luckily enough, nine months later, a bouncing baby boy arrived. Danny seemed to be a perfectly healthy baby boy. When Danny started to walk, he fell a lot, as most children do. On one occasion Danny hit his head on the coffee table and cut himself above his right eye. As concerned parents, Jack and Diane took Danny to their local pediatrician to see if he needed stitches.

As they were driving, Diane commented that the bleeding would not stop. When the pediatrician began sewing up the eye, he knew that there was more to the cut than just a simple laceration. The doctor asked the concerned parents if Danny was a hemophiliac. To this point they had never had any reason to suspect    that their little boy had any problems with blood clotting. The doctor took some blood and sent it to the lab to be analyzed. Their fears were confirmed; Danny was hemophilic.

Hemophilia is an X-linked recessive characteristic that usually occurs in males. If a mother is a carrier of the recessive gene there is a 25% chance she will have a child who is a hemophiliac. If females are born with hemophilia they are certain to have problems during their magical moments (puberty). To treat this problem and other situations involving blood loss, victims are given transfusions of Factor VIII, which is one of the platelet chemicals that healthy people produce to clot blood. The cost of the Factor VIII transfusions can run up to $80,000 a year per patient. Luckily for Jack and Diane they had insurance through his company. The insurance paid 80% of the bills so that left $14,000 to be paid by Jack and Diane. This put some stress on their marriage. However, they decided to have another child, even though they knew there was a 25% chance their next child could be a hemophiliac also.

Would you continue to have more children if your first child were a hemophiliac?  If it were possible, would you be willing to use IVF and embryo selection to choose an embryo that did not carry the problem gene and discard ones that did in order to be sure that you would have a healthy baby?  If you were a doctor would you be willing to perform this procedure?
 

_______________

*Several of these cases were adapted from "Beyond the Genome", Science News, Vol. 146, November 5, 1994. Others were stimulated by articles in the New York Times, from materials provided by the Institute for Global Ethics, Camden, Maine or from cases prepared by teachers at the Woodrow Wilson Summer Institute for Biology instructors.