Medical Ethics Case Studies

Discrimination
Tuskegee Syphilis Experiment

Infamous clinical study conducted between 1932 and 1972 by the U.S. Public Health
Service to study the natural progression of untreated syphilis in rural African
American men who thought they were receiving free health care from the U.S.
government
The men were given free medical care, meals, and free burial insurance, for
participating in the study. They were never told they had syphilis, nor were they
ever treated for it
The men were told they were being treated for "bad blood", a local term for various
illnesses that include syphilis, anemia, and fatigue
The 40-year study was controversial for reasons related to ethical standards,
primarily because researchers knowingly failed to treat patients appropriately after
the 1940s validation of penicillin as an effective cure for the disease they were
studying
The Tuskegee Syphilis Study significantly damaged the trust of the black community
toward public health efforts in the United States
- damaged the trust between medical personnel and much of the African American
community
This study showcased the disconnection between human rights and scientific
research

Life Support
Terri Schiavo Case

Clear-cut debate between pro-life and right-to-die advocates

The issue was whether to carry out the decision of the husband and legal guardian
of Theresa Marie "Terri" Schiavo to remove Terri's feeding tube that provided life
support
- involved a dispute between family members over what Schiavo's wishes would
have been for such a situation
Terri was diagnosed by multiple physicians, including independent court-appointed
physicians, as being in a persistent vegetative state, though this diagnosis was
challenged by her parents and physicians hired by her parents. The highly
publicized and prolonged series of legal challenges presented by her parents and by
state and federal legislative intervention caused a seven-year delay before her
feeding tube was ultimately removed
Husband requested for feeding tube to be removed, as he said his wife would not
have wanted to live in her current condition
- wanted to give his wife a peaceful death with dignity
- Schindlers suspect husband is motivated by money
Schindler family maintains Terri consistently exhibited strong will to live culture
of life
- also argued that as a devout Roman Catholic, Terri believes in sanctity of life

Ethical Situations
Euthanasia and Assisted Suicide

Defined as ending life in order to relieve pain and suffering

Voluntary (conducted with consent of patient), non-voluntary (unable to provide
consent), involuntary (patient would have been in a position to give consent but
instead indicated they did not wish to die or were not asked), passive (lack of action
results in death of person - withholding treatment of patient to live) and active
(most controversial)
Assisted suicide: an individual essentially commits suicide with help of someone
else
Dr. Kevorkian helped more than 130 people end their lives with active euthanasia
and was a euthanasia advocate (wanted euthanasia to be legalised and regulated).
Opened a suicide clinic and built a suicide machine. Sentenced to prison. Said that
death was a human right; that it was cruel to deny that right to someone living in
pain. Not all of his patients died painlessly and not all patients had a proper burial.
He was not a trained psychiatrist.
Netherlands is the first country to legalise the act of euthanasia

For

Legal to commit suicide (Suicide Act 1961)

More humane to allow someone to die with dignity patients can die with dignity at
a time of their choosing
- the right of a competent, terminally ill person to avoid excruciating pain and
embrace a timely and dignified death
Patients should be allowed to choose what is best for them
Patients can avoid a lengthy and unnecessary suffering period
Shortage of hospital space
- would free up beds and other resources utilised for these patients increase
general quality of care and shorten hospital waiting lists
- it is a burden to keep people alive past the point they can contribute to society,
especially if the resources used could be spent on a curable ailment
Principle of non-maleficence
- does not doing harm mean that we should prolong a life that the patient sees as a
painful burden?
- the harm in this instance is done when we prolong the life and doing no harm
means that we should help the patient die

Against

Legalising any form of euthanasia practice will lead to a slipper slope effect,
resulting eventually in non-voluntary or even involuntary euthanasia
- the acceptance of certain practices will invariably lead to the acceptance or
practice of concepts which are currently deemed unacceptable
- in order to prevent these undesirable practices from occurring, we need to resist
taking the first step

Illegal in UK and HK (imprisonment for up to 14 years)

Goes against some religious principles may lead to doctors or relatives playing
God (devaluing human life)
- many Christians consider euthanasia to be morally unacceptable
- Hippocratic Oath: I will neither give a deadly drug to anybody if asked for it, nor
will I make a suggestion to this effect
Even if someone has expressed wish to receive euthanasia when they are in distress,
may change their mind later a time when they may no longer be able to express
their change of position
People may actually recover
If case is not clear-cut or well documented, relatives may face murder charges
Relatives may abuse situation by allowing convenient euthanasia on a patient to suit
their own needs
- relatives may pressure patient into a situation they do not actually wish
There is a loving alternative by providing well-funded hospice care
- the widespread availability of euthanasia in the Netherlands is a reason for the
stunted growth of the Dutch hospice movement (there are very few hospice
facilities, very little in the way of organised hospice activity and few specialists in
palliative care)

Ethical dilemma for doctors

Unless patient has issues an Advanced Directive, decision to withdraw treatment

rests entirely with doctors. Relatives do not have right to make these decisions,
although best practice for doctor to consult them over treatment decisions

Medical Cases

In 2004, Tang Siu-pun, a quadriplegic person, wrote a letter to the Chief Executive
and legislators of HK to request for euthanasia but later changed his mind
- however, he still believes that the choice to live or die is one of the basic human
rights

Abortion
For (Pro-Choice)

If made illegal, back alley abortions would increase leading to an increased risk of
young women dying or becoming sterile
Arguably better for society to have babies aborted than to have them be brought up
poor and neglected
- affects the child and society when that child develops a higher attraction to crime
etc
It is not murder because it is performed before a fetus has developed into a human
person
Gives women the option to choose not to bring fetuses with profound abnormalities
to full term
Justified as a means of population control

Against (Pro-Life)

Abortion is a form of murder and demeans the value of human life

- unborn babies are considered human beings by the US government
- eliminates the legal rights of the unborn child (life begins at conception so unborn
babies are human beings with a right)
- against the doctors Hippocratic Oath
Should not be a form of birth control when there are other methods readily
available
- should not be used as a form of contraception
The advances of genetic testing may prompt more abortions to avoid having the
non-ideal child
- selective abortion based on genetic abnormalities (eugenic termination) is overt
discrimination
There are many couples who spend years on waiting lists trying to adopt a child
The abortion decision is often made by minors or young adults, who dont have the
maturity and life experiences to make a good decision
Exposes women to various health risks and the danger of losing fertility
- also causes psychological damage and stress
Fetuses feel pain during the abortion procedure

Medical Cases

Roe v. Wade
- Roe v. Wade decision held that a woman, with her doctor, could choose abortion in
earlier months of pregnancy without legal restriction, and with restrictions in later
months, based on the right to privacy
- made abortion legal in the United States, which was not legal at all in many states
and was limited by law in others
Baby Hatch
- Shenzhen and Guangzhou welfare authorities will next year start a baby box
program for parents to drop off unwanted newborn babies Baby Safety Island
facility will be placed close to hospitals and welfare centers
- in response to about 100,000 babies being abandoned in mainland
- since Shenzhen has many migrant workers and many Guangdong people prefer
sons rather than daughters, this program could encourage parents to abandon baby
girls in safer and humane way, claiming it could improve survival rate of abandoned
babies
- would not solve root of problem and people should be taught to value life

Doctors Going On Strike

For

Workers go on strike to voice dissatisfaction with work conditions

If doctors are forced to work in hazardous conditions and management refuses to
improve the situation
If go on strike, ensure all patients in critical conditions have been transferred to a
place where they could be cared for
Everyone has a right to protest in a democracy

Against

Doctors provide an essential service if go on strike, no one will be able to provide

service irresponsible
- negates the doctors publically declared declarations of services, codes and
principles of ethics
Striking should never be the first option communication channels need to be set
up so conditions can be negotiated
May result in avoidable harm including the death of patients
Doctors are already well-paid and have the potential to become higher wageearners than the general population

Philosophy
Utilitarianism

Consider intensity and duration of pain

Who will be affected by your decision (extent)?
Does your decision lead to others pleasures (richness)?

Kant

Outcome of an action is not relevant to whether or not it is ethical

- the only right thing is to do what reason dictates
Make moral choices out of compassion, kindness etc
Categorical Imperative
- we should not use people merely as a means to an end
- killing someone to end their pain was using them to another end OR a persons
ends are best served by ending their misery

Natural Law

The end never justifies the means so no amount of evil suffering can justify an evil
act
Does not support active euthanasia

Situation Ethics

Puts people before rules

- ignores any hard and fast rule, and doing what the situation requires

Virtue Ethics

Aristotle believed we should aim for eudaimonia (happiness resulting from a life in
perfect balance)
Terminally ill patients should be courageous and accept their fortune
- take their own life, especially when resources are scarce as euthanasia will make a
huge difference on the well-being of society as a whole
Aristotle was concerned with the good for society above the individual