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Bioethics
Final Exam
Instructions and Grading Rubric
You will be given two case studies below. These will be cases similar to those we have addressed all term and will cover a range of topics. Your task is to write a 700-1000 word analysis of each case. The analysis should be focused. You should avoid lengthy introductions, conclusions, or padding. The analysis should address the following points:
Briefly address the crucial contextual features of this case
(e.g. the medical factors; social, cultural, economic or financial factors; and key personal relationships involved).
What are three important ethical principles and moral theories that must be applied to this case?
Show how the principles and theories apply.
Using the previous information, take a stand on the best ethical resolution for this case.
Then briefly present:
one strong counterargument, and
your best response to the counterargument.
You are to work independently. If you have any questions, please do not hesitate to reach out to Professor Small.
NOTE: If you do not wish to break your professor’s spirit, please avoid spending word count on phrases such as, “THIS IS A DIFFICULT CHOICE.” That is a given. Rather, you may explain WHY it is a true dilemma, why it is difficult and how, despite that challenging reality, we must find the most ethical resolution possible.
Number the cases and put no page breaks between cases. Use parenthetical references to the course materials. No Works Cited is needed if the sources are obvious from the in-text citations; but if the source is outside the readings assigned in the course, then list it in a Works Cited at the end. You may use APA or MLA but please be consistent.
You must upload the assignment by May 9, 2022 at 11:59 pm EST.
You will be graded on:
Contextual features presented:
The student gives a clear, accurate, and cogent summary of the relevant facts of the case as described in the instructions, and shows how these are relevant to making an ethical assessment
Ethical principles and virtues applied:
Major Moral Theories that we will discuss:
Utilitarianism
Kantian Ethics
Natural Law Theory
Rawls’ Contract Theory
Virtue Ethics
The Ethics of Care
The student understands relevant principles and moral theories and accurately applies relevant ethical concepts.
Position, counterargument, and response:
The student takes an informed, supported position and responds effectively to a counter argument.
Clear writing and proper in-text citation:
Professor Small is looking forward to reading your high quality, well-supported, thoughts!
CASE STUDIES:
CASE ONE:
A twenty-eight-year-old Caucasian woman, named Abby Jones, and her husband Ben were driving home from Abby’s OB-GYN appointment when tragedy struck. Another driver, a college student distracted by an incoming text message, ran a red light and T-boned Abby and Ben’s Prius.
Both Abby and Ben sustained severe injuries. Ben died on the way to the hospital. Abby survives but unfortunately she sustained massive injury to her head and spine.
Her physicians now say, a month after the accident, that the prognosis is extremely grim. The best one could hope for—or perhaps the worst—is continuation for some time in a persistent vegetative state (also known as a PVS). There is no chance of recovery. She is what some call “brain dead.”
Just before leaving her doctor’s office, before getting in the car that ultimately crashed, Abby had sent a jubilant text message to her parents. It read: “Guess what?! We’re pregnant!!! J”
Unlike most young adults, Abby had thought about mortality in advance of this accident. She was a nurse. She had gone to continuing education workshops about end of life care and advance care planning with her best friend, Emma who is a physician.
Abby had completed her own advance directives some months ago, naming Ben as her primary agent and durable power of attorney for healthcare decisions. She named her parents as secondary agents.
Abby had also completed, with notarized signature, a healthcare treatment directive. Among her directives was a clear, handwritten statement about life prolongation if she were somehow, “to end up in anything like a Persistent Vegetative State, from which I am not apt to recover.” Abby had written that, in such a condition, “I do NOT, under ANY circumstances, want my life to be extended by means of medically assisted nutrition and hydration, ventilator, or other life support.”
She had made similar verbal declarations to Ben, Emma, and to her parents. As a nurse, Abby knew that no one comes out of a PVS and had confided in Emma that, “she could not believe the medical community ever allows this.”
With Ben gone, treatment decisions are left up to Abby’s parents. Abby’s parents are mourning for their daughter and their son-in-law and the life they imagined. Ben’s parent’s had died when he was young and without any siblings, they had been Ben’s only family. Both parents are thoughtful people, healthcare professionals also, who take very seriously their difficult responsibility of acting as surrogates on Abby’s behalf. It’s true that Abby’s mom had been diagnosed with Multiple sclerosis five-years-ago but it has not yet impacted her decisional capacity.
After consulting Abby’s physicians, other family members, Emma, and even their priest, Abby’s parents make the decision to stop everything except palliative care. Abby’s parents had received a copy of their daughter’s advance directives, and they have determined that this is what she would have wanted, what in fact she had conveyed with such tragic prescience.
Plans are made to transfer Abby the next day to a hospice unit in another part of the hospital where everything except for palliative care would be stopped.
That evening, a resident physician notices in the patient’s chart that Abby is pregnant. Probably about eight weeks. He wonders if this matters, legally or ethically or religiously, for his patient’s transfer to hospice, especially when Abby is not imminently dying otherwise.
The resident does a bit of online research and learns that in their home state a woman’s healthcare directives about “withholding or withdrawal of life-sustaining procedures in a terminal condition may not legally be in effect while pregnant.”
The Statute reads: “The health declaration of a patient diagnosed as pregnant, by the attending physician, will have no effect during the course of the patient’s pregnancy”
A note in the patient’s medical record the next morning references this statute, with a question about how it potentially impacts the impending transfer to hospice care.
When the attending physician reads the note, she calls Abby’s parents and says hesitatingly, “We have a bit of a problem here. It appears we need an ethics consultation. We must postpone Abby’s transfer of care.” The doctor explains further what her young resident colleague had discovered, and questioned.
The parents had spent an excruciating sleepless night anticipating today. It would be the hardest thing they’ve ever done, and yet they firmly believed that it was the right thing in keeping with their daughter’s wishes. Now they can’t believe what they’re hearing.
They’d have to postpone? Ineffective advance directives? Continued life support? Did the doctor really say that? There may even need to be surgery for a feeding tube and a tracheostomy while this glitch is being discussed and gets clarified?
Almost in unison, Abby’s mother and father protest, “But, Doctor, our daughter didn’t want this!”
Abby’s mother, Judy Smith calls you, a member of the hospital ethics committee and requests a consultation. She wants to have her daughter moved to hospice immediately.
CASE TWO:
You have recently completed years of medical training—undergraduate work, medical school, internships, and residency—and are excited to have gotten a job with Rezip, one of the largest pharmaceutical companies in the world.
Based in the United States but operating in 150 countries, Rezip discovers, develops, manufactures, and delivers prescription medicines to patients. Many Rezip drugs make life easier and healthier for millions on a daily basis. You have been interested in global health since middle school, and chose to focus on infectious diseases during your medical training. It seems unbelievable to you that each year hundreds of thousands of people die from bacterial diseases like meningitis, cholera, and pneumonia, especially in developing countries. Your passion for global health and your new job at Rezip seem like the perfect match.
Rezip has developed what it hopes will be a “blockbuster antibiotic” – an antibiotic that would fight a wide range of bacteria and could be taken in tablet form. The drug, called Trovan, is in the late stage of development and so far has been successfully tested on over 5,000 adult patients in the United States, Europe, and elsewhere.
The results are very promising, and Rezip anticipates that the drug will receive approval for adult use. However, additional clinical trials with younger patients are needed to prove its effectiveness and safety for children; otherwise the drug will not receive approval for pediatric use.
Rezip is sending you to Africa for two weeks to dispense Trovan to children as part of this needed clinical trial. If Trovan proves successful overall, millions of adults and children suffering from a variety of deadly bacterial diseases could be cured easily by taking a few pills. Rezip also projects its total sales could reach over a billion dollars a year as a result. Drug clinical trials are heavily regulated by the FDA (Food and Drug Administration).
In Phase I trials, the drug dosage must be proven to be safe in 20–80 healthy volunteers. Phase II trials then prove effectiveness of the drug in 100-300 patient volunteers sick with the disease the drug will treat. Finally, Phase III trials prove widespread safety and effectiveness of the drug in 1,000–3,000 patient volunteers.
Clinical trials must be conducted in target populations – in other words, if the drug will be used on women, it must be tested on women; if the drug will be used on children, it must be tested on children. Certain drugs have been known to affect different populations differently, and therefore the FDA demands rigorous clinical trials on all target populations.
In the United States, the full clinical trials cycle can take two to ten years depending on how many people sign up to be in the trial, the way the trials are conducted, and whether the results are decisive.
Your boss tells you that you are going to Nigeria, which is experiencing the most serious meningitis outbreak ever recorded—hundreds are dying each month. In the first weeks of the epidemic, only about 80% of those with the disease have survived. Understandably, this presents a severe public health crisis for the government of Nigeria. When you arrive at the Nigerian slum city of Kano, you are overwhelmed by the needs of the people—many of whom are children—and the huge crowds gathered at the Kano Infectious Diseases Hospital.
Nearby, an aid group called Doctors Without Borders has set up a medical station and is dispensing treatments to ease the epidemic. Despite their efforts, the lines at the medical station are overwhelmed with people needing treatment. You and your team have been instructed to set up camp close to the Doctors Without Borders station to aid in the relief efforts and collect data for the clinical research study. As a Rezip doctor, you will choose 200 children with serious symptoms. Half will be given doses of the experimental drug Trovan, while others will be treated with an antibiotic from a rival company for comparison (this rival drug has already gone through standard clinical trials and has been shown to be effective and safe).
The children and their families will not know which of the two drugs they are receiving. If Trovan has a very negative effect on the children, the other drug can be administered. Given the chaos of the crowds gathered, it is decided that getting consent from individual families will be impractical, so it is agreed that permission from a Kano ethics committee will serve as consent for everyone. Rezip sought and received permission and consent for the study from a Kano ethics committee made up of local doctors, health officials, and tribal elders. Culturally, tribal elders often represent their communities.
You look around at the malnourished and severely ill children from the slum city raging with meningitis, cholera and measles. These are the children you will dispense medicine to and gather data from for the clinical trial.
You have some concerns about how the trial will be conducted, but you also recognize the potential health benefits of the drug. Should Rezip conduct this clinical trial research?
Some References (Not limited to)
1. Andrade, G. Medical ethics and the trolley problem. J Med Ethics Hist Med. 2019; 12:3.
2. Manthous, C.E. Emergency surgery, cardiopulmonary resuscitation, and the trolley problem. J Crit Care. 2014 Feb;29(1):170-1.
3. Epting, S. A Different Trolley Problem: The Limits of Environmental Justice and the Promise of Complex Moral Assessments for Transportational Infrastructure. Sci Eng Ethics. 2016 Dec;22(6):1781-1795.
4. In Memoriam: Healthcare Workers Who Have Died of COVID-19. Medscape Medical News. WebMD. Accessed June 25, 2020.
5. Jayawardena, A. “Waiting for Something Positive.” NEJM. 2020;382;e89.
6. Hoffman, J. ‘I Can’t Turn my Brain Off:’ PTSD and Burnout Threaten Medical Workers. The New York Times. May 16, 2020.
7. Spoorthy, M.S., Pratapa S.K., & Mahant, S. Mental health problems faced by healthcare workers due to the COVID-10 pandemic-A review. Asian J Psychiatry. 2020 Jun; 51: 102119.
8. Guasti, N. The plight of essential workers during the COVID-19 pandemic. The Lancet. 2020. 395:10237: 1587.
9. Weekly Updates by Select Demographic and Geographic Characteristics: Provisional Death Counts for Coronavirus Disease 2019. Centers for Disease Control and Prevention. Accessed June 25, 2020 via https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm.
10. “The Unemployment Situation-May 2020.” Bureau of Labor Statistics. United States Department of Labor. Accessed June 30, 2020 via https://www.bls.gov/news.release/pdf/empsit.pdf.
11. Bartik, A., Bertrand, M., & Cullen, Z., et al. How are small business adjusting to COVID-19? NBER Working Paper Series. National Bureau of Economic Research. Accessed June 30, 2020 via http://www.nber.org/papers/w26989.
12. The History of Utilitarianism. Stanford Encyclopedia of Philosophy. Revised Sep 22, 2014. Accessed on June 30, 2020 via https://plato.stanford.edu/entries/utilitarianism-history/.
13. Shaver, R., Nuccetelli, S., & Seay, G. Ethical Naturalism. Ethical Non Naturalism and Experimental Philosophy. pp. 194–200. UK: Cambridge University Press. 2012.
14. Tannsjo, T. Taking life: Three Theories on the Ethics of Killing. UK: Oxford University Press; 2015. p. 58, 63, 75.
15. Brush, B.C. Risk, Discounting, and the Present Value of Future Earnings. Journal of Forensic Economics. Fall 2003.16(3):262-274.
16. Bohoslavsky, J.P. COVID-19 Economy vs Human Rights: A Misleading Dichotomy. Health and Human Rights Journal. Published online April 20, 2020. Accessed June 30, 2020 via https://www.hhrjournal.org/2020/04/covid-19-economy-vs-human-rights-a-misleading-dichotomy/.
Videos Crash Course Philosophy (Hank Green) #32, 34-38.
https://thecrashcourse.com/courses/philosophy

Please let me know if you need anything else, or need clarification on anything. Thank You!!!1

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