Healthcare ethics case studies

Pick any 2 cases for your final Your writing

Case 1

Mandatory vaccinations

 

Suppose you live in a state where immunization rates against measles as well as several other diseases have fallen to levels that public health officials fear could result in a major outbreak. The rates have been declining steadily over the last several years despite intense public education efforts and restriction of immunization exemptions only for certified medical indications. The state department of public health is proposing a law that would require all children to age 6 to be fully immunized according to Center for Disease Control recommendations. Parents will be required to carry proof of immunization on their persons at all times and present them on  request by an authorized state official. Children not fully immunized and their immediate families will be barred from entering public places (e.g. schools, houses of worship, shopping malls, theatres). Violators will subject to fines of $500.

No exemptions other than for medical reasons ( requiring certification by a physician ) will be issued.

 

Exam question:

Do you think it would be ethical to enact such a public law?

Do you think such a law would be unethical ?

Do you think such a law would be ethical with some modifications ?  Specify

Using the appropriate analytical format as a guide state your opinion supported by ethical principle-based reasons.  Word limit: 750

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Case 2

 

Prisoners as clinical research subjects

 

Jack Burns is research director for the Cure-All Pharmaceutical Company. His company has developed a powerful new antibiotic that shows promise in animal tests and is ready for clinical testing. His company is one of several that are working intensely  to find an effective drug to combat a new strain of bacteria that has proven resistant to all available antibiotics as it causes serious infection with extremely high mortality rate, especially among hospitalized post-operative patients.

 

His first task is to organize a phase 1 trial, in which the safety of the drug is tested in humans by giving increasing doses to research subjects while looking for pharmacological effect and appearance of toxic side effects. For this stage of the study, he will need about 30 healthy subjects.

 

At the suggestion of his supervisor he makes an appointment to meet the chief warden at the state penitentiary, who is known to have frequently helped drug companies recruit research subjects for their studies.

“I understand you have considerable experience conducting clinical research in your prison. We might be interested in working with you for our project. Tell me more about what you do and why”

 

“Sure”, said the warden, “Thanks for coming to see me about this. Our staff and prison inmates are famous for their willingness to eagerly participate as research subjects. We get a lot of things from the study sponsor for the prison that the state won’t pay for as well as a little extra cash for the prisoners. For example, last year a drug company completely re-built our kitchen with most modern equipment plus a year’s supply of gourmet food ingredients. The year before a drug company built us a new library. We also put extra cash, usually about $200, into the accounts of any prisoner who volunteers to be a research subject . In some cases we also offer prisoner volunteers the possibility of shortened sentences .When our inmates volunteer as research subjects, we get things that make life better for everybody. What do you have in mind?”

 

“I need 30 research subjects to test a new antibiotic. Each prisoner will get $500 and we like the idea that prisoner volunteers would be eligible for consideration of a shortened sentence. In addition we will build a new gym for the prison. You will personally receive $150 for each inmate you recruit for us. After you recruit them, we will tell them more about the study and get the consent forms signed.”

 

Exam question

You are a member of the institutional review board  (IRB) that is reviewing this research proposal. The IRB is debating the ethics of using prisoners as research subjects. Would you vote to approve this research proposal ?

Using the appropriate analytical framework  as a guide, state your opinion supported by ethical principle-based reasons. Word limit: 750

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Case 3

 

             A 16-Year-Old patient Who Refuses a Heart Transplant

16- year old Emma had suffered all her life from a congenital heart defect that had led to over 40 operations during  her short life. Still, she was not doing well. She suffered cardiac episodes periodically while in school or on the street leading to repeated calls to emergency medical services personnel. Up this point, they ad always been able to stabilizer her in the emergency room.

Now her cardiologist, Dr. Duncan, has informed her and her parents that her only long-term hope was a heart transplant and that without one she would not survive much longer. Even with a transplant,  she would only have a 20-30% chance of surviving  another 10-15 years.

Emma was a remarkable young woman. She read everything she could find about    her disease, treatment options and prognosis.  She wrote essays that were used to educate fellow students about heart disease.  Despite her many missed school days, she tested 3 years above her grade level.

She told her parents she had had about all she could take of hospitals, operations and medical crises. After considerable thought she came to the conclusion that the transplant was not worth it. She know the alternative was certain death in the near future. She also understood  that an adult in this position would have the right to refuse the procedure. She told Dr. Duncan that she did not want the transplant. She had discussed with her parents who had reluctantly come to understand her position and said they would support her if that is what she wanted to do.

Dr. Duncan was taken aback. In all his years in practice he had never encountered a young person who refused life-saving surgery. He realized that if he attempted to get consent from her parents, they might also refuse.  He thought about applying for a court order,  but was concerned about creating an adversarial relationship with the family .Several consultations with child psychiatrists and social workers followed, but Emma’s position was firm.

Dr. Duncan  turned his hospital’s ethics committee for advice.

Exam question

You are a member of that ethics committee. What would you advise ?

Using the appropriate analytical framework as a guide, state  your opinion supported by ethics principle-based reasons.  Word limit: 750