TRADITIONAL OPTION FINAL PAPER: CASE I Baby Barbie\'s older siblings both died f
ID: 128285 • Letter: T
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TRADITIONAL OPTION FINAL PAPER: CASE I
Baby Barbie's older siblings both died from an inherited condition that prevented their livers from functioning effectively. Each was placed on the hospital's list for a liver transplant, but no suitable donated organ could be found. As an infant, Barbie already has indications of liver failure that seriously compromises her. Children with her disease have never survived their first year without a transplant. Barbie's quickly worsening condition suggests that, without a transplant, she is unlikely to live out the year. But it is very, very difficult to find a suitable donated human liver for a baby. Further, her parents both have milder versions of the condition and cannot donate parts of their livers.
Dr. Doe heads the hospital's transplantation unit. He proposes to do a xenotransplant - namely, to transplant a part of a piglet's liver into Barbie - with the hope that it will function until a suitable donated human organ can be found. Dr. Row heads the hospital's genetic medicine unit. She has permission from Barbie's half sister to use her embryo, "left over" from a human fertility treatment, to clone a human liver for the child. Each of the physicians argues that it is morally preferable to attempt the experimental procedure than simply to let the child die without taking any action at all.
You are the hospital's bioethicist. The hospital administrator asks you to write a report advising her on the following matters:
a. News of this proposal has leaked out and the hospital has received a complaint from the Executive Director of the Society for the Prevention of Cruelty to Animals, who is outraged at the idea of killing a healthy pig and transplanting its liver into a sickly child. How should the hospital respond to this letter?
b. The hospital also has received a complaint from the Executive Director of the Society for the Prevention of Human Cloning, who is outraged at the idea of using a human embryo to create a body part for another human. How should the hospital respond to this letter?
c. Both physicians argue that it is preferable to try an experimental procedure than to do nothing and let Barbie die. Are they right? Is the hospital obligated to try something new that might work if no tested procedure can be implemented? Does the possibility of gaining knowledge that might benefit other children justify an experimental procedure even if Barbie is not saved? Who should decide? What principles and considerations should the hospital's Institutional Research Board bring to bear?
d. What ethical considerations arise if the embryo is not an existing, donated one but instead created with a purchased human egg, and selected for the process using PGD?
e. What about the risks these procedures pose for other people - are there any biological or social risks and, if so, how should these be weighed?
f. If either of the experimental procedures is attempted and succeeds, the hospital and the physician who executes it will receive favorable publicity. How should the hospital's and the physician's self-interest be weighed against the interests of Barbie and her family?
g. Should the hospital permit the xenotransplant, or permit the cloning and transplant of a human organ, or do a transplant only if a suitable donated organ becomes available? Give the reasons for your decision!
TRADITIONAL OPTION FINAL PAPER: CASE II
For background material, read A Chronicle: Dax's Case As It Happened (Burton) and Commentaries (White and Engelhardt) in the book. Notice, however, that this paper addresses a different question. Twenty years ago, the question was "Should Dax be permitted to refuse treatment and die?" But the question for this paper is, "Should medical resources be expended on Dax?"
You are the hospital's bioethicist. The hospital administrator refers the case of Donald C.(Dax) to you. He is a twenty-six year old who has been so badly burned that his face is disfigured, he has lost the use of his hands, and he is blind. (Use the details of Dax's case except in regard to the matter of payment for his treatment. Unlike the real Dax’s case, how much treatment will be covered by insurance is unclear, and the company whose gas line caused the explosion denies responsibility.) Donald C. states that he does not want further treatment because he prefers dying "to living as a blind and crippled person." He also refuses to give permission for surgery that might improve the function of his hands and of one eye.
Donald C.'s mother asks that the hospital continue the burn treatments and that the physicians try to convince him to give permission for the surgeries. However, the hospital is not sure that Donald's insurance will cover the surgery even if he agrees to it. Some of the medical personnel treating Dax believe that they ought to save his life regardless of considerations of the quality his life will have because of his injuries. Other medical personnel treating Dax believe that he will have such a reduction in quality of life, and therefore will suffer so much, that it is wasteful to expend medical resources on him. The hospital administrator asks you to advise her about the moral dimensions of expending resources on Donald, answering the following questions:
a. Is treatment his right, whether he wants it or not? Should the decision about continuing treatment and thereby expending medical resources on Dax be influenced by considerations of his prospects of attaining a satisfactory quality of life?
b. Should the decision about honoring Donald's mother's request depend on whether the insurance will cover the treatment, or should the decision about whether to continue treating Dax be independent of whether payment is available? Should consideration of the medical resource need of other actual patients weigh in deciding whether to treat Donald? Should consideration of the needs of potential patients weigh?
c. As payment is not assured, should the hospital distinguish between the basic treatments needed to keep Donald alive (the burn treatments) and the treatments to try to restore function (the surgeries)? What about cosmetic surgery to improve his appearance - is there an obligation to provide cosmetic surgery?
d. If Donald needs human organic material for grafts (skin ?? cornea ??), is it ethical to purchase these?
e. How should Donald's youth be weighed in the decision to allocate resources? Would the hospital have a different obligation if Donald were sixty-six instead of twenty-six?
f. More generally, what is usually at issue in considering the cost-effectiveness of allocating medical resources? Assess the strengths and weaknesses of cost-effectiveness as a criterion for deciding how to treat patients.
g. Should decisions about the justice of allocating or withholding medical resources from Donald be made by his physicians? If not by his physicians, than by whom?
Explanation / Answer
Case1:
a. Saving life is the duty of physician. In this case a newborn who equally deserves chance to survive and if there is 50% chance that a baby can survive by transplant of piglet liver the risk of taking this transplant is worthwhile. Considering the fact an animal life is getting sacrificed then we should remember the fact that each day humans are sacrificing pig, hen, etc just for feeding themselves. And in this case pig is getting sacrificed in order to save a life that's a novel cause and physician in this case are doing their duty.
b. Here physician are well aware of the fact that stem cells are pluripotent cells and have the ability to generate or grow a organ by utilizing a technique of cloning. The entire purpose of conducting such experiment is to save a baby life. Physician are trying all possible opportunity that can save a baby life. Here another baby embryo is not getting harm only it's potential cells are getting used to save a baby life.
C. Traditionally the physician are right . Of course there is a chance of failure but not even trying it is itself a wrong decision. Yes the hospital can try something new if they have proper authority to conduct such experiment. Yes if such experiment can benefit future child conducting such experiment with proper documents and if purpose to conduct it is novel then such procedure is important. Hospital research board and board members can take this decision. Hospital research authority can bring points of the importance of such experiment and currently this is the only option that is available to save a baby life.
D. Donated human egg can be used with proper consent of the donor. If donor is having no problem to take participate in such experiment than only it can be used for the process.
E. Conducting any experiment with humans has one issue that no one is allowed to manipulate the natural creation of God. And cloning experiment conducting on humans is not ethical. But in above case only a part of body that is liver is getting cloned only because there is a chance of saving a child life.
F. Definitely if these experiment will be successful the opportunity to save so many other child with these similar condition will be higher and such experiment can save more life.
G. Cloning is a time consuming experiment and the success of it is very less so in case currently doing xenotransplant is the most ethical thing to do in order to gain some time . Maybe later hospital can get a suitable donor that can save baby life.
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