Chapter 14. Applications: Biomedical Ethics
Section 3. Cases

There are a wide range of cases in the area of medical ethics. Some deal with medical research, others with health care and others with social policy concerning access to health care.

The general areas or headings include:

Here is a listing of one case under each heading.

Dax case- Refusing Medical Treatment and Being Ignored - Issue : Autonomy

In 1973, Donald "Dax" Cowart, age 25, was severely burned in a propane gas explosion. Rushed to the Burn Treatment Unit of Parkland Hospital in Dallas, he was found to have severe burns over 65 percent of his body; his face and hands suffered third degree burns and his eyes were severely damaged. Full burn therapy was instituted. After an initial period during which his survival was in doubt, he stabilized and underwent amputation of several fingers and removal of his right eye. During much of his 232 day hospitalization at Parkland, his few weeks at Texas Institute of Rehabilitation and Research at Houston, and his subsequent six month's stay at University of Texas Medical Branch in Galveston, he repeatedly insisted that treatment be discontinued and that he be allowed to die. Despite this demand, wound care was continued, skin grafts performed and nutritional and fluid support provided. He wanted the treatments to stop so that he could go home and die; either through natural causes or by suicide. The doctors, who frequently hear such complaints from patients receiving painful procedures, did not stop the treatment. By continuing the treatment there was a very high probability of survival, while ending the treatment would result in almost certain death. He was discharged totally blind, with minimal use of his hands, badly scarred, and dependent on others to assist in personal functions.

Perhaps of significance is the fact that the procedure that Dax endured was a very new technology, thus if Dax had the accident ten years earlier he would have certainly died. Dax completed the treatment and regained a high quality of life, however, he has never recanted his belief that the decision to discontinue treatment was his, and his alone, and if he could go back into time, even with knowing the quality of life which he now possesses, he would still refuse treatment.


Cowart, who frequently speaks at medical and legal communities, is a libertarian and former Air Force pilot who overcame his disabilities to earn a law degree and who currently practices law argued that his right to die stemmed from natural law as posited by J.S. Mills.


This case raises any number of issues including autonomy, basic right of refusal, competency and paternalism amongst health care providers.


DeMasi Case: Pedophile- Issue: Confidentiality

Doctor should have disclosed colleague's pedophilia, jury says

By Denise Lavoie  Associated Press Story posted Saturday, 10-Oct-98 09:40:33 - Online      Athens Daily News

   BRIDGEPORT, Conn. - A psychiatrist who failed to warn anyone about another doctor's sexual fantasies about children was held partly responsible by a federal jury Thursday for the molestation of a 10-year-old boy.
   Dr. Douglas Ingram was found negligent in not warning anyone about by Dr. Joseph DeMasi. The jury will return Friday to decide how much Ingram should pay the boy's family in damages.
   The verdict's effect on the principle of doctor-patient confidentiality was not immediately clear. One psychiatrist said the case is unusual enough that its effect will not be large.
   As part of his training in psychiatry, DeMasi underwent psychotherapy with Ingram during the mid-1980s. During the sessions, DeMasi admitted fantasizing about sex with children.
   He later was charged with molesting three boys, including a 10-year-old boy who was being treated at Danbury Hospital for suicidal tendencies. That child's family sued Ingram and the New York Medical College, where DeMasi was being trained.
   The jury did not find the medical school at fault.
   Ingram and lawyers for both sides left the courthouse without comment.
   The boy, now 22 and serving a prison sentence for assault, is expected to testify on Friday.
   During the trial, Ingram said that he had questioned DeMasi about whether he had ever molested a child, intended to molest a child or fantasized about a particular child. In each case, Ingram testified, the answer was no.
   Ingram also said that he had consulted with five other psychiatrists and was confident that he had no obligation to report DeMasi's disclosure or force him out of the residency program.
   But the jury concluded Ingram should have known that DeMasi was likely to harm others.
   DeMasi pleaded guilty to risk of injury to a minor and received a seven-year prison sentence in 1987.
   In most cases, conversations between a doctor and patient are considered private. But court cases in the past 25 years have gradually established that psychiatrists also have a duty to protect others who may be threatened by patients, especially when specific individuals have been identified.
   "If patients can't talk to doctors about their fantasies, it's going to destroy treatment," Dr. Walter Borden, a therapist and forensic psychiatrist, told The Hartford Courant. "I see a lot of people who have committed crimes and are potentially dangerous. It's difficult enough to get them to talk. This is not going to help matters."
   But Dr. Harold Schwartz, director of the Institute of Living in Hartford, said the combination of DeMasi's fantasies, his career and his belief that pedophilia should not be illegal should have set off alarms.


CASE: Cold War Radiation Exposure Experiments

Experiments were done on human beings without their knowing about it or without being fully informed.  Some of the subjects of these experiments were very young children.  Read about the range of experiments and the government investigations and the new criteria and guidelines for such studies.

At the University of Cincinnati patients who being treated for cancer were given massive doses of radiation. The Cincinnati Project told the patients that they were being treated for their cancer, when in fact the experiments were funded by the Military. The Military was interested in discovering how much radiation a person can absorb and still remain functional.
At Vanderbilt University in the late 1940's, eight hundred pregnant women were exposed to radiation to determine the effects of radiation on fetal development.
At the Oak Ridge National Laboratory, two hundred cancer patients were exposed to high levels of radiation. The experiments continued up until 1972 when the Atomic Energy Commission discontinued them on the grounds that there was little or no benefit to the patient.
In an Oregon State Prison the testicles of inmates were exposed to X rays to determine the effects of radiation on sperm production from 1963 to 1971. The inmates were never told that the exposure to massive doses of radiation can cause cancer.
During the late 1950's twelve terminally ill cancer patients at Columbia University and Montefiore Hospital were injected with radioactive calcium and strontium 85 to determine the absorption rate of radioactive substances into a variety of tissues and organs.
From 1946 to 1956 nineteen mentally retarded teenaged boys were fed radioactive iron and calcium in their breakfast cereal. The experiment took place at a state residential school in Fernald, Massachusetts. Parent's consent form contained no mention of radiation. The stated aim of the research was to gain information about metabolism.

READ:   Advisory Committee on Human Radiation Experiments


From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  ., Page 55, Decision Scenario #12 

During the two years he had worked for the Bioplus Foundation, Dennis Quade had been in many labs.  Before he could renew the funding of a grant, he was required to make an on-site inspection of the facilities and review the work of the investigators.  Now he was sitting in a small, chilly conference room about to watch a videotape of a phase of the work done at Carolyn Sing’s lab.

                Sing herself was sitting at the table with him, and she leaned forward and pushed the play button.  “The experimental subjects we used are baboons,” she told him.  “We think they possess facial and cranial structures sufficiently similar to humans to make them the best animal models.” Dennis nodded, then watched the monitor in complete silence.  He was appalled by what he saw.  An adult animal, apparently limp from anesthesia, was strapped to stainless-steel table.  Its head was fitted into a viselike device, and several clamps tightened to hold it immobile.  The upper-left side of the baboon’s head had been shaved and the area painted with a faintly purple antiseptic solution.  A dark circle had been drawn in the center of the painted area.

                The while-coated arms of an assistant appeared in the tight focus of the picture.  The assistant was holding a device that looked like an oversized electric drill.  A long, transparent plastic sleeve stuck out from the chuck-end of the device, and through it Dennis could see a round, stainless-steel plate.  A calibrated dial was visible on the side of the device, but Dennis couldn’t read the marks. 

                “That’s an impact hammer,” Dr. Sing said.  “We thought at first we were going to be able to use on off the shelf, but he had to modify one.  That’s an item we didn’t anticipate in our initial budget.”

                The assistant centered the plastic tube over the spot marked on the baboon’s head and pulled the trigger of the impact hammer.  The motion of the steel plate was too swift for Dennis to see, but he saw the results.  The animal’s body jerked in spasm, and a froth of blood, brain tissue, and bone fragments welled up from the purple spot. 

                Dennis Quade turned away from the monitor, unable to stand the images any longer.

                “Through induced head trauma studies, we have been able to learn an enormous amount,” Carolyn Sing said.  “Not only do we know more about what happens to brain tissue during the first few minutes after trauma, but we’ve used that knowledge to develop some new management techniques that may save literally tens of thousands of people of people from permanent brain damage.” Dennis Quade nodded.

Description: A 27-year-old woman in California died from internal bleeding after a doctor performed a late term abortion on her in 1996. It was found after an autopsy that he had perforated the uterus. The doctor pleaded guilty to involuntary manslaughter.

Articles explaining the case:

Title: Baby K: An Anencephalic Infant and a Mother's Request

Description: Baby K born with Anencephalia in 1992 in Virginia. She had very little chance for survival since she only had part of a total brain. Since she had respiratory difficulties, the doctors had to put her on ventilator. The mother insisted the child be put on a ventilator everytime she had breathing problems. The hospital took the case to court so as not to be forced to do so any longer. The court upheld the mother's right to choose to keep the child alive by extraordinary means.

Articles about the case:


Description- Elizabeth Bouvia was admitted to Riverside General Hospital in California when she was twenty-six years old. She was checked into the hospital because she was suicidal and was also suffering from cerebral palsy and paralysis. In addition to these conditions, Elizabeth Bouvia suffered agonizing pain every day of her life due to arthritis. She announced one day that she wanted to starve herself to death and began refusing the solid food that the nurses provided. When the hospital would not agree with her wishes, she chose to alert the media and seek legal assistance. Through many court cases and hearings, Bouvia's wishes were denied and she continues to live today in Los Angeles.

Describing the case:

Austin Bastable, age 52 from Windsor ,Ontario wishes to die. He suffered for 26 years with chronic progressive multiple sclerosis. He daily needs assistance from his family. On September 1995, he tried to commit suicide and realized that he will need assistance to end his life. He started a crusade to legalize assisted suicides in Canada. He wanted to public ally voice his thoughts and opinions. With the help and presence of Dr. Kevorkian, May 6, 1996 Austin ended is life by carbon dioxide poisoning.

Describing the case:

Burlington Northern Santa Fe Railroad

Description of Case: John Wiebelhaus, a track maintenance foreman and Harry Zanville, the attorney representing the railworkers union at Burlington Northern Santa Fe Railroad accused the railroad of taking 125 blood samples and having 18 of them genetically tested. The reason was that the BNSF didn't want to pay out millions in medical bills if they could prove that the employees were predisposed to the condition therefore, they shouldn't have to be held accountable if the workers developed carpal tunnel.

Describing the case:

LaPlant/Griese Surrogate Pregnancy Mom - Daughter

Description of case by student: Paula Griese learned when she was in her teens that she would never be able to have children because she was born without a uterus. Her mother, Marie LaPlant promised her daughter that when the day came she would carry her children for her. Years passed and when Paula was 28 she and her husband decided that they wanted to have a child. They approached Marie who at this time was 45, and she agreed to carry the child for them. Marie was implanted with one of Paula's eggs which had been fertilized by her husband, Dan's semen. 37 weeks later a twin boy and girl were born by Caesarean section.

Describing the case:


Recently the Ethics Committee of American Society of Transplant Surgeons published an paper supporting the need for a study to be conducted to determine if families were to receive compensation for organ donation would increase the amount of organs that are presently being donated. It is reported that there are only 40-60% of families giving consent for organ donation. The committee feels that if non-direct compensation such as reimbursement of funeral costs will increase numbers. It was stated the House of Representatives passed a bill in March 2001, that paid various expenses those living donors who give kidneys or other organs to a low income recipient. The Committee hopes to initiated a study to see their proposed reimbursement would work.

Describing the case:

National health Care single-payer plan

A national health-care single-payer plan is one solution to solving the problem of providing health care for everyone, regardless of ability to pay. This includes rich and poor alike. Currently there are over forty million Americans without any health insurance whatsoever. The single-payer plan would allow all citizens and legal aliens to be enrolled in a program of national health insurance established by the federal government and administered by the states. Needless to say, such a proposal is controversial.

Describing the case:

1.   -- Physicians for a National Health Program -- The mission statement of the 9,000 member national organization that advocates a national, comprehensive single payer national health care program.

2.  -- On the Third World Traveler Website, an essay from PHNP called "How much does single payer national health-care cost?"

3.  -- nov. 4, 1998 -- "Activist Young says 'Gathering Storm' will Propel a Single Payer MovemenT." A JAMA debate between Mass. Rep. Barney Franks and Quinton Young, M.D., about the merits of a single-payer system.

4.   -- In "Speak Up, America! Health Care is our Right," the American Medical Student Asociation endorsed the universal healthcare single-payer proposal.

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