Chapter 2 :Ethical Traditions

Section 15. Decision Scenarios

How do the principles of ethics apply to actual cases?

http://depts.washington.edu/bioethx/tools/princpl.html

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Cases and some leading questions:

1. A surgeon S promises someone P that S will perform an operation on P. The surgeon S has an associate A who needs to learn the new surgical technique used by S. S now is considering whether or not S should tell P that A will actually be doing the surgery. If surgeon S was an ACT Utilitarian how would S go about thinking about the right thing to do? If S were a RULE utilitarian how might S think about it differently?

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2. Physician D is treating someone S who is covered by Medicaid. Physician D thinks that Medicaid does not provide enough financial support for the services being rendered by D to S. Further D wants to do a procedure not covered by Medicaid under its rules which D believes to be antiquated and harmful. D is considering filling out the medical forms in such a manner that would supply financial support for what D wishes to do but in a manner that would not be providing accurate reports of what was actually done. If D is a Kantian and uses the Categorical imperative how would D think about this? What conclusions would be reached?

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3.  A child C has a disease. It is life threatening. A bone marrow transplant might help to save the child's life. The child's mother M is having a hard time finding a matching donor for her child. M is getting desperate and is considering getting pregnant again in order to have a child that might be a compatible donor of bone marrow for her daughter C. If M were to ask for moral guidance from a Kantian what would that advice be?

What would a rabbi or priest advise using Natural Law Theory?

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4.  Doctors at hospital H are asked to participate in the test of a new drug D that will cause people to expectorate the contents of their stomachs. It is to be used when people accidentally or deliberately ingest something that causes severe illness and threatens life. Now such a drug would most often be used in emergency rooms and with those who attempt suicide. The doctors are wondering whether or not to participate in the tests. If they do so they are expected to administer the drug D to those brought into the ER. People brought into the ER who would need to have the contents of their stomachs emptied quickly are likely to be those who have attempted suicide. Now the doctors are wondering if they can inform people who are to receive the test drug of the experiment and get their permission for participating in the test. If they do stop to inform them and get permission many of those people may not give it as they had wanted to die in the first place. Others may not be conscious and rational at a level that they can understand what is being told to them.

If the doctors were to use the principles of John Rawls how might they go about their deliberations? What conclusion would be based on Rawls principles?

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5. Doctor O performs corrective eye surgery using laser techniques. Doctor O has been doing so for a number of years. Doctor O advertises in a variety of media. Doctor O's practice is quite large and there are several offices throughout the neighboring counties. The doctor charges a premium price for the procedures because of the reputation the doctor has achieved and the large number of successful operations. Doctor O has taken several other physicians into the practice. People who contact the practice are told that there is a difference in the fee charged for each procedure depending on which doctor performs the operation. Those doctors with more completed procedures charge more. The founder of the practice, doctor O, having done the most , charges the most. $750 per eye for the novice physician and $4000 per eye for doctor O.

Doctor O has a very large annual income and a very nice life style and so doctor O wishes to spend less time in the office and surgical room and more time enjoying life. Doctor charges people the full fee for doctor O's services but without informing the person having the operation the doctor often has another physician do most of the work, sometime all of it, if the person consents to being unconscious for the procedure. Doctor O sees nothing morally wrong with this practice. Doctor O enjoys the income, thinks the practice is good for the other physicians, and thinks that recipients of the procedure are happy with the results. Doctor O thus has no problem with what is going on. Morally doctor O thinks it is a "win win" situation and so quite right.

Doctor O is using what type of moral justification for the practice? Do you accept it? Why or why not? What do you think the doctor should be doing if you disagree with what is being done?

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Copyright Philip A. Pecorino 2002. All Rights reserved.

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