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Unit 1: End-of-Life Dilemmas
Issue: May Surrogate Decision Makers Terminate Care for a Person in a Persistent Vegetative State?
Yes: Jay Wolfson, from “A Report to Governor Jeb Bush and the 6th Judicial Circuit in the Matter of Theresa Marie Schiavo,” Sixth Judicial Circuit of Florida (2003)
No: Tom Koch, from “The Challenge of Terri Schiavo: Lessons for Bioethics,” Journal of Medical Ethics (2005)
Jay Wolfson, a lawyer and the special guardian ad litem appointed for Theresa Marie Schiavo, explains the clinical and legal considerations that justified removal of Ms. Schiavo’s feeding tube, causing her to die. Tom Koch, an independent writer and researcher, holds that helping a person die cannot be said to benefit the person and that questions of personhood and sanctity of life gave reason to help her live.
Issue: Is “Continuous Deep Sedation” a Valuable Treatment Option for Patients Who Are Close to Death?
Yes: American Medical Association, from "Sedation to Unconsciousness in End-of-Life Care," Report of the Council on Ethical and Judicial Affairs (2018)
No: Mohamed Y. Rady and Joseph L. Verheijde, from “Distress from Voluntary Refusal of Food and Fluids to Hasten Death: What Is the Role of Continuous Deep Sedation?” Journal of Medical Ethics (2012)
The American Medical Association affirms that in cases of extreme suffering the physician’s duty to relieve pain and suffering includes palliative sedation—using drugs that result in unconsciousness and may hasten death. Physicians Mohamed Y. Rady and Joseph L. Verheijde argue that if sedation is used in conjunction with voluntary refusal of food and fluids to hasten death, then it is tantamount to assisted dying and may be bad for both the patient and the medical practitioner.
Issue: Can a Person Direct Caregivers to Withhold Life-Saving Medical Treatment If He or She Develops Moderate Dementia?
Yes: Norman L. Cantor, from “On Avoiding Deep Dementia,” Hastings Center Report (2018)
No: Daniel P. Sulmasy, from “An Open Letter to Norman Cantor Regarding Dementia and Physician-Assisted Suicide,” Hastings Center Report (2018)
Legal scholar Norman L. Cantor asserts that both legal and moral considerations should allow a person to use an advance directive to reject life-saving medical treatment if she is even moderate dementia. Physician Daniel P. Sulmasy responds that granting such a right would be counter to broadly accepted social values and would undermine the practice of medicine.
Issue: Should Physician-Assisted Death Be Legalized?
Yes: Linda Ganzini, from “Legalised Physician-Assisted Death in Oregon,” QUT Law Review (2016)
No: George J. Annas et al., from “Brief of Amicus Curiae Bioethics Professors in Vacco v. Quill,” Supreme Court of the United States (1997)
Linda Ganzini describes the experience in Oregon, as of 2016, with legalized physician-assisted death. Drawing on data collected by Oregon and other sources, she argues that the experience so far shows that legalized PAD does not conflict with physicians’ or hospice workers’ roles and may in fact lead to more sensitive end-of-life care. George J. Annas and cosignatories argue that a “right to suicide” cannot be justified on the same grounds as the right to refuse treatment, identifying several important differences between the two. Nor can such a right be justified on the same grounds as a right to abortion. The authors make it clear that rejecting the claim that people have a right to commit suicide does not affect the right to refuse unwanted medical treatment or to have an abortion.
Unit 2: Choices in Reproduction
Issue: Should Embryos Produced During IVF Be Considered Children?
Yes: Thomas Brejcha et al., from “Brief of Amici Curiae Missouri Right to Life, Lawyers for Life, and American Association of Pro-Life Obstetricians & Gynecologists,” Gadberry v. McQueen, Missouri Court of Appeals (2015)
No: Joseph J. Kodner and John M. Faust, from “Brief of Amicus Curiae American Society for Reproductive Medicine in Support of Respondent,” Gadberry v. McQueen, Missouri Court of Appeals (2016)
In a friend-of-the-court brief submitted in a recent case in Missouri involving a dispute over embryos that a couple had put into storage, lawyers for the American Society for Reproductive Medicine argue that embryos are not persons and that treating them as such would have a profound negative effect on people who seek medical assistance in building their families. In a friend-of-the-court brief on the other side of the same case, lawyers representing several organizations that are opposed to abortion argue that science proves straightforwardly that embryos are persons, and that the embryos in the Missouri custody dispute should be given to the parent who seeks to take care of them.
Issue: Should a Pregnant Woman Be Punished for Exposing Her Fetus to Risk?
Yes: Liles Burke, from “Hope Elisabeth Ankrom v. State of Alabama,” Circuit Court of Coffee County (2011)
No: Lynn M. Paltrow, from “Punishment and Prejudice: Judging Drug-Using Pregnant Women,” Beacon Press (1999)
Liles Burke sets out the majority opinion of the Alabama Court of Criminal Appeals in a case involving a pregnant woman who was found to have used cocaine while pregnant. Burke argues that Alabama law that forbids adults from exposing children to controlled substances applies in cases involving pregnant women and their fetuses. Attorney Lynn M. Paltrow argues that treating drug-using pregnant women as criminals targets poor, African American women while ignoring other drug usage and fails to provide the resources to assist them in recovery.
Unit 3: Professional Integrity
Issue: Should Physicians Be Allowed to Participate in Executions?
Yes: David Waisel, from “Physician Participation in Capital Punishment,” Mayo Clinic Proceedings (2007)
No: Atul Gawande, from “When Law and Ethics Collide—Why Physicians Participate in Executions,” The New England Journal of Medicine (2006)
David Waisel, a professor of medicine, argues that if the state is to administer capital punishment, then physicians may honorably seek to help the condemned die as painlessly as possible. Physician and journalist Atul Gawande supports capital punishment but believes physicians, as healers, should play no role in it.
Issue: Should Pharmacists Be Allowed to Deny Prescriptions on Grounds of Conscience?
Yes: Donald W. Herbe, from “The Right to Refuse: A Call for Adequate Protection of a Pharmacist's Right to Refuse Facilitation of Abortion and Emergency Contraception,” Journal of Law and Health (2002/2003)
No: Julie Cantor and Ken Baum, from “The Limits of Conscientious Objection—May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?” The New England Journal of Medicine (2004)
Law student Donald W. Herbe asserts that pharmacists’ moral beliefs concerning abortion and emergency contraception are genuinely fundamental and deserve respect. He proposes that professional pharmaceutical organizations lead the way to recognizing a true right of conscience, which would eventually result in universal legislation protecting against all potential ramifications of choosing conscience. Julie Cantor, a lawyer, and Ken Baum, a physician and lawyer, reject an absolute right to object, as well as no right to object, to these prescriptions but assert that pharmacists who cannot or will not dispense a drug have a professional obligation to meet the needs of their customers by referring them elsewhere.
Unit 4: The Development and Use of Biotechnology
Issue: Is Human Germline Gene Editing Morally and Socially Acceptable?
Yes: National Academies of Sciences, Engineering, and Medicine, from “Heritable Genome Editing” in Human Genome Editing: Science, Ethics, and Governance, The National Academies Press (2017)
No: Nathaniel Comfort, from “Can We Cure Genetic Diseases without Slipping into Eugenics?” The Nation (2015)
A committee of the National Academies of Sciences, Engineer, and Medicine recommends that clinical trials that would make heritable changes to gametes and other germline cells should be permitted, within a regulatory framework. Historian of science Nathan Comfort argues that such a recommendation would lead relentlessly to the kind of medical and social selection that characterized early twentieth century eugenics.
Issue: Is Research on Creating Babies Using Gametes from Three People Worth Funding?
Yes: National Academies of Sciences, Engineering, and Medicine, from “Do Ethical, Social, and Policy Considerations Preclude MRT?” in Mitochondrial Replacement Techniques: Ethical, Social, and Policy Considerations, The National Academies Press (2016)
No: Tina Rulli, from “What Is the Value of Three-Parent IVF?” Hastings Center Report (2016)
A committee of the National Academies of Sciences, Engineer, and Medicine finds that there are on balance good reasons to proceed with research on transferring mitochondria from one egg to another in order to create a baby free of mitochondrial disease. Philosopher Tina Rulli argues that, while there may not be decisive moral objections to the use of mitochondrial transfer, it has too little social value to justify funding research into it.
Issue: Is the Use of Medical Tools to Enhance Human Beings Morally Troubling?
Yes: President's Council on Bioethics, from “Beyond Therapy: Biotechnology and the Pursuit of Happiness,” U.S. Government Printing Office (2003)
No: Ronald Bailey, from “The Case for Enhancing People,” The New Atlantis (2011)
The President’s Council on Bioethics, a presidential body formed by President Bush, argues that biotechnological interventions for making people better than normal raise profound concerns about the relationship between humans and nature, human identity, and human happiness. The libertarian science writer Ronald Bailey maintains that enhancements will only help people live better lives.
Issue: Should Governments Develop DNA Databanks to Support Law Enforcement?
Yes: David H. Kaye and Michael E. Smith, from “DNA Identification Databases: Legality, Legitimacy, and the Case for Population-wide Coverage,” Wisconsin Law Review (2003)
No: Mark A. Rothstein and Meghan K. Talbott, from “The Expanding Use of DNA in Law Enforcement: What Role for Privacy?” Journal of Law, Medicine, and Ethics (2006)
David H. Kaye and Michael E. Smith, professors of law, argue that a population-wide DNA database could not only help solve crimes but would be fairer than more limited databases. Mark A. Rothstein, also a professor of law and a prominent advocate for maintaining genetic privacy, and his coauthor Meghan K. Talbott argue that DNA databases should be more limited in size and use.
Issue: May Doctors Offer Medical Drugs and Surgery to Stop a Disabled Child from Maturing?
Yes: Sarah E. Shannon, from “In Support of the Ashley Treatment,” Pediatric Nursing (2007)
No: Teresa A. Savage, from “In Opposition of the Ashley Treatment,” Pediatric Nursing (2007)
Nurse Sarah E. Shannon believes that ethically and legally parents have the right and duty to make decisions and to care for their family members who are unable to do so themselves and that we should not abandon parents of severely developmentally disabled children to the harsh social and economic realities that are barriers to good care. Nurse Teresa A. Savage believes that children like Ashley should have independent advocates, preferably persons with disabilities, to weigh the risks and benefits of proposed interventions.
Issue: Should Scientists Create Artificial Living Things?
Yes: The President’s Commission for the Study of Bioethical Issues, from “New Directions: The Ethics of Synthetic Biology and Emerging Technologies,” bioethics.gov (2010)
No: Friends of the Earth et al., from “The Principles for the Oversight of Synthetic Biology,” foe.org (2012)
The President’s Commission for the Study of Bioethical Issues, a bioethics commission created by President Obama, calls for developing the field of synthetic biology, a branch of biological science that aims at genetically modifying organisms to carry out medical, industrial, and other tasks, with “prudent vigilance.” Friends of the Earth, International Center for Technology Assessment, and the ETC Group, leading a group of civil society organizations, counter by recommending a “precautionary” approach and calling for a moratorium on the release and commercial use of synthetic organisms.
Issue: Could Conservation of Wild Species Be Improved through the Use of De-extinction Tools?
Yes: Kent H. Redford, William Adams, and Georgina M. Mace, from “Synthetic Biology and Conservation of Nature: Wicked Problems and Wicked Solutions,” PLoS Biology (2013)
No: Christopher J. Preston, from “De-extinction: A Tale of Two Visions,” Center for Humans & Nature (Accessed 2016)
Kent H. Redford, William Adams, and Georgina M. Mace, who are consultants and researchers working on issues of biodiversity and conservation, propose that synthetic biology, though it is often thought of as providing tool for intervening into nature, can be used as well to protect nature, by aiding in the restoration and protection of species and ecosystems. Christopher J. Preston, professor of philosophy at University of Montana, counters that biotechnological restoration of a species will cut deeply into environmental values.
Unit 5: Access to Health Care
Issue: Does Government Overreach by Mandating Health Insurance?
Yes: James Stacey Taylor, from “The Carelessness of Affordable Care,” Hastings Center Report (2012)
No: Timothy Stoltzfus Jost, from “The Morality of Health Care Reform: Liberal and Conservative Views and the Space between Them,” Hastings Center Report (2017)
Philosopher James Stacey Taylor argues that the Affordable Care Act passed into law during President Obama’ first term is unduly paternalistic, failing to pass muster even on the simple utilitarian grounds that could most easily support policies to require citizens to buy insurance. Timothy Stoltzfus Jost, a legal scholar, holds that the ACA is intended to create a national community of community aid, based on the principle of solidarity.
Issue: Is There an Ethical Duty to Provide Health Care to Undocumented Immigrants?
Yes: Rajeev Raghavan and Ricardo Nuila, from “Survivors—Dialysis, Immigration, and U.S. Law,” The New England Journal of Medicine (2011)
No: David W. Stratas, from “Toussaint v. Attorney General of Canada,” Federal Court of Appeal (2010)
Rajeev Raghavan and Ricardo Nuila, physicians who work with end-stage renal disease patients, argue that standardized coverage for dialysis treatments would alleviate the burden on taxpayers where the most undocumented residents live and would improve these patients’ health, allowing them to return to work. David W. Stratas, a justice with the Federal Court of Appeals of Ontario, Canada, explains why Canada was justified in not providing health care benefits to an undocumented immigrant who lived in Toronto.
Issue: Should Terminally Ill Patients Be Able to Gain Access to Experimental Treatments?
Yes: John E. Calfee et al., from “Regulating Access to Developmental Drugs for Terminally Ill Patients: Abigail Alliance v FDA,” U.S. Court of Appeals for the District of Columbia (2007)
No: Elizabeth Weeks Leonard, from “Right to Experimental Treatment: FDA New Drug Approval, Constitutional Rights, and the Public’s Health,” The Journal of Law, Medicine, and Ethics (2009)
John E. Calfee, a libertarian scholar affiliated with the American Enterprise Institute, leads a group of authors in a friend of the court brief arguing that the Food and Drug Administration’s drug approval process is inappropriately risk averse and that allowing terminally ill patients to receive drugs that are still in clinical trials can improve the drug development process. Legal scholar Elizabeth Weeks Leonard details a variety of countervailing considerations for patients, drug companies, regulators, doctors, and the public.
Issue: Should Vaccination for HPV Be Mandated for Teenage Girls?
Yes: R. Alta Charo, from “Politics, Parents, and Prophylaxis—Mandating HPV Vaccination in the United States,” The New England Journal of Medicine (2007)
No: Gail Javitt, Deena Berkowitz, and Lawrence O. Gostin, from “Assessing Mandatory HPV Vaccination: Who Should Call the Shots?” The Journal of Law, Medicine, and Ethics (2008)
Law professor R. Alta Charo argues that vaccination against the human papillomavirus, which causes most cases of cervical cancer, should be mandatory except in cases of medical, religious, or philosophical objection. Law professors Gail Javitt and Lawrence O. Gostin and physician Deena Berkowitz believe that, given the limited data and experience, and the fact that HPV does not pose imminent and significant risk to others, mandating HPV vaccine is premature.
Issue: Is It Moral to Buy and Sell Human Organs?
Yes: Michael B. Gill and Robert M. Sade, from “Paying for Kidneys: The Case Against Prohibition,” Kennedy Institute of Ethics Journal (2002)
No: Anya Adair and Stephen J. Wigmore, from “Paid Organ Donation: The Case Against,” Annals of the Royal College of Surgeons of England (2011)
Michael B. Gill and Robert M. Sade argue that since there are no moral prohibitions against donating kidneys for transplantation or selling blood plasma, there should be no moral prohibition against selling kidneys for transplantation. They further argue that selling a kidney does not violate a person's dignity and that a system in which a person can receive payment for a kidney is not inherently exploitive. Anya Adair and Stephen J. Wigmore argue that allowing a market for transplantable organs will inevitably work to the detriment of those who are poor and socially disadvantaged.
