Background

There are many ethical problems posed in the case regarding Henrietta Lacks. Unfortunately, her case occurred during a time where black individuals did not have the same rights as white individuals. This discrimination lead to black patients being treated only under the condition that it was then appropriate for medical research to be conducted on them. The two ethical issues I will tackle in this blog are should patients give consent to having their cells researched? Furthermore, to what extent should we violate autonomy to advance science?

Dilemma

Lack’s cells were special as they were the first successfully grown human cells. Her cells led to many advances in the scientific community such as leading to the eradication of polio, a disease that plagued many. When Lack’s tumor cells were taken after her death from cervical cancer, “no one asked her permission to take the cells” (p. 254). However, the case did state “it was considered fair for medical researchers to conduct research on patients because they were being treated free of charge” (p. 254). Operating under this principle, which I believe violates autonomy of black individuals, I will evaluate whether the principle of autonomy was violating regarding Lack’s cell collection. It is clear that the racism at the time was unethical for a multitude of reasons and the case does not make it clear whether Lacks was aware that by receiving medical attention free of charge she was giving herself to research. If she was unaware of the extent to which research would occur on her, than this would violate the principle of autonomy because she did not give consent to the researchers. I believe that it is easy to agree that patients should consent to any research that might be conducted on them as without consent autonomy is violated.

However, if upon entering the hospital Lacks was informed that they would treat her only under the circumstance that her cells would be used for research later, than I do not believe her autonomy was violated past the violation of autonomy as a result of racism. Beauchamp and Childress state, “nothing about economically disadvantaged persons justifies their exclusion, as a group, from participation in research, just as it does not follow from their status as disadvantaged that they should be excluded from any legal activity” (p. 268). Since Lacks was financially disadvantaged, one could argue that she is being exploited by receiving medical attention from this hospital. However, if one were to continue down this path then in an attempt to “eliminate the problem of unjust exploitation” society would have to “deprive these individuals of the freedom to chose [to engage in research]” which “would often be harmful to their financial interests” (p. 268).

Reflection

One of the conditions of the principle of justice is allocation of resources. Allocation of resources implies that if “there is not enough to go around, [then] some fair means of allocating scarce resources must be determined” (principle of bioethics online website). What if we could make the resource less scarce? Then issues surrounding justice and prioritizing distribution would be less of a concern. In Lack’s case researchers utilized her cells after her death, and advanced science exponentially as her cells were the first “ever successfully grown human cells in a lab” (p. 254). In regard to organs, after individuals are deceased and are not organ donors, their organs decay, providing no advancements or cures for live individuals suffering medical conditions. Does it seem logical to allow all the organs or people who are not organ donors to go to waste after death? Should we as a society utilize the bodies of not only donors, but also individuals who are not labeled donors after their death for the advancement of science? Many would argue strongly against this, expressing concern that this blatantly violates the person’s autonomy and free will. However, currently arguable greater ethical violations are occurring due to the lack of available organs. Individuals might contemplate having another child for the primary purpose of providing one of their current children an organ necessary to live. Is this a greater violation of autonomy than taking the organs of someone who has lived a full life and now has died? The person who is dead would be unaware their autonomy is being violated unlike the child who will later realize that their autonomy was violated from a young age. In Lack’s case, her cells were taken after her death. Looking back, knowing all the amazing advancements that occurred as a result of her cells, it is difficult to imagine where we would be today without her cells. Nobel prizes, the treatment of polio, and cell culture industries all resulted from Lack’s cells. It is fascinating to imagine the advancement that could result from having access to organs after individuals are deceased. An average of 21 people die a day waiting for an organ transplant (http://www.organdonor.gov/about/data.html), it is interesting to think about how many lives we could save by implementing a policy regarding organ donation of the deceased. Furthermore, if we had an ample supply of organs, researchers would have more material to investigate and try treatments on, which could lead to eradications of other diseases and conditions. Although this notion seems far fetched, I think it is an interesting idea to consider in the light of Lack’s case. While Lacks was alive she was provided with medical attention and treatment she would not have received without the possibility of research on her cells after her death. If Lacks gave consent to the researchers allowing them to conduct research on her after her death, even though there is the concern of exploitation, I do not feel it was wrong to utilize her cell’s after her death. The main moral issue I found with this case was the lack of acknowledgement and compensation her family received after the success of her cells. The case states, “Henrietta’s family remain[ed] in poverty and have never received any benefit or recognition for their mother or grandmother’s contribution to science” (p. 254).

Work Cited

“African American Trailblazers in Virginia History.” N.p., n.d. Web.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 7.3: Who Owns the Research? The Case of the HeLa Cells.” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. N.p.: n.p., n.d. 254-55. Print.

Principles of Bioethics. Thomas R. McCormick, D.Min., Senior Lecturer Emeritus, Dept. Bioethics and Humanities, School of Medicine, University of Washington, n.d. Web. <https://depts.washington.edu/bioethx/tools/princpl.html>.

Beauchamp and Childress describe the principle of beneficence as a “statement of moral obligation to act for the benefit of other” one that “connotes acts of mercy, kindness [and] friendship” (B&C p. 203). In this case Dax Cowart was severely injured during a gasoline explosion, leaving the majority of his body very deeply burned. Not only was Dax severely physically injured (burned, blind, lost use of hands, and fingers amputated), but also he was emotionally distraught (lost father in accident).

In this case, the main dilemma that arises is did the physicians have the right to go against Dax’s wishes, even though he was competent? Dax endured the excruciating pain he was put through and has achieved many accomplishments since the accident, but does this make the actions of the physicians justified? Dax states, “I tried to take my life twice–three times if you count the time I crawled over the hospital bed rails trying to get to the window to jump out an eight-story window” (RD p.21). The desperation Dax felt was evident and the suffering was immense. I do not believe the doctors were sympathizing with Dax nor were they displaying mercy and kindness towards Dax, especially since Dax implied pain management treatment was withheld.

One could argue that Dax is not being realistic about his possible life quality after enduring the surgeries. Dax makes statements alluding to little success in his life post operation stating “you know, all I’m going to be able do is to sit on a street corner and sell pencils” (RD p.15). This is Dax’s opinion of what will happen, and an opinion the doctors seemed to disagree with and thus a reason why the doctors are continuing with the surgeries and procedures despite Dax’s unwavering objections. Now since Dax has surpassed both his own and the doctors expectations it is clear that he did not have a realistic image of his future. Does this make Dax incapable of being competent at the time? In the article, it states Dax was deemed competent at least twice. I do not believe just because Dax did not imagine a future with the quality of life he wanted to live, he should be deemed incompetent. Although his quality of life was much greater than he ever imagined, this may not have been the case and thus Dax is entitled to the uncertainty of the future and the right to make his decision based on his current state and not on a possible future state.

I will now consider the principles autonomy and non-maleficence. Since Dax was deemed competent multiple times he should hold autonomy and the “freedom…to make the wrong choices” (RD p.17) as he wishes. Furthermore, he is suffering immensely to such an extent that I believe the principle of non-maleficence is being violated. Two of the five rules specifying non-maleficence are “do not kill” and “do not cause pain or suffering” (B&C p. 154). In Dax’s case these two rules are in conflict. One could argue the principle of non-maleficence is supported as we are not killing Dax nor are we depriving him of the goods for life by conducting the surgeries. In fact, one may argue by doing the surgeries we even may be providing Dax the opportunity to enjoy the goods of life. However, the pain and suffering we are causing him through extensive replacement of skin grafts needs to be evaluated. Dax states, “the pain was so excruciating, it was so far beyond any pain that I ever knew was possible, that I simply could not endure it “ (RD p.17). Although one could argue by not performing these surgeries on Dax we are killing him, the intention is to relieve Dax of his suffering and respect his wishes. I support Dax’s current stance that his wishes to die should have been respected at the time.

Work Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. Seventh ed. New York, NY: Oxford UP, 2001. Print.

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” JSTOR. The Hastings Center, n.d. Web. 18 Mar. 2015. <http://www.jstor.org/stable/3527969>

“Tag Archives: Doctor/patient Relationship.” Tag: Doctor/patient Relationship. N.p., n.d. Web. 18 Mar. 2015. <http://www.thehealthculture.com/tag/doctorpatient-relationship/>.

When I first read that Stephen’s parents wished to not continue with surgery, I thought this was justifiable. Stephen is a minor, and thus it is up to the parents to decide his fate. However, it becomes apparent that the parents did not have extensive interactions with Stephen once he was admitted to Sunny Hill. A professional at Sunny Hill who had worked with Stephen commented that he was a “happy little fellow…[who] responded to people and smiled.. and giggled often” (pg 231). After reading this I questioned whether it was up to the parents to decide his fate. The case states that the person who should make the decision should have “the best knowledge of the patient’s condition and day-to-day life, [be] most concerned, and …bear the fullest impact of the decision” (pg234). The parents certainly do not meet the first criteria and the second and third criteria could be argued against their interest. In terms of autonomy, it is not clear what would be in the best interest for Stephen. Does the family have the right to decide that he be “allowed to die with dignity rather than continue to endure a life of suffering” (pg 231)? We cannot fully understand the life condition of Stephen through his perspective and thus is it ok for the parents to passively allow him to die when in reality Stephen may be enjoying his very simple life? In the eyes of non-maleficence, it seems like the logical move would be to interfere and carry out the procedure. This would likely not only do no harm, but also improve Stephen’s quality of life.

Ultimately, I believe the parent’s wishes should be supported and the operation should not be performed. This was a difficult case for me, as the details presented highlighted personable characteristics in Stephen, such as giggling and smiling. However, ultimately if the parents do not want to continue supporting him and believe he is enduring a life of suffering (a thought justifiable by his current state), I think it is appropriate to respect their wishes in light of appropriate allocation of resources. If the government steps in and over powers the parents, insisting the surgery be performed, the government has now taken over the care of this child. The facilities responsible for caring for individuals like Stephen are very costly and arguably this money could be spent more effectively. For example, the money could be spent on researching a cure that could prevent future circumstances like Stephen’s from arising. It is mentioned that Stephen was removed from the institute and placed in foster care because “Stephen’s condition was so poor and of such low quality, that the services and facilities could be better used by others” (pg229). This mindset would likely agree that with costs considered, it does not seem necessary for the government to go against the parents wishes to keep Stephen alive. When we are talking about state driven actions, the state has to act in a manner that is most just for all of its citizens, and a manner that is blind to emotion. Consider the case of Terri Schiavo. Was it just for the government to spend hundreds of thousands of dollars on her life support when this money could have gone to shelters for battered woman or infinite other social needs?

Work Cited:

Cerminara, Cathy, and Kenneth Goodman. “Ethics Programs .” Schiavo Timeline, Part 1. N.p., n.d. Web. 18 Feb. 2015.

“Ernestine’s Women Shelter.” N.p., n.d. Web. 20 Feb. 2015. <http://ernestines.ca>.

Thomas, John E., and Wilfrid J. Waluchow. “Case 6.4: Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?” Well and Good: Case Studies in Biomedical Ethics. Peterborough: Broadview, 1987. N. pag. Print.

The moral issue involved in Case 5.4 Protecting an “Unborn Child,” is the dilemma of placing the mother, “G”, into a treatment facility against her will. The desire to place G into the treatment facility stems from the fact that G is addicted to glue-sniffing and the use of other solvents and is currently pregnant. G’s previous children have all been taken into the Winnipeg Child and Family service, and two of the children were “both physically and mentally damaged from birth as a result of their mother’s solvent addictions”(pg 201WG). Based on these results, it would seem logical to infer that without intervention of G’s addictive habits, her next child would have a significant chance of enduring physical and/or mental damage.

Johns Hopkins has a Center for Addiction and Pregnancy (CAP), which offers substance abuse treatment, psychiatric evaluation and care, obstetric evaluation and care, pediatric health care, and overnight stay services. The barriers of transportation and inconvenience are diminished in this program as CAP provides “comprehensive health care and complementary services in one convenient location” (Brooner, R). There are many treatment facilities like this available around the country for women like G, and thus G should take advantage of the opportunity to improve the health of her child.

The dilemma that is at stake here is one of autonomy versus non-maleficence. If the situation was to take place with autonomy for living beings predominating, than it could be suggested that the respect of the mother’s wishes take precedence and she not be placed in a treatment facility. However, if the argument were made in favor of non-maleficence, than there would be good reason to place the mother in a treatment facility. In an attempt to minimize the harm in this situation, the health of the unborn fetus should be considered greatly. One might argue that placing the mother in a treatment facility would harm her as it would go against her wishes, but this is not the opinion that should take priority. The mother is currently engaged in activities that are considered harmful, and thus society should not act to minimize her harm over the harm of the unborn fetus, which is only vulnerable to the actions of the mother.

In my opinion, it is our responsibility as a society to look out for the health of the unborn fetus. The case goes in to explain that it could become a “slippery slope” to limit freedoms on glue-sniffing while pregnant. Chief Justice Antonio Lamer expresses concerns that, “if we prevent pregnant women from sniffing glue…we will end up preventing women from drinking alcohol” (pg 204), a concern I do not find distressing. A pregnant woman should not be drinking alcohol. When a woman is pregnant it is her duty to provide the best nurturing environment for the unborn fetus as she is capable of providing. And yes, I feel this includes minimizing exposure to second hand smoke as much as possible, along with eliminating glue-sniffing, alcohol, and any other toxin that could reach the unborn fetus. Although it may go against the mother’s autonomy to “coerce and compel” her into treatment, now that she is pregnant it is not only her autonomy, but also the autonomy of the unborn fetus must be taken into account (pg205).

References:

Brooner, Robert, Ph.D. “Center for Addiction and Pregnancy (CAP).” Http://www.hopkinsmedicine.org/psychiatry/bayview/medical_services/substance_abuse/center_addiction_pregnancy.html. N.p., n.d. Web.

Thomas, John E. 1926-. “Case 5.4: Protecting an “Unborn Child”” Well and Good. a Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. N. pag. Print.

Image citation:

“Mother To Unborn Daughter Quotes – Viewing Gallery.” Mother To Unborn Daughter Quotes – Viewing Gallery. N.p., n.d. Web. 30 Jan. 2015.