Or just no exploitation period.

This week we read about the infamous case of Henrietta Lacks, a 31 year old cancer patient who upon passing away had her cells stolen from her without her consent or knowledge. In addition, her family was never informed that their beloved one’s cells were being used in research labs. Most importantly, after years of secretly conducting research on Henrietta’s cells, also known as HeLa cells, researchers have won numerous Nobel Peace Prizes and launched the multibillion dollar cell culture industry. Meanwhile, Henrietta Lacks family has never received any compensation for having their beloved ones cells exploited, nor have they seen a single cent of the profits earned from this research. No matter the amount of good things research on HeLa cells has done for the world, there is no excuse for why Henrietta’s family has not yet been compensation for this deception.

In the passage, “Vulnerability, Exploitation, and Discrimination in Research”, Beauchamp and Childress address three problems involved in enrolling the economically disadvantaged in research: 1) undue inducement, 2) undue profit, and 3) exploitation. Under inducements include monetary payments, shelter, and food and are considered unduly large and irresistible payments. In contrast, undue profits are when “subjects receive unfairly low payments, while the sponsor of the research gains more than is justified” (Beauchamp and Childress, 269). One could argue that it would be unethical for a researcher to approach a subject who is weak and constrained by their poverty, and thus more likely to be coerced into being a research subject with menial benefits. The compensation offered could be so little that it is viewed as exploitative. Contrastingly,  monetary payments could be unduly large and irresistible and be seen as coercive or as a form of bribery. Therefore, after reading this passage from Beauchamp and Childress, I have concluded that there is no real solution for how one can determine a method of payment or reimbursement that is nonexploitative.

One simple solution could just be to not exploit subjects in the first place; the Lacks’ doctors could have just informed the Lacks family and received their consent. I think an even better solution would be to ask research subjects how they would like to be compensated. Obviously the subject would not be allowed to make an outrageous request like ask for $1 million dollars. For example, say a homeless person was recruited for research, if the person requested 1 meal and shelter for a night, the researchers should ablige their request. Better yet, for low income subjects, researchers should say, ” Even if you decide you will not do this study, we will still offer you shelter, food, money, etc. just for your time.” This would show the subjects that the researchers are sincere in their endeavors. But I think the best solution would be to allocate more money to fix entire low-income communities so that the issue being an “economically disadvantaged” person is resolved completely.

Ultimately, in the case of Henrietta Lacks’ family, where billions of dollars has been raised off of the research done on Lacks’ cells, there is no reason why Lacks’ family should still be poverty stricken with no access to healthcare themselves. It is unfortunate that no justice has been served, and I am curious to know why no legal action has been taken against this case. Even if Lacks’ family cannot afford to finance a lawyer, it is appalling that no one, not even the many researchers who have profited from this deception nor a generous lawyer willing to offer their time to the case have come forth to at least help Lacks’ family gain the compensation they deserve.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview Press, 2014. Print.

In this week’s reading “Confronting Death: Who Chooses, Who Controls?”, a man named Dax Cowart, was severely burned in a propane gas explosion, which killed his father and severely burned two-thirds of Dax’s body leaving him blind and without the use of his hands. During his recovery, Cowart continuously demanded that the doctors stop treating him due to the extreme painfulness of skin graft treatments for his burns. Despite being deemed competent by a psychiatrist, Cowart’s requests were denied, his autonomy was not considered, and treatment was forced upon him. Despite surviving the incident and now living in what he believes to be the happiest time of his life, when asked today if the doctors should have treated him all those years ago, he still strongly believes that the doctors should have respected his wishes to have “please let [him] die.”

The dilemma in this case is one of the patient’s autonomy versus the healthcare professionals’ paternalistic beliefs that they know what is best for the patient. According to Beauchamp and Childress, paternalism in healthcare is the belief that the superior training and knowledge of a healthcare professional gives said healthcare professional the authority to determine a patient’s best interests (Beauchamp and Childress, 215). Mr. Cowart’s health care providers were not wrong in doing their job to be beneficient and non-maleficent towards Mr. Cowart. However, the amount of pain that Mr. Cowart went through makes this situation an even bigger predicament. If this was a situation where the patient was not as in such excruciating pain, and the patient was competent, then the amount of time the doctor’s took to try to battle the patient’s request to die probably would not be as big of an issue.

I think that if I were the health care professional, I would have attempted to treat Mr. Cowart for a period of time, but I would like to believe that I would step back at some point and respect Mr. Cowart’s wishes to die. What’s difficult to determine is when exactly that point would be? According to Robert Burt, that point in time would be after a physician has had the time to “get the resources [he/she knows] to exist [that could address the [issue] in some way” (Cowart, 20). Although Cowart was declared competent by the psychiatrist and was making demands to forego treatment and thus end his life, his doctor’s acted on the grounds that the excruciating pain he was going through was not allowing him to think clearly. For instance, Cowart believed that his condition was so bad that his only way to make a living after the accident would be to sell pencils on the streets. I agree with Alexandra’s post in that, although Cowart could not envision the life he currently has, a life in which he practices law and is more physically active than he could have ever imagined, these were still not grounds for the doctors to declare him unreasonable.

In a traumatic situation like this one, Mr. Cowart admitted that his pain was so bad that he could not even fathom his life after the pain, even though he knew the pain was temporary. Healthcare professionals should not allow a patient to endure such pain and suffering in order to one day be healed. The ends never justify the means. Cowart states in the interview that “[He doesn’t] believe our health care providers would be honest about letting go of a patient earlier than whatever we set up as the maximum time” (Cowart, 19). He ultimately believes that paternalism has clouded most doctor’s judgments and that legal action needs to be taken against abuse of the paternalistic mentality so that situations like his do not happen again. I agree. Paternalism and the belief that “doctor knows best” needs to be done away with so that horrible instances like this case do not happen to others.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015. <http://www.jstor.org/stable/3527969>.

Background

William Shroeder, a 52-year old native of Illinois, was the 2nd recipient of a permanent artificial heart.  In January 1983, he suffered from a massive heart attack, which severely damaged his heart and left him unable to walk a few feet without experiencing chest pain and shortness of breath. According to his family physician, if Shroeder received a transplant, the antirejection drugs would throw his diabetes out of control. Therefore, his only option was an artificial heart, which on average costs $150,000 per patient. Four years after he received his artificial heart, Shroeder passed away.

Case Discussion

The major dilemma in this case is whether or not our health care money should be spent on costly medical hearts, which are more cost than gain and only benefit a relatively small pool of people. Furthermore, could this money be better spent on early detection of disease and programs for preventative medicine?

According to the authors, “The bill for Will Shroeder’s operation ‘represents 790 days of hospital care equivalent to full treatment of 113 patients for an average stay of a week’ ” (Thomas, Waluchow, & Gedge, 172). Although the money it takes to treat one person for an artificial heart could clearly be used to save many more, a doctor cannot simply deny healing someone if there is a treatment option available, whether that option is extremely costly or not. The doctor has a duty to do no harm and to provide treatment to the patient. In fact by providing Shroeder with the artificial heart, the physician followed the three principles of beneficience, which according to Beauchamp and Childress are as follows:

1. One ought to prevent evil or harm.
2. One ought to remove evil or harm.
3. One ought to do or promote good.

The authors of this case also go on to say that, “exotic medical technologies have offered us only marginal returns in reducing illness and premature death” Thomas, Waluchow, & Gedge, 170). However, the improvement of other factors such as better air, improved sanitation, and more conscientious lifestyles work just as well and provide benefits to a larger population.

Analysis

The authors suggest that we must stop and “weigh out the short term losses against the long-term gains” and decide if it’s feasible to treat someone (Thomas, Waluchow, & Gedge, 173). The authors continuously bring up the dilemma over whether we should treat someone who has a preventable disease such as diabetes. According to the American Diabetes Association, with Type 1 diabetes, you inherit risk factors from both parents and an environmental trigger like exposure to a virus or even cold weather can trigger the onset of the disease.  Type 2 diabetes has a stronger link to family history, but both types can be triggered by early eating habits.

However, we also have to think of the socioeconomic factors that cause people to have preventative diseases like diabetes. What if cheaply made processed foods was all that someone could afford to eat and that person could not help that they developed diabetes? Despite his diabetes, Shroeder was responsibly managing his diabetes and could not help that he had a heart attack. You would not deny someone who got into a car accident medical treatment even if it was their fault for being drunk and getting themselves into the accident. So how can we debate whether or not we should deny people of an artificial heart?

Conclusion

Ultimately, in my opinion, there is no decision to be made when it comes to saving a person’s life: you should just do it. I think that it is unfortunate that a medical miracle like the artificial heart could be so expensive and offer such little marginal returns. Thus, more money should be allocated to public health programs that focus on preventative medicine, research to cure these diseases, and the improvement of factors that affect our living conditions, so that we are not faced with costly medical procedures like the artificial heart.

 Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.

“Genetics of Diabetes.” American Diabetes Association. American Diabetes Association, 20 May 2014. Web. 20 Feb. 2015. <http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview Press, 2014. Print.

Image:

http://transplants.ucla.edu/images/heart/SynCardia/SynCardia_Freedom_Portable_Driver.jpg

Background

When I first read ” ‘G’ was a pregnant 22-year-old […]” I paused and laughed and already knew I would be interested in this article because my first initial is “G” and I’m also 22. Fortunately, no, I am not pregnant, but I digress.

The real “G” is addicted to glue sniffing and other solvents and has already surrendered three children to family services, two of whom were both physically and mentally damaged as a result of their mother’s addiction (Thomas, 201).  Due to “G” ’s history, the doctor’s believed it was in the unborn child’s best interest to place “G” in a treatment facility and monitor “G” ’s activity. However, the Manitoba Court of Appeal ordered that “G” be released from the treatment facility on the grounds that every individual has the right to security of the person. Fortunately, the baby was born healthy and “G” is no longer suffering from her addiction.

Dilemma

The dilemma in this case is that of non-maleficence vs. autonomy. “G” ’s physicians have a duty to protect the unborn child. On the other hand, it is within “G” ’s legal right to do whatever she wants to her body. She does not have the right, however, to abuse her baby and inflict harm on another human being, which is exactly what she would be doing if she continued to abuse solvents and sniff glue.

My Stance

I believe that “G” ’s right to autonomy was rightfully outweighed in this situation. In terms of moral status and answering the question of whom we ought to be morally responsive, society has a duty to be morally responsive to the unborn child who cannot speak for itself. In addition, based on the Theory of Human Properties from Principles of Biomedical Ethics, all humans have rights because they are human; no human is excluded because it is a fetus, has brain damage, has a cognitive anomaly, etc.

I am not sure what the laws on substance abuse are in Canada, however in the United States, “18 states consider substance abuse during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment” while, “15 states require health care professionals to report suspected prenatal drug abuse, and 4 states require them to test for prenatal drug exposure if they suspect abuse” (Guttmacher, 2015). I hope that more states and Canadian provinces will implement these laws in the near future.

For me personally, there was nothing to debate in this case, but then I ready Alexi Msays’ post, and I realized that if I were “G”, it would be completely wrong to have treatment forced upon me. As mentioned in the case study, ” […] feminists [argued] that the woman’s right to control her own body, whether pregnant or not, must be provided the strongest possible protection” (Thomas, 201). However, “G” ’s body is no longer solely hers. The child did not ask to be born, let alone to be born both physically and mentally impaired. “G” is fully capable of knowing how to prevent herself from getting pregnant, and she could have easily made the decision to abort the baby. However, since she has decided to keep the baby, “G” has a duty to keep her body healthy for the sake of the baby’s health as well. Fortunately, that duty was fulfilled, but on “G” ’s own accord.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.

Guttmacher Institute. “State Policies in Brief: Substance Abuse During Pregnancy.” Guttmacher Institute. Guttmacher Institute, 1 Jan. 2015. Web. 30Jan. 2015.<http://www.guttmacher.org/statecenter/spibs/spib_SADP.pdf>.

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview Press, 2014. Print.

Images:

http://www.russellmoore.com/2011/07/18/an-open-letter-to-an-unborn-baby/

https://richardwiseman.files.wordpress.com/2012/11/scales.jpg

http://www.treatment4addiction.com/images/article_images/addiction_drug_pregnancy.jpg

https://101careersinpublichealth.files.wordpress.com/2011/08/baby-and-mom-by-phanlop88-freedigitalphotos.jpg