Taking Sides: Clashing Views on Bioethical Issues, 16/e

Unit 1:: Medical Decision Making

Issue 1. Is Patient Autonomy the Central Value in Making Medical Decisions?

YES:: Dan W. Brock and Steven A. Wartman, from When Competent Patients Make Irrational Choices, The New England Journal of Medicine (1990)

NO:: Gordon M. Stirrat and Robin Gill, from Autonomy in Medical Ethics after ONeill, Journal of Medical Ethics (2005)

Philosopher Dan Brock and physician Steven Wartman explicate the concept of “shared decision-making,” in which decisions about the patients medical care are reached through collaboration between the patient and the physician. Physicians should sometimes provide guidance to patients, argue Brock and Wartman, but decisions depend fundamentally on the patients choices. British bioethicists Gordon Stirrat and Robin Gill, building on influential work by the moral philosopher Onora ONeill, argue that the core moral value of medical decision-making is mutual trust in the covenantal relationship between patient and caregiver.

YES:: Jay Wolfson, from A Report to Governor Jeb Bush and the 6th Judicial Circuit in the Matter of Theresa Marie Schiavo, A Report to Governor Jeb Bush and the 6th Judicial Circuit in the Matter of Theresa Marie Schiavo (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. Schiavos 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.

Unit 2:: End- of-Life Dilemmas

YES:: American Medical Association, from Sedation to Unconsciousness in End-of-Life Care, Report of the Council on Ethical and Judicial Affairs (2008)

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 physicians duty to relieve pain and suffering includes palliative sedation—using drugs that result in unconsciousness and may hasten death. Physicians Mohamed Rady and Joseph 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.

YES:: Marcia Angell, from The Supreme Court and Physician-Assisted Suicide--The Ultimate Right, The New England Journal of Medicine (1997)

NO:: Kathleen M. Foley, from Competent Care for the Dying Instead of Physician-Assisted Suicide, The New England Journal of Medicine (1997)

Physician Marcia Angell asserts that a physicians main duties are to respect patient autonomy and to relieve suffering, even if that sometimes means assisting in a patients death. Physician Kathleen M. Foley counters that if physician-assisted suicide becomes legal, it will begin to substitute for interventions that otherwise might enhance the quality of life for dying patients.

Unit 3:: Choices in Reproduction

YES:: Alexander R. Pruss, from I Was Once a Fetus:: That Is Why Abortion Is Wrong, University Faculty for Life (2002)

NO:: Margaret Olivia Little, from The Morality of Abortion, Ethical Issues in Modern Medicine (2002)

Philosopher Alexander Pruss argues that abortion is on par with killing an adult human being because the fetus is the same individual, and therefore has the same moral value, as the adult who develops from it. Philosopher Margaret Olivia Little believes that the moral status of the fetus is only one aspect of the morality of abortion. She points to gestation as an intimacy, motherhood as a relationship, and creation as a process to advance a more nuanced approach.

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 4:: Professional Integrity

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.

YES:: Donald W. Herbe, from The Right to Refuse:: A Call for Adequate Protection of a Pharmacists 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 5:: The Development and Use of Biotechnology

YES:: Presidents Council on Bioethics, from Beyond Therapy:: Biotechnology and the Pursuit of Happiness, Presidents Council on Bioethics (2003)

NO:: Ronald Bailey, from The Case for Enhancing People, The New Atlantis (2011)

The Presidents Council on Bioethics was commissioned by George Bush to report to him their findings about the ethical issues involved in the uses of biotechnology. Included in this selection are the expected positive benefits from the biotechnologies that are on the horizon. They could change society in major ways. The libertarian science writer Ronald Bailey maintains that enhancements will only help people live better lives.

YES:: Domestic Policy Council, Bush Administration, from Advancing Stem Cell Science without Destroying Human Life, Domestic Policy Council (2007)

NO:: Insoo Hyun, from The Bioethics of Stem Cell Research and Therapy, The Journal of Clinical Investigation (2010)

The Bush Administrations Domestic Policy Council argues that advances with adult stem cells and alternative sources of pluripotent stem cells make it unnecessary to conduct stem cell research that destroys human embryos, and that if the research is unnecessary, then it should not be done. Insoo Hyun, past chair of the Ethics and Public Policy Committee of the International Society for Stem Cell Research, argues that the alternatives present their own ethical questions and do not eliminate the need to conduct research on embryonic stem cells.

YES:: David H Kaye, Michael E. Smith, and Edward J. Imwinkelried, from Is a DNA Identification Database in Your Future?, Criminal Justice (2001)

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)

A group of authors led by David Kaye, a professor of law and author of a number of articles about the benefits of forensic uses of DNA, sets out the case for creating a population-wide DNA database. Mark Rothstein, also a professor of law and a prominent advocate for maintaining genetic privacy, and Meghan Talbott, a research associate with Rothstein, argue that DNA databases should be more limited in size and use.

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.

YES:: The Presidential Commission for the Study of Bioethical Issues, from New Directions:: The Ethics of Synthetic Biology and Emerging Technologies, Bioethics.org (2010)

NO:: Friends of the Earth, et al., from Principles for the Oversight of Synthetic Biology, foe.org (2012)

The Presidents 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.

Unit 6:: Access to Health Care

YES:: Karen Davenport, from Should Everyone Be Required to Have Health Insurance? Yes:: Its the Key to Reform , The Wall Street Journal (2012)

NO:: Michael F. Cannon, from Should Everyone Be Required to Have Health Insurance? No:: Premiums Will Rise, The Wall Street Journal (2012)

Karen Davenport, a health policy analyst, argues that an individual mandate to purchase health insurance emphasizes conservative ideals of personal responsibility and is necessary to ensure that health care is available and affordable for all citizens. Michael F. Cannon, also a health policy analyst, argues that it will promote irresponsibility, restrict personal freedom, increase the cost of health care, and lead ultimately to government rationing.

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 (2011)

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 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.

YES:: Emil J. Freireich, from Should Terminally Ill Patients Have the Right to Take Drugs That Pass Phase I Testing?, British Medical Journal (2007)

NO:: George J. Annas, from Cancer and the Constitution--Choice at Lifes End, The New England Journal of Medicine (2007)

Physician Emil J. Freireich believes that patients with advanced cancer and limited life expectancy should have the same privilege as all individuals in a free society. Law professor George J. Annas argues that there is no constitutional right to demand experimental interventions, and that fully open access would undermine the FDAs ability to protect the public from unsafe drugs.

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.

YES:: Sally Satel, from Kidney for Sale:: Lets Legally Reward the Donor, The Globe and Mail (2010)

NO:: The Institute of Medicine Committee on Increasing Rates of Organ Donations, from Organ Donation:: Opportunities for Action (2006)

Psychiatrist Sally Satel contends that a regulated and legal system of rewarding organ donors will not only save lives but also stop the illegal trafficking that offers no protections for poor people around the world. The Institute of Medicine Committee argues that a free market in organs is problematic because in live organ donation both buyers and sellers may not have complete or accurate information, and selling organs of dead people raises concerns about commodification of human bodies.