There are a wide range of cases in the area of medical ethics. Some deal with medical research, others with health care and others with social policy concerning access to health care.

The general areas or headings include:

• Autonomy and Informed Consent
• Privacy and Confidentiality
• Experimentation on Humans
• Experimentation on non-Humans
• Abortion
• Infanticide
• Care of the Dying
• Assisted Suicide
• Genetics: Intervention, Control and Research
• Reproduction: Assistance and Control
• The Allocation of Resources and Triage
• A Right to Health Care

Here is a listing of one case under each heading.

• Autonomy and Informed Consent

Dax case- Refusing Medical Treatment and Being Ignored - Issue : Autonomy

In 1973, Donald "Dax" Cowart, age 25, was severely burned in a propane gas explosion. Rushed to the Burn Treatment Unit of Parkland Hospital in Dallas, he was found to have severe burns over 65 percent of his body; his face and hands suffered third degree burns and his eyes were severely damaged. Full burn therapy was instituted. After an initial period during which his survival was in doubt, he stabilized and underwent amputation of several fingers and removal of his right eye. During much of his 232 day hospitalization at Parkland, his few weeks at Texas Institute of Rehabilitation and Research at Houston, and his subsequent six month's stay at University of Texas Medical Branch in Galveston, he repeatedly insisted that treatment be discontinued and that he be allowed to die. Despite this demand, wound care was continued, skin grafts performed and nutritional and fluid support provided. He wanted the treatments to stop so that he could go home and die; either through natural causes or by suicide. The doctors, who frequently hear such complaints from patients receiving painful procedures, did not stop the treatment. By continuing the treatment there was a very high probability of survival, while ending the treatment would result in almost certain death. He was discharged totally blind, with minimal use of his hands, badly scarred, and dependent on others to assist in personal functions.

Perhaps of significance is the fact that the procedure that Dax endured was a very new technology, thus if Dax had the accident ten years earlier he would have certainly died. Dax completed the treatment and regained a high quality of life, however, he has never recanted his belief that the decision to discontinue treatment was his, and his alone, and if he could go back into time, even with knowing the quality of life which he now possesses, he would still refuse treatment.

READ: http://www.ascensionhealth.org/our_essence/ethics/affiliates/cases/case12.asp

Cowart, who frequently speaks at medical and legal communities, is a libertarian and former Air Force pilot who overcame his disabilities to earn a law degree and who currently practices law argued that his right to die stemmed from natural law as posited by J.S. Mills.

READ: http://www.dcl.edu/ril/2-2/dax.htm

This case raises any number of issues including autonomy, basic right of refusal, competency and paternalism amongst health care providers.

• Privacy and Confidentiality

DeMasi Case: Pedophile- Issue: Confidentiality

Doctor should have disclosed colleague's pedophilia, jury says

By Denise Lavoie  Associated Press Story posted Saturday, 10-Oct-98 09:40:33 - Online      Athens Daily News

   BRIDGEPORT, Conn. - A psychiatrist who failed to warn anyone about another doctor's sexual fantasies about children was held partly responsible by a federal jury Thursday for the molestation of a 10-year-old boy.
   Dr. Douglas Ingram was found negligent in not warning anyone about by Dr. Joseph DeMasi. The jury will return Friday to decide how much Ingram should pay the boy's family in damages.
   The verdict's effect on the principle of doctor-patient confidentiality was not immediately clear. One psychiatrist said the case is unusual enough that its effect will not be large.
   As part of his training in psychiatry, DeMasi underwent psychotherapy with Ingram during the mid-1980s. During the sessions, DeMasi admitted fantasizing about sex with children.
   He later was charged with molesting three boys, including a 10-year-old boy who was being treated at Danbury Hospital for suicidal tendencies. That child's family sued Ingram and the New York Medical College, where DeMasi was being trained.
   The jury did not find the medical school at fault.
   Ingram and lawyers for both sides left the courthouse without comment.
   The boy, now 22 and serving a prison sentence for assault, is expected to testify on Friday.
   During the trial, Ingram said that he had questioned DeMasi about whether he had ever molested a child, intended to molest a child or fantasized about a particular child. In each case, Ingram testified, the answer was no.
   Ingram also said that he had consulted with five other psychiatrists and was confident that he had no obligation to report DeMasi's disclosure or force him out of the residency program.
   But the jury concluded Ingram should have known that DeMasi was likely to harm others.
   DeMasi pleaded guilty to risk of injury to a minor and received a seven-year prison sentence in 1987.
   In most cases, conversations between a doctor and patient are considered private. But court cases in the past 25 years have gradually established that psychiatrists also have a duty to protect others who may be threatened by patients, especially when specific individuals have been identified.
   "If patients can't talk to doctors about their fantasies, it's going to destroy treatment," Dr. Walter Borden, a therapist and forensic psychiatrist, told The Hartford Courant. "I see a lot of people who have committed crimes and are potentially dangerous. It's difficult enough to get them to talk. This is not going to help matters."
   But Dr. Harold Schwartz, director of the Institute of Living in Hartford, said the combination of DeMasi's fantasies, his career and his belief that pedophilia should not be illegal should have set off alarms.

• Experimentation on Humans

Experiments were done on human beings without their knowing about it or without being fully informed.  Some of the subjects of these experiments were very young children.  Read about the range of experiments and the government investigations and the new criteria and guidelines for such studies.

At the University of Cincinnati patients who being treated for cancer were given massive doses of radiation. The Cincinnati Project told the patients that they were being treated for their cancer, when in fact the experiments were funded by the Military. The Military was interested in discovering how much radiation a person can absorb and still remain functional.

 

At Vanderbilt University in the late 1940's, eight hundred pregnant women were exposed to radiation to determine the effects of radiation on fetal development.
 

At the Oak Ridge National Laboratory, two hundred cancer patients were exposed to high levels of radiation. The experiments continued up until 1972 when the Atomic Energy Commission discontinued them on the grounds that there was little or no benefit to the patient.
 

In an Oregon State Prison the testicles of inmates were exposed to X rays to determine the effects of radiation on sperm production from 1963 to 1971. The inmates were never told that the exposure to massive doses of radiation can cause cancer.
 

During the late 1950's twelve terminally ill cancer patients at Columbia University and Montefiore Hospital were injected with radioactive calcium and strontium 85 to determine the absorption rate of radioactive substances into a variety of tissues and organs.
 

From 1946 to 1956 nineteen mentally retarded teenaged boys were fed radioactive iron and calcium in their breakfast cereal. The experiment took place at a state residential school in Fernald, Massachusetts. Parent's consent form contained no mention of radiation. The stated aim of the research was to gain information about metabolism.

READ:   Advisory Committee on Human Radiation Experiments

• Experimentation on non-Humans

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  ., Page 55, Decision Scenario #12 

During the two years he had worked for the Bioplus Foundation, Dennis Quade had been in many labs.  Before he could renew the funding of a grant, he was required to make an on-site inspection of the facilities and review the work of the investigators.  Now he was sitting in a small, chilly conference room about to watch a videotape of a phase of the work done at Carolyn Sing’s lab.

                Sing herself was sitting at the table with him, and she leaned forward and pushed the play button.  “The experimental subjects we used are baboons,” she told him.  “We think they possess facial and cranial structures sufficiently similar to humans to make them the best animal models.” Dennis nodded, then watched the monitor in complete silence.  He was appalled by what he saw.  An adult animal, apparently limp from anesthesia, was strapped to stainless-steel table.  Its head was fitted into a viselike device, and several clamps tightened to hold it immobile.  The upper-left side of the baboon’s head had been shaved and the area painted with a faintly purple antiseptic solution.  A dark circle had been drawn in the center of the painted area.

                The while-coated arms of an assistant appeared in the tight focus of the picture.  The assistant was holding a device that looked like an oversized electric drill.  A long, transparent plastic sleeve stuck out from the chuck-end of the device, and through it Dennis could see a round, stainless-steel plate.  A calibrated dial was visible on the side of the device, but Dennis couldn’t read the marks. 

                “That’s an impact hammer,” Dr. Sing said.  “We thought at first we were going to be able to use on off the shelf, but he had to modify one.  That’s an item we didn’t anticipate in our initial budget.”

                The assistant centered the plastic tube over the spot marked on the baboon’s head and pulled the trigger of the impact hammer.  The motion of the steel plate was too swift for Dennis to see, but he saw the results.  The animal’s body jerked in spasm, and a froth of blood, brain tissue, and bone fragments welled up from the purple spot. 

                Dennis Quade turned away from the monitor, unable to stand the images any longer.

• Abortion

• Infanticide

• Care of the Dying

• Assisted Suicide

• Genetics: Intervention, Control and Research

• Reproduction: Assistance and Control

• The Allocation of Resources and Triage

• A Right to Health Care

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