Advance Bio/ Comp & Comm
Objectives: Examine in detail a bioethics issue- Explore opinions of those in the forum community- Participate in a class discussion
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| |  | The hospital ethics committee was discussing an important and urgent case. A donor heart had become available, but an extremely rare thing had happened. Two heart-transplant candidates in the hospital were both matches for the donor heart. One patient was known to the committee as Mr. X, the other as Ms. Y.
For someone with heart failure, Mr. X had been on the transplant waiting list a long time. He had been waiting one year and was near death. Ms. Y had just been placed on the list and could be sustained with medication for quite some time, possibly until another heart became available. The answer seemed obvious-give the heart to Mr. X.
A number of the members of the committee did not agree with this answer. They argued that time on the transplant list should be only one factor considered. They saw a problem in Mr. X's medical record.
Mr. X was 64 years old and had suffered from a heart condition for years. He had had two angioplasties and two bypass operations to correct a blockage of the heart's blood vessels. The problem seen by some committee members was that Mr. X still smoked, ate fatty foods, and was very overweight. After each procedure, doctors had warned Mr. X that he must change his life-style, and that if he didn't, his condition would worsen. He never stopped smoking, however, and never changed his diet. He said it was too hard.
Research has proven that smoking and high cholesterol are risk factors for heart problems. Blockage of the coronary arteries is directly attributed to these two factors. Treatments such as angioplasty (opening the blood vessels by passing a tube into the arteries) and bypass surgery (connecting new blood vessels that go around the clogged ones) can correct the problem, but they are not a total cure. To avoid further problems, patients must control their diet, stop smoking, and alleviate stress. This, of course, is not easy. Mr. X appeared not even to try.
The heart was about to be airlifted to the hospital. The committee had to make their decision very soon.
Questions
What should the committee do?
How would you vote if you were on the committee?
In some cases, transplant operations are not successful, and a second operation is needed. Should someone be allowed two transplant procedures? Three? Why or why not?
In some hospitals, alcoholics are not allowed to receive liver transplants. In other hospitals, they are. Those who see alcoholism as a genetically determined condition argue that these people cannot help their addiction. Others feel that these people are responsible and should just stop. Should hospitals deny transplant livers to alcoholics?
What other factors should go into choosing who should get an organ when two people are eligible? List three.
| 9 | 23 | Wed Apr 25, 2012 9:18 pm
kenzieandrews  | | Martha Revere had not seen her friend Kelly Franklin for several years, though they had kept in touch across country via telephone and e-mail. Now, Martha was going to Los Angeles for a convention and couldn't wait to see Kelly.
They made plans to meet for dinner at a trendy California restaurant whose specialty was a giant salad bar. The first thing Martha noticed about Kelly was how thin she was. She reminded herself, however, that several years had passed, and that people change.
During the meal she watched with some surprise as Kelly consumed a huge amount of salad. Kelly must have gone back to the salad bar ten times. Each time, she filled her plate high with food, finished it, and excused herself to go to the rest room. Martha didn't think much about it. She kiddingly mentioned how much Kelly ate, and then let the subject drop.
On the way back to her hotel, however, Martha thought about the dinner more carefully. What had Kelly been doing in the rest room? Could she have been throwing up her food? Isn't that bulimia?
Bulimia (bulimia nervosa) is a psychiatric illness and an eating disorder, present in some 2 million people, mostly women. It involves binge eating and then purging the eaten food by vomiting, using laxatives, or through serious fasting. The bingeing and purging are often followed by guilt and shame, and the sufferer often feels out of control, understanding that the behavior is not normal. Bulimia is very dangerous to one's health, and can also include depression. It is estimated that 5 percent of women have suffered from this condition.
Martha didn't know what to do. Hadn't Kelly's husband and son noticed Kelly's unusual behavior?
Questions
What should Martha do? List three things.
Whose responsibility is it to stop someone who is self-destructive?
If her family approached Kelly and asked her to stop, and she said no, could they force her into a treatment program? Why or why not?
Bulimia and anorexia (not eating) are eating disorders found almost exclusively in women. Why do you think this is so?
5. What might happen if Martha told someone about her suspicions? List three things.
| 9 | 27 | Wed Apr 18, 2012 9:39 am
nkahle | | Mark Silano lived in a small town that rarely had serious problems. Recently, however, there had been a particularly brutal crime. A young girl had been found murdered in one of the town's parks. It had been almost three months and the police didn't seem to be getting anywhere.
As he was skimming his local newspaper, Mark came across an advertisement with a large black border. He read it carefully:
All males between the ages of 18 and 25 are asked to come in voluntarily to help in the investigation of the Anna P. murder case. One vial of blood will be drawn from each volunteer for the purpose of DNA testing.
At first Mark didn't understand the implications of the ad. Then he remembered a show he had seen on television, which told about DNA fingerprinting and how criminals could be identified from tissue samples found at a crime scene. Mark was 22 and so fell into the category asked for in the ad. He thought he should volunteer, but he was really frightened of needles. He didn't want to give blood.
The first investigation to use DNA forensics took place in the United Kingdom in 1983. All the men in a town where a murder had occurred were asked to give blood samples for DNA testing. Colin Pitchfork, who was the murderer, tried to pay a number of people to give blood for him. When one man did, but then realized what this meant, Pitchfork was arrested.
DNA dragnets, as they are often called, are now used all over the United Kingdom, and are increasingly used in the United States.
Questions
1. What should Mark do?
2. What might happen if Mark does not volunteer?
3. Can authorities force Mark to give blood if he does not volunteer?
4. Why, do you think, does this technique work better in the United Kingdom than in the United States?
5. In one case, a baby was found abandoned. Police officials asked for DNA samples from all girls in the community who were between the ages of 12 and 18 and absent from school on the day of the birth. Do you see any problems with this procedure?
6. If an action is "voluntary," can one refuse to perform it? Why or why not?
| 9 | 25 | Tue Apr 03, 2012 7:03 am
stoski | | Reflect on the following article:
http://www.time.com/time/magazine/article/0,9171,1738513,00.html?artId=1738513?contType=article?chn=us
| 9 | 27 | Mon Mar 26, 2012 10:41 pm
kenzieandrews | | Heather and Steven have just left a meeting with their son Daniel’s first-grade teacher, and they are worried. They have been told that Daniel fidgets constantly in class and has a hard time staying in his seat. He usually has trouble following instructions, and doesn’t complete his work. Daniel also talks excessively and at inappropriate times, often interrupting others. Heather and Steven have always thought of Daniel as energetic and rambunctious, but they’ve brushed it off—after all, “boys will be boys.” Steven even reminds Heather that his parents claim Daniel acts exactly like he did at that age. However, at the meeting Heather and Steven just attended, the teacher recommended that Daniel be evaluated for ADHD (Attention Deficit Hyperactivity Disorder).
Heather and Steven have heard a lot about ADHD. News stories about the abuse of ADHD medications and the increasing incidence of ADHD diagnosis are common. Many of their friends and family claim that ADHD is just a fad—or that it could easily be prevented by stricter parenting, a better diet, less television, and so on. However, Daniel’s teacher told them that there is increasing scientific support for the reality of ADHD.
The teacher said that ADHD appears to have a biological basis. Scientists have found physical differences in the brains of children with ADHD that are detectable through noninvasive procedures such as MRI (magnetic resonance imaging). More work is necessary before brain scans can be used as a reliable basis for diagnosis, but the areas of the brain most affected in ADHD appear to be those where the neurotransmitter dopamine is particularly important. Some of the genes involved in these dopamine-using pathways may be at least partly responsible for ADHD. This is no surprise, since family studies have shown ADHD to be highly heritable. Someday, a genetic test may be used to assist in the diagnosis of ADHD.
Since brain scans and genetic tests are not yet available for ADHD, diagnosis is based on an assessment of the child’s symptoms. Daniel’s teacher recommended that Heather and Steven first take Daniel to his pediatrician for a full physical examination. This will allow them to rule out other conditions that lead to ADHD-like behavior. The pediatrician may then focus on evaluating Daniel’s behavior, or perhaps refer him to a mental health professional with expertise in treating ADHD. At this time, diagnosis of ADHD is based on whether or not a child regularly exhibits specific behaviors from a standard list as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). If it is concluded that Daniel does have ADHD, he may be treated with medication, behavioral therapy, or a combination of both approaches.
Questions
1. Do you think Heather and Steven might have come away from their meeting with somewhat different feelings if the teacher had suggested that Daniel needed to have his vision or hearing tested, rather than be evaluated for ADHD? Why or why not?
2. Some people feel that the evaluation of ADHD symptoms is too subjective, making accurate diagnosis difficult. Does the need to help children who may have ADHD outweigh the possibility of an incorrect diagnosis? Explain your response.
3. Objective means of evaluating children for ADHD, such as brain scans and genetic tests, may become available in the near future. Such developments would be expected to increase the accuracy of ADHD diagnosis. Some people are likely to call for routine screening of school children to see if they have or are at risk for ADHD. Do you think such ADHD screening should be mandatory? If so, should it be required only for children exhibiting symptoms of ADHD, or for everyone? Explain your answer.
4. Do you think it's right that the teacher suggested having the student tested?
| 9 | 27 | Mon Mar 05, 2012 11:03 pm
JHarriger | | How many of us have seen newspaper articles about child abuse? How about heroine addicts trying to raise children? How about infants who have died of heat exhaustion after being left in a locked car? Have you ever shook your head and said, "There should be some kind of license to have a child"?
David Lykken, a psychologist from the University of Minnesota, felt that there was a genetic link to criminality and other antisocial behavior. Due to Lykken's thoughts about genetics and the links to behavior, he proposed a very controversial solution: potential parents must acquire a license before they have children! The purpose of the licensing would be to certify people for parenthood. Potential parents who are underage, too poor, alcoholic, or ex-criminals would be turned down. One proposed result would be to ultimately decrease crime rates throughout the United States. Criminals would not be issued a license and therefore could not bear offspring. Lykken's idea was to "fight crime in the cradle."
What We Need to Know
What genetic evidence is there that links an alcoholic parent and offspring? How about criminal behavior? How about poverty?
What types of behaviors are directly linked to genetics?
Consider the Following Data
Consider the following evidence in Table 1. Many professionals such as R.R. Crowe, author of Archives of General Psychiatry, believe that the majority of children with criminal offenders as biological mothers are criminal offenders themselves. These children have all been brought up by adoptive parents.
Table 1. Arrest Records of the Biological Offspring of Female Criminal Offenders
Arrest Record
Probands
Controls
Number of subjects checked for records
52
52
Subjects with records
8
22
Total number of arrests
18
2
Subjects arrested as adults
7
2
Subjects with convictions
7
0
Subjects with two or more arrests
5
0
Subjects incarcerated for an offense
3.5
0
What does the data suggest to you?
If you were doing this research, what else might you have examined as evidence?
How do criminal records compare with antisocial behavior which could lead to criminality?
What is the genetic transmission of antisocial behavior? Is it linked to a gene?
RESOURCES
Barker, Penelope, ed. 1995. The Reference Shelf: Genetics and Society. New York: The H.W. Wilson Co.
Colt, George Howe. 1998. Were You Born That Way? Life. April, pp. 39-50.
Shaie, K. Warner. 1975. Developmental Human Behavior Genetics. Lexington, Massachusetts: D.C. Heath and Co.
"Research Bits." http://www.umn.edu/~urelate/kiosk/9.25text/research.html
http://shadow.autono.net/sin001/violen.htm
| 9 | 26 | Wed Feb 29, 2012 10:55 am
JHarriger | | The week before the start of the new semester would be a busy one for Sandra Maxwell. As one of three biology teachers at Irving Community College in Marshall, Alabama, she would have to meet with the entire science department, get her laboratory ready, and review the new textbooks.
Last year the department had gone through the long, tedious adoption procedure that involved reading and rating over fifteen different books. They had narrowed the fifteen down to three, and the community college board picked from those. Sandra really didn't care which one they had picked; no matter what, she would have to redo her lessons to fit a new book.
There was even more about her new textbook that Sandra didn't know. The Alabama State Board of Education had adopted an anti-evolution insert to go in all high school and state college biology texts. The insert stated that evolution is a "controversial theory" accepted by "some scientists." When Sandra saw the insert, she was upset. Could she teach creationism?
Creationism, broadly speaking, is the view that God (the Judeo-Christian God) created the universe, life, and the various kinds of life. Some creationists have sought to undermine the theory of evolution by claiming, for example, that the earth is only 10,000 years old, not 4.5 billion, and that therefore evolution hasn't had time to occur. They also have argued that DNA could not have developed on its own without the help of an "intelligent agent"-namely, God.
Ever since State v Scopes, the famous Tennessee "Monkey Trial" in 1925 (dramatized in the 1960 film Inherit the Wind), the biology classroom has been the site of a battle pitting science against religion. In the era of the Scopes trial, American fundamentalists had pressed for, and achieved in some states, the passage of anti-evolution laws. More recently, as reported in Science magazine in 1996, creationists have attempted a new strategy: persuading local school boards to give "equal time" in school curricula to alternative theories such as "scientific creationism." In several states-Ohio and Georgia being two-legislatures are considering bills that will require biology teachers to present "alternative theories" to evolution.
Sandra Maxwell and her fellow biology teachers were confused and unhappy about the situation. As a teacher, Sandra wasn't sure what to do.
Questions
What should Sandra do? Give three options.
If you were a member of the legislature in any of the states considering the bills referred to, would you vote to include "creationism" in the curriculum? Give three reasons why or why not.
Some biology teachers are skipping evolution altogether in order to avoid the controversy. Do you think evolution should be left out of the curriculum? Why or why not?
Although many of the "anti-evolution laws" have been struck down at the state and federal level, groups have found other ways to promote "creationism." One of these is getting onto local school boards who select textbooks. What might textbook companies do to avoid problems with these school boards? Give three options.
In 1982, in McLean v Arkansas Board of Education, a federal district court ruled that "creation science" is religion, and in 1987, the Supreme Court reaffirmed that in Edwards v Aguillard, ruling that "creationism" could not be taught in the public schools. Speculate on the reasoning behind these rulings.
| 9 | 31 | Thu Feb 16, 2012 11:44 pm
JHarriger | | Sports & Fitness
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The law suit was unusual, but the story wasn't. It involved high stakes sports and negligence.
Mike O'Malley had excelled in high school academically as well as athletically. He was varsity quarterback for all four years, and everyone expected him to be drafted by a professional team. After graduating from high school, he received a full scholarship to a very well known university and immediately became the starting quarterback on the football team.
The high school coach, Frank Inset, felt very close to Mike and was watching his career with interest and concern. He went to many games to see Mike play. One day, at an important game, Frank was watching a play through his binoculars. He noticed Mike was limping slightly. During another play, Mike was tackled and did not get up immediately. Frank was concerned. He continued to watch even during the time-outs to see how the coach would handle the situation. Frank thought that Mike should be taken out of the game.
That didn't happen. Mike played the rest of the game. By the end of the day, he was in severe pain. He went to the emergency room that night and was admitted into the hospital immediately. He was found to have serious damage to his knee, and was told he needed surgery. Doctors felt that he would need months of physical therapy following the surgery and might have permanent damage. His college football career was probably over, and he would almost certainly never play professional football.
Frank told Mike's parents of his concerns about the college coach's decision during the game. He felt the damage would have been much less if Mike had been taken out of the game as soon as he was injured. Mike's parents saw an attorney who said they might have a case against the university and the coach.
Questions
If you were Mike's attorney, how would you argue the case? Give three arguments.
If you were the attorney for the university or the coach, how would you argue the case? Give three arguments.
Should the university have rules that control a coach's behavior in such situations? Why or why not?
In pro football, an athlete often has a contract that requires him to be paid even if he is injured. Is this right? Why or why not?
| 9 | 29 | Wed Feb 08, 2012 11:37 pm
JHarriger | | Use the following articles and other resources to generate a response to whether organ harvesting should be legal. Should people be allowed to sell their organs for money? Clarify your position.
http://www.popsci.com/technology/article/2010-01/which-organs-can-i-live-without-and-how-much-cash-can-i-get-them
http://www.radicalnewthoughts.com/selling-human-organs.html
http://www.bloomberg.com/news/2011-11-01/organ-gangs-force-poor-to-sell-kidneys-for-desperate-israelis.html
| 9 | 31 | Wed Dec 07, 2011 10:38 pm
JHarriger | | Using research and citing articles, answer the following question:
Do patients who are terminally ill have the right to decide how and when they die?
| 9 | 26 | Fri Dec 16, 2011 11:42 am
erica2012 | | For What Reasons Would You as a Patient Enter a Randomized Clinical Drug Trial?
Pharmaceutical companies as well as other research laboratories are regularly developing new drugs for treatment of symptoms and diseases. At some later stage of the drug development it is necessary to determine in human subjects whether the new drug is effective for treatment. This requires a study called a clinical drug trial and will require patients who have the symptoms or disease to be the subjects of the trial. The goal of the trial is to determine if the new drug has some beneficial effect over no drug and if so is the new drug equal to or superior to an established drug for the condition. Patients are divided into groups in which one group will get the new drug treatment and one group will get the established drug treatment, if one is available, and the third group will get a placebo ("sugar pill"), which may represent no drug treatment. In order to provide a scientifically significant answer, it is necessary to randomize the trial so that no patient and no investigator who is doing the study is aware of who got what. This is called a "double blind randomized controlled study". A scientist who is not involved making a conclusion of the results is aware of the randomization and can stop the study for a patient who is having a reaction or for a group that may be harmed.
The details of the scientific and therapeutic value of the study, potential benefits and risks should be made available to the subject as part of what is called informed consent. The ethical use of a placebo is controversial but is considered by some ethical if the risk for harm is small and potential harm to the patient by no treatment is mild.
What would be of interest is whether you as a patient with a condition, which is being studied, would volunteer for a study where you would not know whether you got a new or old medicine or no medicine. And if you would enter the study, for what reasons would you do so?
| 9 | 25 | Wed Jan 04, 2012 1:43 pm
erica2012 | | s It Ethical to Obtain Stem Cells from Embryos Respectfully Let to Die?
Stem cells are cells within early embryos prior to implantation in the uterus that have the potential to create tissues which can be given to patients whose own tissues are missing or diseased. Currently, stem cells are being used for research to see how this can be successfully accomplished. There has been much concern by some how stem cells are obtained for this scientific research. The concern revolves around whether embryos are being killed in order to remove these special cells. Some feel that embryos even prior to implantation represent potential persons who have rights that include the right to live and not be killed even to save the life of a patient.
To get around this moral dilemma, Mary and Anthony Mahowald writing in The American Journal of Bioethics (volume 2 number 1) suggest an ethical bypass. They argue that "killing: and "letting die" should have the same standard moral and legal distinction in embryos as it has with persons who have been born. In these persons, organs are not obtained for research or transplantation by killing the person but are obtained only after the person has died. The Mahowalds argue that "embryos in a petri dish are more likely to die than become indisputably persons by being born---even if they are transferred to a woman’s body for gestation. The great majority are non-viable, which means that they will die in a short time (the onset of which may be delayed though freezing) no matter what efforts are made to sustain their development. Since death is certain for thousands of in vitro embryos, shouldn't the same standard by which hospital patients are legally and morally allowed to die be acceptable for them? ... If stem cells are then retrieved from embryos that have expired, the retrieval is morally analogous to retrieval of vital organs from those who are newly deceased. ... Regardless of whether developing embryos are deemed persons, respect for human life in its earliest stages is compatible with research on stem cells obtained from human embryos so long as the cells are retrieved from embryos that have been allowed, respectfully, to die." Since stem cells can be used from recently dead embryos, the ethical bypass by the Mahowalds could be practical. How do you feel about their argument in defence of the procurement of stem cells from such embryos? Should embryos that have just died have more right to their own integrity than a patient who has just died? If not, then there should be nothing unethical or immoral to obtain their stem cells. Correct?
| 4 | 12 | Wed Jan 11, 2012 1:23 pm
erica2012 | | When Should Parental Child Abuse Or Neglect, Not Be?
Parents, beyond the innate biologic or humanistic need or action to care for and provide for their offspring in addition to keeping them safe and avoiding abuse or neglect, have a socially dictated duty to do so. Those parents who fail in these duties may be subject to legal penalties up to and including imprisonment and the removal of their children from their control.
The definition of parental child abuse or neglect has in recent times been subjected to some ethical and legal debate. Whereas intentional and obvious physical injury or sexual abuse by a parent is seemingly uncontestable, there remains some parental behavior which is yet uncertain. Some recent areas of discussion, where legal action against parents have already occurred include the outcomes of fetuses (fetal death or ill newborns) of addicted mothers who have used cocaine during pregnancy. If cocaine causes harm to the fetus, is this different than mothers who smoke or drink alcohol during pregnancy which is also understood to be harmful or a mother not wearing a seat restraint while driving? Another issue are parents who allow their children to become morbidly obese and thus subjecting them to associated serious medical illnesses such as hypertension or diabetes. Is overfeeding children an abuse? Still another situation brought to legal attention as neglect involved parents of a child already treated for cancer but the parents declined consent for further physician-advised therapy because to them the harms of the treatment outweighed the benefit.
Consider whether these behaviors represent to you child abuse or neglect and what would be an explanation of your view
| 9 | 35 | Thu Feb 02, 2012 9:48 am
nkahle |
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