DIVERSITY & THE BOTTOM LINE -
PROFESSOR ALFRED LEWIS
Case Study 1
Intra-familial organ transplants
Category: Bioethics
A 19-year-old woman is being treated for a serious kidney disease. She is currently on a dialysis
machine, but treatment is steadily decreasing in efficacy. Before her condition declines any further,
the physician suggests family members undergo tests to determine tissue compatibility to transplant
a kidney. Only the brother shows a degree of compatibility high enough to be considered a candidate.
The physician meets the brother alone to discuss the risks and benefits of the operation. Although
agreeing to be tested, the brother decides not to donate a kidney after weighing the various alternatives
because of the risks, and because, as he puts it, he doesn't "feel he and his sister have ever been close
enough that they would ever take that kind of a risk for each other." The physician repeats a full
explanation of the risks involved, and urges him to rethink his decision because of the serious nature
of his sister's illness with increasingly little time to spare. The brother remains adamant in his refusal.
What should the physician tell his kidney patient?
Author Information
Name: Carole F. Huston
E-mail: huston@acusd.edu
Homepage: Error! Hyperlink reference not valid.
Institution: Department of Communication Studies, University of San Diego
Case Study 2
A Matter of Principle
Category: Bioethics
In early 1982 Ms. Corrine Worthen, a registered nurse, protested against assignment to perform kidney
dialysis upon a terminally ill patient who was a double amputee. She notified her head nurse that she "had
moral, medical, and philosophical objections" against doing so. Prior to her protest Ms. Worthen had
performed the procedure on the patient and twice had to interrupt it because the patient suffered cardiac
arrest and severe hemorrhaging. Convinced that the procedure was more harmful than beneficial to the
patient, Ms. Worthen asked to be reassigned. The head nurse granted her request.
Several months later, however, Ms. Worthen again was called upon to dialyze the patient. She objected,
stating that she thought she had worked out an agreement not to be given this assignment. The head nurse
referred Ms. Worthen to the treating physician who informed her that the patient's family wanted the patient
kept alive, and that the patient would soon cease to live without dialysis. Nonetheless, Ms. Worthen said she
refused to dialyze the patient anymore. The head nurse then warned her that she would be fired if she
continued in her refusal. Ms. Worthen continued to refuse to dialyze the patient, and she was terminated.
The Code of Professional Ethics for Nurses, that applied to Ms. Worthen at the time she was fired, contained
a provision with the following words:
1.4 THE NATURE OF HEALTH PROBLEMS
The nurse's respect for the worth and dignity of the individual human being applies irrespective of the nature
of the health problem. It is reflected in the care given the person who is disabled as well as the normal, the
patient with the long-term illness as well as the one with acute illness, or the recovering patient as well as the
one who is terminally ill or dying. ….
If personally opposed to the delivery of care in a particular case because of the nature of the health problem
or the procedures to be used, the nurse is justified in refusing to participate. Such refusal should be made
known in advance and in time for other appropriate arrangements to be made for the client's nursing care. If
the nurse must knowingly enter such a case under emergency circumstances or enters unknowingly, the
obligation to provide the best possible care is observed. The nurse withdraws from this kind of situation only
when assured that alternative sources of nursing care are available to the client.
Ms Worthen sued the hospital for terminating her and lost.
Author Information
Name: Robert F. Ladenson
E-mail: ladenson@iit.edu
Homepage: http://www.iit.edu/departments/humanities/
Institution: Department of Philosophy Illinois Institute of Technology (IIT), and Illinois Institute
of Technology (IIT), and Faculty Associate, Center for the Study of Ethics in the Professions
(IIT)
Web site: http://ethics.iit.edu/
Copyright: 2000
Case Study 3
Siamese twins
An anonymous couple from Malta traveled to England this past year for a complicated delivery of their
Siamese twin daughters, Jodie and Mary, who were born on August 8, 2000, joined at the abdomen and with
a fused spine. Doctors soon determined that unless the twins were surgically separated both would die. Mary,
the weaker twin, whose brain was underdeveloped, would never be able to survive separated from Jodie.
Jodie, who was strong and alert, had an 80-90% chance of dying if surgery was not performed. She had a
good chance of surviving in the event of surgery, although, in all likelihood she would be severely
handicapped and need medical attention throughout her life. In similar cases in the past, the surviving twin
has sometimes died within six months of surgery. In other cases neither twin survives. The medical team at
St Mary's Hospital, to which the twins were taken, had never done a successful separation of Siamese twins.
When the medical team suggested surgical separation, the Parents, who were Roman Catholic, refused on
religious and moral grounds to give their consent. The Hospital went to court, pleading that life-saving
surgery was in Jodie's best interest, and that saving one of the twins would be morally preferable to losing
both. The presiding judge acknowledged the court's duty "to put the welfare of each child paramount," but,
nonetheless, concluded that Jodie's right to life outweighed Mary's, thus ruling in favor of the Hospital.
The Parents appealed the decision of the court. In support of the Parents' position, Archbishop Cormac
Murphy-O'Connor, head of the Catholic Church of England and Wales, submitted a statement to the court of
appeals in which he said:
[T]hough the duty to preserve life is a serious duty, no such duty exists when the only available means of
preserving life involves a grave injustice. In this case, if what is envisaged is the killing of, or a deliberate
lethal assault on, one of the twins, Mary, in order to save the other, Jodie, then there is a grave injustice
involved.
Despite the objections of the Parents and the Archbishop, the court of appeals ruled that the surgery should
go forward. On November 7,2000 a team of twenty surgeons, nurses, and technicians at St. Mary's Hospital
performed the 20 hour surgery that would result in the death of Mary and give Jodie a chance to live.
Author Information
Name: Robert F. Ladenson
E-mail: ladenson@iit.edu
Homepage: http://www.iit.edu/departments/humanities/
Institution: Department of Philosophy Illinois Institute of Technology (IIT), and Illinois Institute
of Technology (IIT), and Faculty Associate, Center for the Study of Ethics in the Professions
(IIT)Web site: http://ethics.iit.edu/
Copyright: 2001
Case Study 4
Designer Babies
Most of us know families where all the children are of the same sex, either boys or girls. In at least some of these
cases, the parents often wish for at least one more child of the other sex. They desire this, not because they do not
like or appreciate the children they already have, but because their hopes and dreams of parenthood often involve
having a child of the other sex. A father may dream of teaching a son sports or being the father of the bridge, a
mother may look forward to sharing in her daughter’s journey into womanhood or her son’s carrying on of the
family name.
Until recently, these desires would remain unfulfilled unless they were lucky. Now physicians have available a
technique called PGD (Pre-implantation Genetic Diagnosis), which allows physicians to screen embryos for a wide
range of possible diseases as well as for gender. Suitable embryos can then be implanted, while the future parents
may decide not to implant other embryos. These other embryos, depending on the reasons why they were rejected,
may be destroyed or given to other infertile couples, where they will be implanted in the woman and (hopefully)
brought to term.
Consider the following three questions in regard to PGD:
• What restrictions, if any, should the government impose on the use of PGD?
• What restrictions, if any, should physicians and health care organizations impose of the use of PDG?
• What moral considerations should prospective parents consider in regard to their use of PDG?
Author Information
Name: Lawrence M. Hinman
E-mail: hinman@sandiego.edu
Homepage: http://ethics.sandiego.edu/About/editor/index.asp
Institution: University of San Diego
Web site: http://ethics.sandiego.edu/
Copyright: Lawrence M. Hinman 2002
Case Study 5:
Creating a Life to Save a Life
In England, the Whitaker family faced a terrible situation: their son, Charlie, suffered from a rare disorder
that prevented his body from producing red blood cells. Without daily medications and frequent
transfusions, Charlie would simply die. With them, he continues to live, but under close medical care.
For a while, it looks as though Charlie’s parents had figured out an answer to this dilemma. They proposed
to use in vitro fertilization to have another child, but with an added twist. They would, as is usual in this
procedure, have the eggs fertilized outside the womb in a laboratory dish, but they would then include an
additional step. Using new screening techniques, they would screen the embryos to see which would be
most able to donate blood-making cells to Charlie. That would be the one that they would choose to
implant and bring to term.
In contrast to the United States and many other countries, in England someone proposing such a procedure
must obtain government permission –in this case, from the Human Fertilization and Embryology Authority.
The Authority rejected the request by the Whitaker family, saying that it was not right to create a human life
with the express intent of saving another life.
This case raises two kinds of questions.
First, do you agree with the Authority’s decision? Why or why not? What are the significant moral
considerations in this case? What consideration is decisive for you?
Second, who should make these decisions? The United States does not currently have such a board, nor do
most other countries. However, something similar is currently under consideration in several countries.
Leaving aside financial considerations about who should bear the cost for the moment, who should have the
right to make the final decision in such cases? Who should make the decision if the procedure is being paid
for by federal health insurance? Private health insurance? The individual patient or family?
Notes:
Source: Aaron Zitner, “COLUMN ONE. A Matter of Life, Ethics.” Los Angeles Times, October 29, 2002,
p. 1..
Author Information
Name: Lawrence M. Hinman
E-mail: hinman@sandiego.edu
Homepage: http://ethics.sandiego.edu/About/editor/index.asp
Institution: University of San Diego
Web site: http://ethics.sandiego.edu/
Copyright: Lawrence M. Hinman 2002