ISD I – Ethics/Humanities/Health Law
Session 2
Paper Topics
As part of the
E/H/HL requirements for the ISD I course, students are required to write a 4-5
page essay (8-10 page essay, if not also doing the journal assignment). This essay should be submitted to Andrew
Latus by Monday, June 9th.
Some possible topics are below.
1. The following case raises a
number of difficult questions regarding the idea of informed consent (and, in
particular, about decisions to refuse treatment). Write an essay which explores the ways in
which this situation is problematic both ethically and legally. What should be done in such a case?
Tom is an 80 year-old man with diabetes, renal insufficiency,
hypertension, coronary artery disease and severe peripheral vascular disease.
Two years ago, Tom had a left above the knee amputation. For the last three months, Tom has had an
infection in the right lower extremity.
Two weeks ago, he was admitted to hospital concerning this
infection. At this time, a right below
the knee amputation was recommended to him (since other treatment options had
failed). Tom refused, saying that he had
already lost a leg and saw no reason to live without any legs. Tom was discharged with a prescription for
oral antibiotics although he was advised that this was not the optimal
treatment.
Today, he was admitted to the hospital with a right lower extremity
infection and sepsis. He was extremely
confused and unable to communicate clearly.
The orthopaedic surgeon brought in to consult on his case recommended
that a right below the knee amputation be carried out. When his prior refusal of this procedure was
brought up, the physician who discharged Tom the last time was consulted. He indicated that their conversation prior to
discharge had concerned what the optimal way of treating the infection was, not
the choice between amputation and death.
The consulting surgeon is now of the opinion that Tom faces a real risk
of dying if the amputation is not performed soon. Tom has no living relatives, nor a designated
substitute decision maker, nor has he prepared an Advance Health Directive.
Note: A similar, although not identical, case is
discussed in the article “Achieving Informed Consent When Patients Appear to
Lack Capacity & Surrogates,” by Neil S. Wenger et al in Clinical
Orthopaedics and Related Research 378 (2000): 78-82. This journal is available in the library.
2. Although the idea of informed consent has come to be
thought of as one of the cornerstones of medical ethics, there are those who
think that the goal of acquiring informed consent from patients is a futile
one. Discuss this claim. Should informed consent have the status it
does within medical ethics?
Note: For discussions of this issue, see “Informed
(But Uneducated) Consent” by F.J. Ingelfinger, New
England Journal of Medicine 287 (1972): 465-466 and “Abandoning Informed
Consent: An Idea Whose Time Has Not Yet Come”
by B.C. White and J. Zimbelman, Journal of
Medicine and Philosophy 23 (1998):477-99.
3. Discuss, from an ethical point of view, what was done
in the following case. Could there be
circumstances under which a kidney donation without consent is ethically
acceptable? Is this
such a case? Defend your answer.
Doctors take kidney from patient
incapable of giving consent
British Medical Journal 318
(1999): 753
Doctors in the southern Indian city of
Nephrologists said that a transplant was
the only option for the 40 year old patient in whom kidney failure of
unknown cause was diagnosed in January this year. The patient could
not afford long term dialysis, and a search for a donor showed that
his brother, who was born deaf and mute, had the same blood group
and an ideal antigen match.
The family was poor, and the deaf and
mute brother had never received specialised education and was thus incapable of
communication. "There was no way we could make him comprehend
what he was being asked for," said Dr Ajit
Huilgol, transplantation surgeon at the Karnataka
Nephrology and Transplantation Institute in
The institute's doctors sought opinions
from medical and legal experts in
The Indian parliament outlawed five years
ago the removal of organs from unrelated donors in exchange for payment, but
the law allows organ donations by related individuals with their
informed consent.
On the advice of medicolegal
experts, the doctors spent several weeks evaluating the relationship between
the brothers. "We convinced ourselves that genuine affection
exists between them," said Dr Shankaran
Sundar, a nephrologist at
the institute.
The family's absolute financial dependence
on the patient was also a factor.
4. What ‘message’ does this
cartoon carry? It is from a postcard (c.
2000) advertising the Drugs and Therapeutics Bulletin.
You may also write on a
topic of your own choosing. Please see either
John Crellin or Andrew Latus to discuss a topic.