Case Study 1.1. The Nurse Who Told A Lie: Did The Nurse Do The Right Thing? Was The Doctor's Advice Good Advice?

Case Study 1.1.
The Nurse Who Told a Lie[8]
One evening five victims of an automobile accident were admitted to the ward of a small rural hospital.
The nurse in charge knew the woman who had been driving and her four children who were also
injured. Three of the children survived, but the oldest child, a daughter, died shortly after admission.
The mother suffered contusions and abrasions, but her major problem was her mental anguish about
her children. The nurse asked the doctor, who was busy in the operating theatre, what she should tell
the mother about the daughter’s death. The doctor told the nurse to reassure the woman at all costs
because she was in great distress and her husband could not be reached until the next morning.
All through the night the mother constantly asked the nurse about the children. As the nurse put it, “It
went strongly against my conscience to have to look her in the eye and repeat a lie of such magnitude.”
The doctor told the woman the truth the next day in the presence of her husband. She cried out, “Why
did she lie to me?”
Did the nurse do the right thing? Was the doctor’s advice good advice?
Before attempting to answer the questions identify the following aspects of the case: the major agents
in the case (patients, medical personnel and others), the major facts of the case, the major moral issue
raised, how each agent responds to the moral issue in the case, the moral principles used by the agents
to support their position on the issue, if stated.
Now consider the following: what resolution would each of the moral principles (for example,
autonomy, beneficence, non-maleficence, and justice) in the case suggest? Are the principles in conflict?
Do not worry if you do not feel confident about your suggested resolution since your ability to analyze
and resolve cases will improve with practice and greater familiarity with the resources provided.
Join the Case Study 1.1 discussion forum and explore these questions with other students. Your
participation in the forum is optional; marks are not awarded. However, your participation in the forum
is recommended, because Assignment 2 is an analysis of a case study and, therefore, you will benefit
from having engaged in as many case study questions as possible.
Case Study 2.1. To Tell the Truth[4]
Neloufer is a clever, caring twelve year old girl who was treated at age 10 for osteosarcoma in her left
arm. Her arm was amputated, and she was treated with chemotherapy, which seemed to work fine,
even though the side effects were unpleasant and at times painful. Neloufer attends the clinic for
regular check-ups, and has been living cancer-free for the past two years, doing well in school and
enjoying growing up with her friends.
But one spring morning, everything changes. Upon receiving the results of the latest tests, Dr. Eaton,
Neloufer’s pediatric oncologist, calls Neloufer’s parents into her office. While Neloufer waits outside, Dr.
Eaton reports, grimly, that Neloufer’s cancer has recurred, and has metastasized to her lungs and liver.
Neloufer’s parents are devastated by this news. Their daughter’s prognosis is not good: even an
aggressive treatment regimen would likely have little effect.
Neloufer’s parents then ask Dr. Eaton not to tell Neloufer about the prognosis.—“Disclose the diagnosis,
and begin the treatment,” they say, “but please don’t tell our daughter that she has only a 10% chance
of recovery.”
Just then, Neloufer impatiently opens the door and pops her head in. She looks worried. “What’s
wrong?” she asks.
What should Dr. Eaton do? In answering this question, use at least two of the ethical theories described
in the readings for this unit.
As an additional exercise, consider whether your moral response would change if Neloufer were seven
years old?—Seventeen years old?
in the case (patients, medical personnel, and others), the major facts of the case, the major moral issue
Do not worry if you do not feel confident about your suggested resolution, since your ability to analyze
Case Study 3.1. Who Gets the Last Bed?[5]
It had been a very busy week in the coronary care unit (CCU) at University Hospital. Karen Pence, RN and
administrative coordinator of the CCU, was very glad it was Friday afternoon. One of her final tasks of
the day was to review the staffing for the coming weekend.
Karen’s review showed two things: first, seven of the available eight beds in the CCU were full and these
patients had great need for intensive nursing care; second, it would be possible to provide safe and
quality care for these seven patients for the next three shifts. However, this was accomplished only after
a great deal of time had been spent reworking and switching her staff’s time schedules. This was an
unpleasant task but one that was often required to provide adequate coverage on weekends for a full
CCU.
At this point, Dr. North approached Ms. Pence and related the following situation. Dr. North’s patient,
Mr. Dombrowski, a 52-year-old white male with documented three-vessel coronary artery disease, was
in need of coronary artery bypass surgery. Mr. Dombrowski’s surgery, scheduled two days ago, had
been cancelled because of inadequate blood supply in the blood bank. Mr. Dombrowski had naturally
been upset over this, his third cancellation. (During the past month, his surgery had been postponed
twice, once when the CCU was already full, and another time when an emergency situation involving an
elderly man had arisen.) Dr. North was satisfied that the medical risks of waiting a few days were not
great, but this assurance did little to relieve Mr. Dombrowski’s anxiety over the surgery. In fact, the
more anxious he became, the more important it was for the surgery to take place. A few minutes ago,
Dr. North was notified by the blood bank that the blood was finally available for Mr. Dombrowski’s
surgery. Dr. North asked Ms. Pence if the CCU could provide the necessary coverage for Mr.
Dombrowski’s care over the weekend if he were to begin the surgery later that afternoon. In other
words, could Mr. Dombrowski occupy the last bed in the CCU over the weekend?
Ms. Pence was aware that this is the only unit in the hospital equipped to provide appropriate nursing
and medical care for Mr. Dombrowski postoperatively. Since the step-down unit for the CCU is also full,
there is little likelihood that any of the present patients in the CCU can be transferred, even if they could
be ready for transfer in 8 to 10 hours. There is another CCU in the region, but that unit also has only one
bed free; moreover, the airlift service is very expensive.
Mr. Dombrowski will require one-to-one nursing care for approximately 16 hours postoperatively. His
admittance to the CCU will fill the last available bed early on a Friday evening. On any given weekend,
the CCU will usually admit between one and three patients; the last three weekends, though, have seen
no admissions.
Should Ms. Pence tell Dr. North that her unit could adjust to provide adequate care for Mr. Dombrowski
(and adequate coverage for the needs of the other patients in the unit)? Why or why not? Which model
of micro-allocation is the best one to use in this situation? Is that model a morally acceptable one to use
in other cases? Would you like to have additional information about this case? (If so, what else would
you like to know, and why?) What sort of macro-allocation decisions would help to avoid similar
situations in the future? How would you attempt to influence macro-allocation decision-making?
Before attempting to answer the questions, identify the following aspects of the case: the major agents
in the case (patients, medical personnel and others), the major facts of the case, the major moral issue
Case Study 4.1. Conflicts Visible and Invisible[1]
Nao Vang Xiong, his wife Sheng, and their two small children, ages 1 and 2, were Southeast Asian
refugees. Their settlement in the United States was being sponsored by an agency of the Catholic
Church. After settling in their new community, the Xiongs visited the county health department for
individual health evaluations, accompanied by an interpreter. Through their interpreter, Mr. and Mrs.
Xiong indicated to the community health nurse that neither they nor their children had ever had a
serious illness, and repeatedly expressed deep gratitude to be living in a new country. Preliminary
results showed no serious illness, though the chest X-rays of Mrs. Xiong were suspicious; some of the
test results would take several weeks to be completed, so follow-up visits were scheduled. The Xiongs
returned to their new home and began English-as-a-second-language courses.
At the follow-up visit two weeks later, the nurse, Jane Murphy, was dismayed to disclose that various
tests had revealed what was suspected from the chest X-ray, namely that Mrs. Xiong had active
tuberculosis. The clinic nurse explained, with the help of an interpreter, that Mrs. Xiong must take
medications for an extended period of time and should have lots of rest and nutritious food. She was
placed on isoniazid (INH), rifampin, and ethambutol hydrochloride, each to be taken once a day.
At a repeat visit to the clinic two months later, it was determined that Mrs. Xiong was approximately six
weeks pregnant. Because of the risk of fetal abnormality from taking the antituberculosis drug during
the first trimester of pregnancy, the clinic physician, Kelly Morrice, suggested that Mrs. Xiong consider
an abortion. Arrangements for the procedure were easily made through the health department and the
county hospital. The matter seemed settled.
To Ms. Murphy and Dr. Morrice’s surprise, the Xiongs and Mr. James Walsh, a representative of the
church-sponsored agency visited the clinic the very next day. The Xiongs appeared very upset and said,
through the interpreter, that they had changed their minds about having an abortion. When Ms.
Murphy asked why they had changed their minds, Mr. Walsh pointed out that it was directly contrary to
the sponsoring agency’s religious viewpoint for Mrs. Xiong to have an abortion. He adamantly objected
to the clinic’s recommendation in this regard, since her life was not directly threatened by the
pregnancy. Through the interpreter, Ms. Murphy also learned that Mrs. Xiong was under the impression
that she and her family would lose the agency’s support if she underwent the abortion, and would have
to return to the country from which they had fled.
Although Ms. Murphy and Dr. Morrice tried to reassure Mrs. Xiong and her husband that she had the
right to make this decision regardless of the sponsoring agency’s position on abortion, Mrs. Xiong was
not convinced. The young family was completely dependent on the sponsoring agency and was very
fearful of what might happen to them without this support.
Ms. Murphy, herself a Christian and not entirely comfortable with the very idea of an abortion, believed
nonetheless that Mrs. Xiong should be able to decide on her own whether to give birth to a possibly
seriously ill child. She explained to Mr. Walsh why abortion was suggested in this case and supported
Mrs. Xiong’s right to make this choice without influence from the sponsoring agency. Mr. Walsh,
however, insisted that abortion was morally unacceptable to the sponsoring agency. Since they were
supporting the Xiongs, they could not permit them to make such a choice. He stated that he and his
agency would arrange other health care follow-up for Mrs. Xiong and her family if the health
department continued to suggest that Mrs. Xiong have an abortion.
At this point, neither Ms. Murphy nor Dr. Morrice was sure what she should do. They could decide that
the Xiongs’ lack of proficiency in English and limited understanding of Mrs. Xiong’s right to choose were
cultural problems beyond their expertise or intervention. On the other hand, they could decide to
advocate for this patient by communicating with the International Refugee Service and requesting
another sponsor for the Xiong family. This intervention could take many weeks, however, and Mrs.
Xiong would be well into the second trimester of pregnancy before the abortion could be performed.
Since Mrs. Xiong’s general physical condition was not good, the health care providers wondered if this
choice of action would, in the long run, be in her best interests.
Given what you know about this case, which model of the therapeutic relationship do you think best
captures the dynamics? Does this model provide any advice about ethically appropriate courses of
action? What would caring for and caring about the patient require? Remember that time is a
consideration here: a protracted dispute would render an abortion unhealthy for Mrs. Xiong and
eventually, legally problematic. Drawing on the ethical theories discussed in Unit 2, and what you have
learned in this unit about therapeutic relationships, what should the health care providers do? Why?
raised, how each agent responds to the moral issue in the case, and the moral principles used by the
agents to support their position on the issue, if stated.
Case Study 6.1. A Research Ethics Board Debate[4]
Administrators and researchers of a study of pheloxytine decanoate, a new drug intended as an

antipsychotic, have secured funding for their drug research from the GHI Company, the manufacturer of
the drug they are testing. In their submission to their University’s research ethics board (REB), the
researchers claim that this situation poses no ethical problem for the following three reasons.
1. They are trained scientists and thus virtually immune to bias.
2. The research participants do not know whether they are in the experimental group or the
control group.
3. The money was given to their institution, St. X’s University, rather than to the researchers
directly.
During their monthly meeting, the members of the REB deliberate about the ethics of this particular
academic-pharmaceutical relationship, and what safeguards may need to be put in place. Four of the
questions raised are as follows.
1. In what sense does being a scientist ensure or even make it more likely that one will be free of
intentional or unintentional bias? If scientists can be assumed to be free of bias, why is the
standard methodology to use a double-blind study (in which neither those gathering data, nor
the participants, know who is in the control group)?
2. Does the fact that the participants are “blind” to whether they are in the experimental or
control group eliminate any possible bias on the part of the researchers?
3. Suppose the money were given directly to the research team. Would that then become morally
unacceptable (or more unacceptable than otherwise)?
4. Can GHI refuse to allow the research results to be published if the drug proves ineffective?
Imagine that you are a member of the REB at St. X’s University. Drawing on the reading assignments and
discussion material for this unit, how do you think the REB should respond to the researchers’ argument
that their case poses no ethical problems? Do you think any special safeguards should be put in place in a
case such as this?
Case Study 7.1. Dilemma of Teenage Abortion[3]
Erin, 15, and Craig, 16, have had sexual intercourse several times, and now Erin has discovered that she
is two month’s pregnant. Erin’s mother, Angela, has very conservative views about abortion, and she
does not want her daughter to have an abortion. Neither, however, does Angela wish to raise or help
Erin to raise the child. Instead, Angela wants Erin to go through with the pregnancy and give the child to
an adoption agency. Erin’s father, Gordon, wants Erin to have an abortion because he knows that Erin is
a good student and is interested in pursuing a career in law. Gordon is concerned that the pregnancy
will take its toll on Erin both physically and emotionally, and he is concerned that this pregnancy will
significantly affect Erin’s education and future prospects in a professional career. Craig, who wants to be
an engineer, also wants Erin to have an abortion, and he is willing to see to it that all of her expenses are
paid. Erin herself is unsure about what she should do. She shares some of her mother’s misgivings about
abortion, and she knows that she does in fact want to be a mother at some point. Erin has visited the
abortion clinic to discuss the abortion procedure and cost. They have been very helpful and supportive.
Erin is still not sure what she should do.
Drawing upon the views and arguments covered in this unit, identify the relevant ethical issues and
challenges in this case study. What do you think Erin should do and why?
raised, how each agent responds to the moral issue in the case, and the moral principles used by the
agents to support their position on the issue, if stated.
Case Study 8.1. The Quest for a Perfect Baby[11]
Excerpt from the introduction to a dissertation in the history of medicine, as it might be written in 2040:
In the 1990s, as in the preceding three decades, parents mainly practiced negative eugenics, using tests
for major chromosomal anomalies (such as Down syndrome) and aborting “defective” fetuses. By 2020,
the standards for acceptable fetuses had been raised: prospective parents routinely aborted fetuses that
were otherwise healthy but had genes that gave them a significantly higher risk of breast cancer,
colorectal cancer, Alzheimer’s dementia, or coronary heart disease. By 2030, the trend was toward even
higher standards: fetuses with any range of “undesirable” or “less than optimal” combinations of genes
were routinely aborted, including those predicted not to be in the highest quintile with respect to
intelligence or even height. Widespread use of these techniques by parents who could afford them
began to raise the average level of health, physical strength and stature, and intellectual ability in the
population, a trend encouraged by politicians aiming to promote the national interest. But the insistence
of many parents that their child be in the upper quintile created a spiral in which no amount of genetic
boost ever seemed enough.
How likely do you think it is that this scenario will be upon us (say, in Canada or the United States) by
2040? Why? Now, imagine yourself as the author of this dissertation, and imagine that the abstract
above provides an accurate image of the period between the 1990s and the 2030s. What do you expect
you will have observed as the most important ethical issues in the period under study? How do you
expect individuals, social groups, and governments will have responded to these ethical issues? How do
you think they should have responded?
Case Study 9.1. Active Euthanasia with Parental Consent[1]
Andrea was a nine-year-old girl who had been diagnosed at the age of thirteen months as having cystic
fibrosis. Since then she had been hospitalized twelve times; eight times during the last year.
When admitted for the last time she was already receiving an experimental antibiotic, which was being
administered in an attempt to control a resistant pneumonia superimposed on severely damaged lungs
(a result of her underlying disease). She was at that time a severely ill, emaciated child with moderately
laboured breathing. She seemed to have no interest in her environment and refused to communicate
with anyone but her mother.
Because of the severity of the child’s illness and because the parents had accurately perceived that the
experimental antibiotic was a “last ditch” attempt to control her pulmonary infection, the physician
discussed with the parents their perception of “extreme medical measure” and the significance of a “no
code” (or “Do Not Resuscitate”) order. The parents indicated that in the event of a cardiac or respiratory
arrest, they did not want their child to be resuscitated and the appropriate “no code” order was written.
The child was not involved in these conversations or subsequent decision-making, nor had the mother
previously been able to answer her daughter’s questions about death and dying.
As the child’s condition continued to decline, the parents asked how much longer she would live and
how she would die. At one point the father said: “Watching your own child die is worse than dying
yourself.” This comment led to a discussion of active euthanasia utilizing intravenous potassium chloride
or a similar drug. The physicians pointed out that no matter how hopeless a situation or the amount of
suffering that a patient and family were enduring, the law prohibits the active taking of a patient’s life.
They refused to consider this option.
The following day Andrea’s heart began to fail. Her condition became progressively worse, and she died
approximately forty-eight hours later. During these last two days her parents were appalled by her
grotesque appearance . . . and were in great despair because of her steadily deteriorating condition.
They felt powerless to alleviate their daughter’s distress. Medical treatment was continued to the end,
and no measures were taken to hasten Andrea’s death.
Approximately two months after her death, the mother was asked if she would still have given
permission for active euthanasia if she had been offered that option. She replied, “Yes.”
Referring to this case, discuss whether active euthanasia should be permitted to spare the patient and
family from suffering when death is inevitable. Or is passive euthanasia the only moral option (or is
neither option)? Provide one argument in favour of, and one against, legalizing active euthanasia. Be
sure to identify clearly the moral principles on which you are basing your arguments.
Note
[1]
“Active Euthanasia with Parental Consent,” Case 31 from Carol Levine, ed., Cases in Bioethics:
Selections from the Hastings Center Report. New York: St. Martin’s Press, 1989.
Case Study 10.1. The Emergence of New Diseases[1]
A 37 year old southwestern American farmer experienced flu-like symptoms—fever, nausea, vomiting—
for six days in August 1993 before his health suddenly deteriorated. Now suffering additionally from
shortness of breath and fits of coughing, he sought medical attention. Physicians determined by X-ray
that the man had fluid in his lungs; within twelve hours, he developed acute respiratory distress and
died. After investigation of similar cases reported to the United States Centers for Disease Control, it
was concluded that the culprit was a new strain of hantavirus. During 1993, there were forty-two
reported cases of hantavirus pulmonary syndrome in the southwestern United States; twenty-six people
died as a result. What is striking about this sudden emergence of hantavirus is that the virus had not
previously been known on the North American continent. In Europe and Asia, hantavirus had been
implicated in hemorrhagic fevers and kidney disease, but there had been no reported cases in North
America.
Richard Levins and his colleagues, perplexed by this turn of events, posed the questions, “where had the
virus come from, and why did it suddenly emerge?” By chance, a team of researchers at the University
of New Mexico happened to be investigating a drastic increase in the regional population of deer mice.
As was known, hantavirus is carried by rodent hosts, including deer mice. Thus, a likely scenario would
involve these mice in the spread of hantavirus. But, why should there have been so many deer mice
there and then?
The New Mexico researchers noted that a six-year drought in the southwestern United States had ended
abruptly in the spring of 1992, as very heavy rainfall plagued the area and severely altered the region’s
ecosystem. Suddenly, the dietary needs of deer mice could be abundantly met, as the region was
positively littered with pine nuts and grasshoppers; moreover, as a result of the drought, the predators
of the deer mice—coyotes, snakes, and owls—had all but vanished. Consequently, the deer-mouse
population increased ten-fold between May 1992 and May 1993, dropping off about six months after
that as the ecosystem emerged from crisis. At roughly the same time, the hantavirus epidemic subsided
as well. The hantavirus epidemic, then, was caused by deer mice, but only in the context of the
disruption of a stable ecosystem that resulted in the fortuitous (for mice) interaction of a range of
ecological processes that left them fat and happy, thanks to absentee predators.
Now, let us ask, “What are the ethical issues associated with this case?” Which issues we identify
depends on how broad we deem the scope of health ethics (or bioethics) to be. As noted in Unit 1,
ethical aspects of health and health care have been explored ever since the fourth century BCE; but
there was no academic field of study encompassing these explorations until 1970-1971, when the word
“bioethics” was invented. Two men have claimed credit for its invention, Van Rensselaer Potter of the
University of Wisconsin and Sargent Shriver at Georgetown University in Washington, DC.[2] They offered
very different interpretations of the mandate of bioethics—one broad (and now unfamiliar)
interpretation and a second, comparatively narrow but very common one. Potter’s Wisconsin usage was
the first in print, and it was intended to consider not only the health of individuals and populations, but
also the state of the environment, as being within the scope of bioethics. Potter’s concern was thus
more wide-ranging than the current standard meaning of “bioethics.” The narrower Georgetown usage
is by far the more familiar one: bioethics as mainly, if not strictly, health care ethics. Typically, then,
“bioethics” today refers to ethical principles as applied in medical (clinical or research) contexts.
Consequently, as the determinants of health of populations rarely enter into clinical consciousness, they
are not a stock concern of bioethical inquiry.
Georgetown’s Kennedy Institute of Ethics has been associated with two dominant trends in bioethics.
1. The “principles approach” to bioethics (focusing largely on autonomy, beneficence, justice, and
non-maleficence).
2. A straightforward focus on medical ethics primarily at the level of individual cases.
As Reich notes,
The Georgetown model introduced a notion of bioethics that would deal with concrete medical
dilemmas restricted to three issue-areas: (1) the rights and duties of patients and health professionals;
(2) the rights and duties of research subjects and researchers; and (3) the formulation of public policy
guidelines for clinical care and biomedical research.[3]
From this perspective, the ethical issues of interest in medical situations—including the hantavirus case
outlined above—are primarily the patient’s informed consent to treatment, and the physician’s
obligations to act in the patient’s best interest without causing harm. These are important
considerations, to be sure—but from the perspective of a broad approach to bioethics, such as Potter’s,
they do not go nearly far, or deep, enough.
If we take a broad perspective on the nature of health and the scope of health ethics, there are a
number of lessons to be drawn from the hantavirus epidemic and innumerable similar stories about new
and resurgent diseases. Levins and colleagues, for instance, emphasize the need to “integrate complex
social, epidemiological, ecological and evolutionary processes to understand how events in these
various dimensions interact under changing circumstances to produce radically new health
problems.”[4] “Changing circumstances” is meant to be understood very broadly, as incorporating
processes of globalization, economic and industrial growth, temperature, international aggression,
antibiotic resistance, pollution, medical progress, and more, all of which are substantially if not wholly
caused by humans, and which interact in complex ways. Levins and colleagues conclude that “any
effective analysis of emerging diseases must recognize the study of complexity as perhaps the central
general scientific problem of our time.”[5] In this view, then, perhaps complexity should be seen also as
the central ethical problem of our time.[6]
As noted above as well as in Unit 1, health is multiply determined by the interaction of any number of a
broad range of socio-economic, ecological, historical, physiological, and cultural factors; accordingly,
health is not exclusively, or even primarily, a medical affair (see, e.g., Callahan 1999). This is the thrust of
Levins and Lopez’s proposal for an ecosocial approach to health (in Unit 1). Such an approach is sensitive
to the complexity of health and of the emergence of disease. One important implication is that concern
for health cannot focus solely at the level of individuals and individual medical cases. In the bioethical
context, feminist ethicists have long since recognized this point, and they and others now often speak
not of abstract individuals, but rather of persons-in-relation—to each other, as well as to larger social
and political structures and processes. An ecosocial approach to health implies that we should extend
this recognition of context in health ethics still further, to encompass the larger ecology in which
humans and other organisms are deeply embedded. Hence the appeal of the broad understanding of
bioethics advanced by Potter, which would require more of bioethics than that individual clinical needs
be ethically met.
Potter’s basic bioethical concern was for the long-term survival of the human species; as an oncologist
(cancer researcher) he was especially attuned to the connection between environmental carcinogens
and human illness; for this reason, among others, Potter saw bioethics as embracing long-range
environmental concerns as a central component of its mandate. One of Potter’s original formulations of
“bioethics” is as follows:
Bioethics is advanced as a new discipline that combines biological knowledge with a knowledge of
human value systems. . . . I chose bio- to represent biological knowledge, the science of living systems;
and I chose -ethics to represent knowledge of human value systems.[7]
From the outset, then, environmental concerns as being biological knowledge are at the root of the
concept “bioethics.” Potter urged further that clinicians should be both individually and collectively
concerned with environmental well-being. But since the early 1970s, when both bioethics and
environmental ethics were born as academic disciplines, the path between bioethics and environmental
ethics has seldom been travelled.
There are significant obstacles in the way of the reconciliation of health ethics and environmental ethics.
The most obvious of these is that health ethics is almost exclusively concerned with human well-being
from the perspective of humans (health ethics is, as philosophers say, “anthropocentric”), while
environmental ethics is concerned with the well-being of nature, or of the biosphere, of which humans
are only one part (environmental ethics is “biocentric” or at least “non-anthropocentric”). Within
environmental ethics, though, philosophers have begun to argue that, despite their different focal
points, anthropocentric and non-anthropocentric perspectives may actually converge on principles to
protect the well-being of both humans and non-humans as well as their ecosystems.[8] As Mary Midgely
has put it, “the measures needed today to save the human race are, by and large, the same measures
that are needed to save the rest of the biosphere.”[9]
Accordingly, if it is reasonable to believe that the health concerns of humans are inextricably tied up
with the health concerns of the environment—that is, that human health and environmental health are
mutually determining and interdependent—then it is also reasonable to believe that of the two kinds of
bioethics, it is ethically preferable to cultivate a variation on the original meaning of
“bioethics.”[10] Hence the proposal for a bioethics adequate to the complexity of health: a radical
reorientation of the field to include sustained, multileveled attention to the complex feedback
interrelations between economic, industrial, political, social, medical, ecological, evolutionary and other
biological and social determinants of health.
Notes
[1]
This case is borrowed from an article written by members of the Harvard Working Group on New and
Resurgent Diseases. Richard Levins, Tamara Awerbuch, Uwe Brinkmann, et al., “The Emergence of New
Diseases,” American Scientist 82 (1994): 52-60.
[2]
Details about the birth of bioethics can be found in two articles by Warren T. Reich: “The Word
‘Bioethics’: Its Birth and The Legacies of Those Who Shaped It,” Kennedy Institute of Ethics Journal 4
(1994): 319-335; and “The Word ‘Bioethics’: The Struggle Over Its Earliest Meanings,” Kennedy Institute
of Ethics Journal 5 (1995): 19-34.
[3]
Reich, 1995, 20.
[4]
Levins et al., 1994, 52.

Case Study 1.1. The Nurse Who Told A Lie: Did The Nurse Do The Right Thing? Was The Doctor's Advice Good Advice?

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Case Study 1.1.

The Nurse Who Told a Lie[8]

Case Study 2.1. To Tell the Truth[4]

Case Study 3.1. Who Gets the Last Bed?[5]

Case Study 4.1. Conflicts Visible and Invisible[1]

Case Study 6.1. A Research Ethics Board Debate[4]

Administrators and researchers of a study of pheloxytine decanoate, a new drug intended as an

1. They are trained scientists and thus virtually immune to bias.

Case Study 7.1. Dilemma of Teenage Abortion[3]

Case Study 8.1. The Quest for a Perfect Baby[11]

Case Study 9.1. Active Euthanasia with Parental Consent[1]

Case Study 10.1. The Emergence of New Diseases[1]

2. A straightforward focus on medical ethics primarily at the level of individual cases.

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