HYPOTHETICAL CASE STUDIES
● 87 and living with advanced dementia
● Advanced Directive indicating her wishes to have all resuscitative and life sustaining
● intubated as she has problems breathing on her own advanced dyspnea accompanying
● her physicians suspect intestinal obstruction but an MRI is required to confirm
○ WHAT SHOULD HAPPEN?
■ have the MRI done
○ WHAT RELEVANT ISSUES?
○ dementia; privacy, cannot entirely consent to MRI
■ even with Advanced Directive; we do not know when she wrote it, or if her
wishes are the same
■ why is consent so important? autonomy; allows agency in life
■ social justice; limited/finite resources. is she entitled to those social
resources? determine severity of her illness, what quality of life is left,
perhaps if she were younger
■ weigh consequences: to what extent is the treatment really required?
■ family interests: what are their wishes? what do they want done?
● the infant is born with anencephaly: there is a main brain stem but a lack of functional
○ little chance for remedy
● the baby will never gain consciousnesslacks the neocortex responsible for cognition
● infants born with the condition typically die within a few hours to a few days after birth
● the parents would like to donate the baby’s organs, but transplant organs need to be
removed while there is still circulation or immediately after death
● since there is a partially functioning brain stem and spontaneous respiration, the infant
cannot be declared brain dead
○ WHAT SHOULD HAPPEN?
■ baby’s organs should be harvested; at a time before death
○ MORALLY RELEVANT ISSUE
■ baby not conscious; however, not whole brain death. legal conception of
“death”, legal definition of death could be whole brain death (no heart / lung
● could be argued that “death” could be “partial” brain death, the part
of the brain being cognitive function
■ many other infants stand the chance of surviving based on this baby’s organs; utilitarianism
■ family’s interests: parents want the baby’s organs to be harvested
■ value of individual’s life
● is this baby’s life exchangeable? does the life of five other babies
justify the death of this one?
● what makes human life valuable? our dna? if our dna is valuable,
does that make semen/embryos extremely valuable? skin? what is
the value, and is it justified?
HOW DO WE MAKE HARD ETHICAL DECISIONS IN THE MEDICAL CONTEXT?
● codes of ethics and conduct
○ law/morality; could be official codes of ethics
■ ex: hippocratic oath, american medical association, canadian medical
association, college of physician and surgeons
● legal statues
○ look to federal and provincial law for guidance
■ regardless of what we think about abortion, is it legal? what role should the
law play? what if there’s a bad law? Is it the responsibility of HCPs to lobby
to get the bad law off the books?
○ moral theory and ethics?
■ how ought we behave?
● we begin to think we cannot behave in a way we want to with no
regard for other individuals to get what we wish for ourselves
■ what is right and wrong?
■ what has value? why?
○ is there a single, universally true morality? isn’t morality subjective?
■ perhaps one person thinks abortion is permissible, and another doesn’t
believe abortion is permissible
● systematic study of morality, the study of conceptions and theoretical justification
involved in practical reasoning or reasoning meant to be applied to govern individual
○ we begin to think: what makes this wrong?
● we discuss ethics on two different levels; think on these to organize thoughts:
■ morality as a concept
■ discusses whether or not morality is actually something that can be
■ is this actually wrong? is there something fundamentally wrong with this,
or is is conceptually wrong? ○ normative ethics
■ concern the content of moral judgments and their justifications
■ daytoday moral debates; moral arguments in context of situations
● involves considering whether morality can exist, whther morality can be justified, what the
nature of morality is, what the sources of morality are, and what is the nature of moral
● are there objective facts that match up or don’t match up what was said. or is there a
feeling? is someth