The Case of Dr. Cecil JacobsonA physician was recently convicted of using his own sperm for artificially inseminatinghis patients. He told the court that he didnt see anything wrong with this practicebecause these women came to him wanting to have a child. However, his patientswere unaware that he was using his own sperm for the procedure. Some of his officestaff became suspicious of the physicians methods, but failed to report their suspicionsimmediately. Many children were conceived as a result of this physicians spermhaving been implanted into the mothers.Questions1. Is this a legal, ethical, or bioethical issue? Explain your answer.It is a legal, ethical, and bioethical issue.2. Was the office staff at fault?3. What is the potential long-term effect for this physicians patients and membersof the surrounding community?4. What should happen to this physician?
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How to analyze cases
Identify the relevant facts relating to all aspects of the case being discussed.
A. Medical facts
Medical facts include (but are not limited to):
Diagnosis/prognosis (chance of recovery).
Course of present illness/hospitalization.
History of treatments and results.
Possible treatments with their potential benefits and risks.
Status of daily living skills (ambulation, feeding, hydration, communication,
and so on)
6. Patients emotional state.
7. Patients decisional capacity (competence).
The level of decisional capacity for any particular patient falls somewhere along a
continuum from fully capable (awake, conscious of ones environment, capable of
expressing ones wishes, and stable) to totally incapable (in a persistent vegetative
state or an irreversible coma).
A patient’s decisional capacity may also falls somewhere between the two extremes:
a. A patient who is aware and informed, yet is distraught or confused.
b. A patient who is otherwise aware and informed, yet changes his mind
constantly and is inconsistent.
c. A patient who be stable and aware yet is not fully informed.
B. Patients beliefs and wishes.
1. Patients wishes.
2. Cultural and religious beliefs that are relevant to decision-making.
C. Interested parties (who has something to gain or to loose)
1. Society at large
2. Institutions-Hospitals, medical professions.
3. Individualstheir rights, duties, competence, values, and authority.
b. Adult or minor children.
c. Surrogate/proxy (someone who has been designated to make decisions of behalf
of the patient in case the latter is incapacitated).
d. Significant other.
e. Health care providers.
f. Conflicts among these individuals or between any of them and the patient, if any.
D. Legal/administrative concerns.
1. Financial considerations.
2. What the law says.
3. Hospital policies.
II. Identify the ethical issues/conflicts.
A. Articulate the problem.
B. What makes the situation an ethical problem:
1. Uncertainty. When decision-makers sense that there is something wrong, yet are
unable to identify the moral problem or when they do not know which moral
principle or value applies.
2. Conflict over the application of an ethical principle.
3. Moral dilemmas.
a. A choice must be made between two (or more) possible courses of action all of
which appear at first glance to be moral.
Example: in the case of a terminally ill patient both to keep the patient alive and
to let him die are both morally right one based on the belief that it is
morally right to preserve life, the other on the belief that it is morally wrong to
b. There is a conflict between two different moral principles. To choose one is to
infringe on another.
The patient refuses treatment and is aware that, as a result, he will die. The
physician feels that he has a duty to continue to treat cure and prolong life. This a
case of conflict between autonomy and beficence.
III. Identify options
A. List the different courses of action that are available.
1. Treat aggressively: initiate new therapies, perform surgery, resuscitate if patient goes
into cardiopulmonary arrest.
2. Continue present level of treatment: maintain current level of medication, maintain
all presently used, and maintain current CODE status.
3. Provide palliative care: use medications for pain control, do not initiate therapy if
condition deteriorates, and do not resuscitate (DNR) CODE status.
4. Withdraw life-sustaining treatment: discontinue curative medications, disconnect the
ventilator, discontinue artificial feeding and hydration, and do not resuscitate
B. Identify the potentially positive and the potentially negative consequences of each course
of action for the patient and for all the interested parties.
C. Rank the different options from an ethical point of view:
1. Identify the basic moral principle of moral theory that underlies each option.
2. Find out which course of action results in the greatest good (consequentialismbeneficence) and the least harm (consequentialism-nonmaleficence) while at the
same time respects the rights, dignity, and integrity of all persons involved
(deontology, virtue ethics, autonomy).
State the most ethically sound option and the justification for it.
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