Again a set of case studies but this time it is not the same element that changes and becomes more significant, but the same case changes in a different respect each time. This allows students to consider the significance of each change and weigh up these competing considerations while holding everything else constant. Of course in reality more than one things will change at any one time, but if we allow students time to consider the importance of each change one at a time they will be able to develop an account of why these changes matter which can then be adapted to respond to more than one changes.
What is it in a nut-shell?
The same case study presented many times, each time changing a different element.
Cheating at Exams
You are sitting your finals. Your course did not include a lot of on-going assessment and as a result everything is resting on these exams. You see an opportunity to cheat, such that if you take it you will do very well and get a First class degree.
Will you cheat?
STOP READING and think about your answer. If you decide to cheat go to A below. If you decide not to cheat go to B below.
A: If you decide to cheat, have you done anything wrong? Can you speculate on why other people might think you have done something wrong? Can you answer your critics? Write a paragraph elaborating on your answers, try to justify your view and respond to what you imagine your critics would say.
B: Now consider the further information below and see if it changes your original answer:
You are absolutely guaranteed no one will ever find out what you did.
You are absolutely guaranteed the University will never find out what you did, there will never be formal penalties, but your classmates will know what you did.
If you cheat you will get a First as a result of which you will have a great job, which will be exciting and pay a brilliant salary. If you do not cheat you will get a much lower class degree and as a result you will get a poorly paid and uninteresting job
Write down your thoughts, especially whether you are tempted to cheat in any of the variations above. If any one of these situations tempts you to cheat, why is that? Why are you justified in cheating in this case but not in others? White a paragraph elaborating on your answers.
Consider the following cases. In all of them an employee has made public (or is threatening to make public) some aspect of the internal workings of his company. Which cases are instances of morally justified whistle-blowing (i.e. when was the employee right in making public the information) and which are not? What aspect of the decision justifies some employees but not others?
Adam has been working for his company for eight months. During this time he has stood by which two of his co-workers have been promoted. His boss regularly ignores him and only talks to him when he wants to give Adam instructions on how to do things Adam is perfectly capable of doing on his own. Only the other day everyone went out for a drink without inviting him, Adam knows they were plotting to exclude him as all day long they would stop talking when he walked in the room. Adam has decided to contact the local tabloid press and expose this campaign of discrimination against him.
Bernice works for a large pharmaceutical company that specializes in drugs for animals. In recent years her company claims to have made a breakthrough in the treatment of degenerative bone conditions such as arthritis with their new product “MiracleFlex”. “MiracleFlex”, when taken regularly, helps patients have remissions of their symptoms. For best results “MiracleFlex” should be taken long term, even when symptoms disappear. Bernice knows that scientifically it is very difficult to prove whether “MiracleFlex” works or not, as the conditions it purports to treat can go into remission spontaneously in 70% of the cases so it is unclear whether the improvement would have happened anyway or not. “MiracleFlex” is a best seller for the company, but Bernice is wondering whether she should let the public know.
Caitlin works for a company developing and producing instruments for medical applications. She works as part of a production line under strict guidelines to ensure the instruments are packed in a sterile environment. Caitlin has been working for the company for the last three months and she has notices several instances where health and safety guidelines have been breached and could well mean that the resulting product is no longer sterile. She has brought this to the attention of her line manager who assured her that he would look into it, but nothing seems to have changed. Caitlin took her concerns to the factory administrator who was surprised to hear what she had to say and promised to conduct a full investigation.
Deacon is a third year medical student. Part of his training now includes hospital visits, ward rounds and learning by observing procedures. Since the first day in medical school Deacon has been aware of the importance of identifying himself as a medical student to the patients he meets and obtaining their consent for his presence. Most patients are happy to allow Deacon to observe and occasionally, under his teacher’s supervision, he has performed small tasks such as taking a history. Deacon is currently being taught by a well respected consultant surgeon who has invited his students to observe an operation (Deacon has not been involved in obtaining consent from the patient, but assumes his consultant did this for him). As the operation is underway, the consultant turns to Deacon and suggests he takes the opportunity to perform an anal examination. Deacon hesitates and asks whether this procedure is necessary for the well being of the patient and whether she has consented to it. The consultant sharply answers that Deacon has to learn sometime and the patient is hardly in a position to object. Deacon performs the procedure and tries to avoid this consultant for the rest of his training.
Adam seems to be motivated by a personal, and probably unjustified, grudge. This case should high-light the importance of one’s motive when deciding to blow the whistle. If one’s motives are self-centered perhaps this has a bearing on the judgment of whether the issue at hand is serious enough to warrant blowing the whistle. Feeling personally slighted or mistreated can skewer one’s judgment and undermine evidence which rests solely on that person’s interpretation of the situation. The general issue here is whether whistle blowers should always act from praiseworthy motives, or whether the act of revealing information is less praiseworthy when it proceeds from mixed motives. Another issue raised by this case is the reliability of the complaint in the first place, as it is possible that Adam’s interpretation of the situation is incorrect; there is no campaign to pass him by, he is just very sensitive.
Bernice's case tries to raise questions about the severity of the practice that the whistle blower wants to uncover. People are paying good money for this drug, but really it is impossible to tell whether it works or not. In fact, even Bernice cannot categorically say that it does not work. Perhaps whistle blowing is not justified when little or possible no harm is done by the practice.
Caitlin's case study calls attention to the fact that whistle blowing needn’t always involve bodies external to the company, but may involve by-passing one’s immediate supervisor and informing higher level management. One could argue that Caitlin was right to go higher up as her immediate supervisor did not appear to respond to her concerns. Another issue here is Caitlin’s short time at this job which may raise questions about her ability to judge whether procedures were being followed and the effect of any lapses.
Deacon's case high-lights the difficulty of subordinates refusing to follow instructions from their superiors and raising concerns which question the authority and judgment of those above them in the managerial order. We can safely assume that many people stay quiet about wrongdoing out of fear of the consequences, both in terms of alienating themselves from their colleagues, limiting their opportunities for career advancement and sometimes even being subject to punitive conditions of work.
Pre-implantation diagnosis is a technique which makes it possible to investigate the genetic make-up of an embryo produced by in vitro fertilization prior to its implantation into a woman’s uterus. It can be used to select a variety of characteristics. At present it is used to analyse chromosomal abnormalities, specific genetic defects, or detect the sex of the zygote (some of the case studies are based on actual possibilities and real cases, whereas others are not possible at the moment). Split the students into three groups and ask them to consider the following three sets of case studies:
Case A: A couple seek permission to select the sex of their child to avoid haemophilia (a genetically inherited disorder, which only very rarely affects female children). The disorder means that sufferers can bleed for much longer than normal due to a lack of clotting factor in the blood, which makes some traumas life-threatening.
Case B: A couple seek permission to select the sex of their child as boys are preferred in their culture and play a large role in their religion. The family name is preserved through male heirs, boys inherit the family fortune, they play a role in religious ceremonies, e.g. males light their father’s funeral pyres, and in general fulfil cultural roles which cannot be fulfilled by girls.
Would you allow either of these two couples to select the sex of their child?
Questions to consider:
- Is it a form of discrimination to prefer one sex over another?
- Is it harmful for a society as a whole to promote discriminatory practices?
- Do people have a right to exercise their religion? Does this right extend to cases where it affects the lives of others?
- Is there a difference between sex selection to avoid a painful disease and sex selection for religious/cultural reasons? Is it frivolous to choose one embryo over another based on cultural stereotypes?
Case A: A couple seek genetic screening to avoid embryos with Lesch-Nyhan syndrome. Lesch-Nyhan syndrome is a condition which leads to mental retardation and compulsive self-mutilation (children are known to bite their own fingers off or gouge their own eyes). The family have already lost one son to the disease and they want to avoid having to go through the same extremely painful experience.
Case B: A couple seek genetic screening to avoid homosexuality. They believe that nature intended us to be heterosexuals and that homosexuality is an aberration. They do not want their future children to suffer in this way.
Would you allow either of these two couples to select their embryos?
Questions to consider:
- Is it acceptable to choose a healthy embryo over one which will suffer from disease or disability?
- Are all diseases or disabilities so bad that it is better not to have been born?
- Who should decide what is a disease/disability and what is not?
Case A: A couple are seeking permission to select an embryo which will be a compatible bone marrow donor for existing sibling.
“A ruling could pave the way for British couples to select an IVF baby who provides a cure for another of their children. The Human Fertilisation and Embryology Authority (HFEA) says that, in some cases, it may be acceptable for embryos to be checked to see if they are a tissue match for an existing child. This would enable blood from the new baby's umbilical cord to be used in bone marrow transplants. This means that Raj and Shahana Hashmi, from Leeds, could now get the go-ahead to use only embryos that precisely match the tissue makeup of their son Zain. He has thalassaemia, a blood disorder which could prove fatal without a bone marrow transplant. As no match has been found either within his family, or on international bone marrow registers, the creation of a matching sibling is his only hope. Despite this, the decision has provoked fury among "pro-life" campaigners, who say that it is wrong to have a child under such circumstances.” BBC News
Case B: A couple are seeking permission to select the sex of their child in order to balance their existing family.
“Sally hopes to use sex selection technology to have a baby girl. She already has two young sons, but her daughter died eight years ago of meningitis at the age of just five. "I really enjoyed having a daughter, and I miss her very much," she said. "I would like the balance back in my family that I had originally." She said that if the technology did not work and she had another boy she would be perfectly happy. "I would not be looking for 100%, I would just like the opportunity to try for the sex of the child I would like. "If that was not to be then that would be fine, but at least I would like to try to make my odds slightly better than they are naturally. "There are lots of people I know who would like to have a child of a different sex just to balance out their family." BBC News
Would you allow either of these two couples to select their embryos?
Questions to consider?
- Are these couples using their embryos as commodities, things to be used to satisfy their desires?
- Is it acceptable to create one life in order to benefit another?
- What is a ‘balanced family’? Does it have anything to do with the sex of its members?
This exercise uses brief examples, all themed around the same topic, but with subtle differences, in order to tease out the significance of these different factors. The theme is genetic information and confidentiality consideration, i.e. pressures to maintain or break confidentiality in the special case created by genetic information (thus the conclusions of this discussion form the content of the assignment for this topic).
All the following cases are examples of the importance of genetic information, however they all create a tension between an obligation to disclose this information and an obligation to keep this information confidential. In each case,
- first, identify the reasons why there might be an obligation to disclose the information (this obligation may be overridden by other considerations, but this doesn’t matter here – simply identify reasons for disclosure)
- secondly, identify the reasons why there might be an obligation to keep this information confidential (again this obligation may be overridden by other considerations, but this doesn’t matter here – simply identify reasons for disclosure)
- thirdly, once you are finished with the first and second tasks above, now consider how all these reasons interact, i.e. given that there are so many reasons to disclose and so many reasons to keep confidential, what should you do? What is the strongest argument you can construct in each case and how is it supported by the reasons you have identified?
Fred: Fred sold tissue samples to a local biobank for research purposes ten years ago when he was a student. At the time he did this purely for financial purposes and indicated that he was happy for the tissue to be used in any way that would help research. Ten years on, Fred is a successful surgeon. Recent research had demonstrated that there is a very clear link between the possession of the gene AbC and susceptibility to TB. The genetic data of Fred was used to establish this result and Fred was duly informed of his status – he is positive (not for TB, but for susceptibility to TB).
Levels of TB in the general population have expanded dramatically over the last 10 years. It is likely that 20% of NHS patients have undiagnosed TB. In a drive to reduce this escalating problem the NHS proposes to terminate the contracts of all staff known to have the AbC gene. Fred contacts the biobank to request that they ensure that his genetic information be kept confidential. At the same time his local NHS Trust contacts the biobank asking for information on TB susceptible individuals who are also Trust employees and could be putting their patients at risk of contacting TB.
Joe: Joe is Fred’s best mate and also took the opportunity to make a bit of money as a student by donating tissue to the same biobank. Luckily Joe tested negative for gene AbC. Joe is now a successful politician, running for election as the leader of his party and possible candidate for as Prime Minister at the next election. An investigative journalist, looking into Joe’s past as background for a piece on him, has a theory (based on good journalistic research) that Joe (who was adopted as a baby) is, in fact, the son of a serial killer who is currently in jail. The journalist discovers that Joe once donated tissue and applies to the tissue bank for access to his records.
Marilyn: Marilyn has volunteered to take part in a trial for the Human Genome Project which is identifying all the approximately 20,000 – 25,000 genes in the human DNA. During the course of this trial she is told that she is a carrier for the Hemophilia A gene, although luckily she has no symptoms of the disease (males are predominantly affected by hemophilia, but females may also have very mild symptoms). Marilyn has two daughters, each of which has a 50% chance of also being a carrier, but won’t be having any more children as she had a hysterectomy a couple of years ago. Marilyn’s younger sister, Caryn, has no children but her partner and her are trying to conceive and are keen on a large family. Marilyn thinks that her carrier status is a private matter not to be discussed with anyone else.
Caleb: Ten year old Caleb is being brought up by his mum, his dad left them before Caleb was born and has had no contact with them since. Caleb’s dad has immigrated to Australia and has recently found out that he has Huntington’s disease, an adult-onset, lethal, progressively degenerative neurological disorder with no known cure. Anyone with a parent with Huntington’s has a 50% chance of inheriting the disease, there is a test to determine whether an individual has the gene responsible for Huntington’s, but the test will not determine the onset of the disease. Caleb’s dad is wondering whether he should contact Caleb.
Dr Roberts: Dr Roberts, a research scientist working for Pharmaceuticals Inc, has recently discovered 500,000 new DNA sequence variations (SNP, Single Nucleotide Polymorphisms), some of which could have a significant impact on how humans respond to disease and may lead to various predictive tests, diagnostics or even cures. The Human Genome Project has identified and holds the patent on 1.8 million SNPs, information, however, which is freely available to everyone. Pharmaceuticals Inc. is seeking a patent for these new SNPs and intends to enforce the patent.
The differences high-lighted by each case are:
Fred: this case puts pressure on the importance of confidentiality when the information can be useful to prevent harm to others. In addition, it raises questions about an employer’s or service provider’s specific responsibilities to prevent harm to employees or service users even when this requires a breach in confidentiality. You may want to extend this example to the insurance industry: if employers have a right to this information to protect the public, do insurers also have a right to it in order to manage their risks in an economically viable manner?
Joe: is purposefully similar to Fred, but in a way escalates the danger to the public. Where Fred might get TB, Joe might go on a homicidal rampage. At the same time though, while Fred’s susceptibility to TB is more robustly guaranteed by his genetic make-up, there are serious concerns about drawing conclusions about a person’s behaviour and personality from (sometimes disputed) claims about their genetic make-up (genetic determinism).
Marilyn: raises further questions of ownership of the information. Marilyn now knows something about herself that also might affect her daughter, sister, her partner and their future children. Is Marilyn under any obligation to reveal this information? Does the extent of this obligation differ depending on the severity of the condition? There are also peculiar implications for consent here. Presumably Marilyn gave informed consent for the tests and accepted the implications of taking a genetic test (i.e. knowledge about genetic make-up), however her daughters, sister and partner never consented to finding out and perhaps would never have wanted to. This idea that not everyone might want to know about their genetic make-up comes up again more forcefully below.
Caleb: The nature of the condition is really significant here, since there is no cure for Huntington’s and therefore there could be an argument that there is no point in knowing. In fact, given the late onset of the disease perhaps it is better to have a few, happy but ignorant years (which may turn out to be many, happy ignorant years if Caleb is not affected), than to find out that Caleb is affected and spend every minute worrying that any change is the start of the disease. On the other hand, for many people knowledge is power (to prepare, to question, to seek other kinds of help) and also fundamentally since this information is crucial to Caleb he has a right to know about it (it seems deceitful to keep this information from the person most affected by it). To make matters more complicated Caleb is a young child. Adults are able to weight up all these factors about genetic testing and decide for themselves; Caleb is too young to comprehend the implications of the decision, so someone else has to decide for him.
Dr Roberts: this one is on implications of genetic information and confidentiality which may not be immediately apparent, but could be extremely far reaching. Patents exist to protect our intellectual labour and it seems fair that an individual and a company who have invested time, money and unique skills into a research project should reap the benefits. However, one objection here is that the nature of the information is significant, genetic information goes to the core of who human beings are and therefore cannot be ‘owned’ by any one person. Another objection is the idea that this information has tremendous potential for good, so it should be public on the grounds of public interest.
For more information on patenting and genetic information here.