Bioethics Test 2 Review

Two Master Questions of Bioethics

1. What is a person? 2. What if anything makes an act right?

Christiaan Barnard

South African surgeon who transplanted the first heart. Grew up in South Africa and attended a medical school there. Did a fellowship under famous surgeon Owen Wangansteen in Minneapolis St. Paul between 1955-1957. When Barnard returned to South Africa in 1967, Wangasteen gave him a heart and lung transplant machine, expecting him to transplant kidneys but Barnard found a way to transplant a heart with the help of his brother Marius. They assembled a team at Groote Schuur Hospital in Cape Town.

Louis Washkansky

A 53-year-old weightlifter suffering from end-stage cardiac disease who received the world's first heart transplant.

Denise Ann Darvall

The car accident victim whose heart was transplanted into Louis Washkansky; her controversial death led to the Harvard brain death criteria.

Ring of Gyges

A mythical ring of invisibility; Socrates argued that true character emerges when a person gets absolute power to do anything.

Willem Kolff

Inventor of the first hemodialysis machine using an auto fuel pump; dubbed the 'Father of Artificial Organs.'

Robert Jarvik

Medical student in Kolff's lab who created the Jarvik-7 artificial heart without ever completing a medical residency.

Jarvik-7

The Jarvik-7 artificial heart was made of polyurethane, plastic, and aluminum, with an inner diaphragm that pumped blood through its chambers. An external air compressor powered the diaphragm through six-foot tubes inserted through the upper abdomen. The compressor weighed 375 pounds and was mounted on a large, wheeled metal cart. The device also used four commercial heart valves similar to those found in a natural human heart. On December 1, 1982, Dr. William DeVries implanted the Jarvik-7 in Barney Clark, nearly 15 years after the first human heart transplant.

Isabelle Dinoire

Recipient of the world's first partial face transplant in 2005 after her dog mauled her following a suicide attempt.

Katie Stubblefield

The youngest recipient of a face transplant, In 2014-18 year old petite Katie Stubblefield, who's boyfriend broke up with her, went into the bathroom and put a 0.308 caliber hunting rifle to her chin pulling the trigger and blowing off her face. Because of the way the rifle is pointed it only destroyed the front of her skull that is her face and not most of her brain. This left her blind and without a mouth, jaw, or nose. 2016 after 11 operations and reconstructive surgery 21 year old Katie became the youngest recipient of a face transplant..

In Vitro Fertilization (IVF)

Conception outside the womb in a petri dish, combining an egg and sperm before uterine implantation.

Louise Brown

The first "test-tube baby," Louise Brown, was born through in vitro fertilization (IVF), a process in which an egg is fertilized by sperm outside the womb in a laboratory dish. Her mother, Leslie Brown, had damaged fallopian tubes due to ectopic pregnancies, making natural conception difficult. Scientists combined one of her eggs with her husband John's sperm to create an embryo, which was then transferred to her uterus for normal development. Leslie later had a second child, Natalie, through IVF in 1982.

Superovulation

The process of using fertility drugs like Clomid or Pergonal to stimulate the ovaries to release multiple eggs.

Robert Edwards and Patrick Steptoe

The physiologist and gynecologic surgeon who pioneered IVF, resulting in the birth of Louise Brown (102nd attempt)

Gamete Intrafallopian Transfer (GIFT)

1980s. Unite sperm and egg not in a Petri dish but inside a Fallopian tube, approximately where normal conception takes place.

Intracytoplasmic Sperm Injection (ICSI)

Belgian group in 1993 succeeded and used a single sperm to fertilize an egg, making it possible for one sperm to be used to achieve a pregnancy.

Baby M Case

In 1986, biochemist Bill Stern and pediatrician Elizabeth Stern paid Mary Beth Whitehead $10,000 to carry a baby created using Stern's sperm and Whitehead's egg through artificial insemination. After giving birth to Melissa Stern, known as Baby M, Whitehead developed an emotional bond with the baby and refused to surrender her to the Sterns. This case involved traditional surrogacy, in which the surrogate contributes her own egg, unlike gestational surrogacy, where she does not. In 1987, Judge Harvey Sorkow upheld the surrogacy contract and ordered Whitehead to give the baby to the Sterns, but the New Jersey Supreme Court later reversed his decision. The court recognized Whitehead as the legal mother, granted her visitation rights, and invalidated the surrogacy contract. Whitehead later became a prominent critic of surrogacy, while Melissa went on to graduate from George Washington University and study the experiences of children born through surrogacy.

Paul Ramsey

In 1970, Protestant theologian Paul Ramsey criticized in vitro fertilization (IVF), comparing it to genetic manipulation and warning of potential societal dangers. He argued that if physicians could fertilize an egg, they might eventually alter human genes, which he considered sinful. Ramsey used provocative phrases such as "test tube babies," "dial-a-baby," and "playing God" to express his concerns about reproductive technology. He also introduced terms like "supermarket of embryos" and "celebrity seed" to warn against the commercialization and manipulation of human reproduction. Decades later, advances in genetic engineering, particularly CRISPR, have raised questions similar to those Ramsey predicted. Ultimately, Ramsey condemned IVF because he believed it involved experimenting on embryos without their consent.

Paradox of Harm

The philosophical concept that someone can be harmed simply by being born.

Baseline Harm vs. Abnormal Harm

Baseline harm requires an existing being made worse off from a starting point; abnormal harm requires a failed norm of development.

Alcoholics Anonymous (AA) Disease Model

Alcoholics Anonymous (AA) is an organization dedicated to helping people stop drinking alcohol, while its sister organization, Narcotics Anonymous (NA), helps people struggling with drug addiction. The disease model views alcoholism as an illness that cannot be cured but can be arrested through recovery. It suggests that alcoholism involves both a physical sensitivity to alcohol and a mental obsession with drinking that cannot be overcome through willpower alone. According to this model, vulnerable individuals may develop a pattern of addiction that worsens over time, as they continue using substances to avoid the misery of withdrawal. This pattern may lead to a person losing control over their substance use, harming relationships, and eventually reaching rock bottom before seeking help. The disease model emphasizes that people with addiction should not be blamed for their illness and should receive professional medical treatment, with health insurance covering the cost of care.

Nora Volkow on Addiction

Neuroscientists believe addiction begins with a powerful dopamine release during the first high, leading people to seek that feeling again. Over time, drug use produces less dopamine, and people may continue using substances not for pleasure but to avoid the misery of withdrawal. This model supports tapering or substituting medications to reduce withdrawal symptoms. However, it does not explain why some people naturally stop abusing substances as they mature, a process known as maturing out.

Genetic Model of Alcoholism

Argues alcoholism is polygenic (60% caused by genes); notes Native Americans have high sensitivity and aldehyde dehydrogenase deficiency.

Herbert Fingarette's Critique of AA

Argues alcoholics choose to drink and retain free will, noting they moderate behavior based on costs, DUIs, and social consequences.

Purdue Pharma and OxyContin

Aggressively marketed Oxycontin as a 'fifth vital sign' while downplaying addiction risks, driving the opioid epidemic.

Harm Reduction

A public health approach focusing on minimizing the negative consequences of risky behavior rather than eliminating the behavior entirely.

John Rawls and Social Justice

underlying Rawls approach to justice is the ability to imagine ourselves as worse off. Rawlsian Justice asks whether the basic structure of our society has evolved to allow corporations to create addicted people and profit from them or to discourage such addictions. For Social Justice theorists, something unique occurred in North America around 2,000 that did not occur elsewhere. Systems of financial reimbursement allowed some drug companies and their employees to become quick millionaires by pushing opiates on vulnerable people.

One bad thing piggy-backed on another: (1) Oxycontin was already more powerful than previous drugs and (2) Purdue Pharma and Infys aggressively oversold it, and millions of vulnerable people became addicted.

Daniel Callahan on Obesity

Bioethicist who argued that social shaming made smokers quit and advocated using fat-shaming to combat the obesity epidemic. Callahan correctly predicted our current pandemic of obesity. Callahan argues that society should use fat-shaming to fight obesity. He writes, "It will be imperative, first, to persuade them that they ought to want a good diet for themselves and for their neighbor and, second, that excessive weight and outright obesity are not socially acceptable." Believes obesity is a contagious disease in a social sense.

The Biggest Loser

tv show where overweight people would go on and see who could lose the most weight. Contestants were forced to workout intensively for hours on end, diet, and participate in challenges to tempt them. Almost all of the contestants gained back the weight they had lost on the show. When they lost this weight their metabolism slowed, which meant they would have to eat 800 fewer calories a day than when they were at their previous weight.

Hawthorne Effect

The phenomenon where individuals modify their behavior simply because they know they are being observed or studied.

Leptin

A hormone that controls hunger.

Food Deserts

Geographic areas where residents have little to no convenient access to affordable, nutritious, and fresh food.

Faith Fitzgerald

Questioned equating health solely with thinness, expanding it to wellness and warning that failing to be healthy becomes stigmatized. Warned that being overweight should not be considered a disease. For Fitzgerald the dark side of our new view of health is that failure to be healthy (or thin) becomes a fault, either the patient's or society's.

Bariatric Surgery

Surgical procedures (like gastric bypass and gastric sleeve) to permanently reduce stomach size for severe obesity.

Iatrogenic

Any illness, injury, or psychological harm inadvertently induced in a patient by medical treatment or diagnostic procedures.

Schadenfreude

The feeling of pleasure or satisfaction experienced when watching someone else experience something bad.

Dual Loyalty

When a healthcare provider feels torn between obligations to the patient and demands from an outside authority.

John Stuart Mill and Utilitarianism

Ethical theory focusing on results and harm, seeking to maximize the most good or save the most people with limited resources. Triage is an example of this

Eugenics vs. eugenics

Capital 'E' eugenics involves forced sterilizations; lowercase 'e' eugenics involves voluntary choices against genetic diseases.

Gastric Bypass Surgeries

divide the stomach into a small upper pouch and a large lower catch pouch for remnants afterwards they connect the small intestines to both.

What can geneticists not explain about alocholism

can't explain why alcoholism can skip generations

What happens when a person drinks alochol

the body breaks down ethanol into acetaldehyde, a toxic substance, and then into acetate. Enzymes called dehydrogenases help these chemical reactions occur. Acetaldehyde can cause unpleasant physical reactions, such as headaches, facial flushing, and excessive sweating.Some people have difficulty breaking down acetaldehyde, which causes these symptoms and may discourage them from drinking.

Biogentic Child

One connected biologically and genetically to two different females

Barney Clark:

Barney Clark was a 57-year-old dentist and longtime smoker who suffered from emphysema and cardiomyopathy, a disease that weakens the heart muscle. In 1982, he received the Jarvik-7 artificial heart but experienced serious complications from blood clots that caused several minor strokes. Doctors administered blood thinners to prevent clotting, but this caused bleeding from his surgical wounds, forcing them to stop the medication and allowing clots to develop again. Both the Jarvik-7 and the later AbioMed artificial heart faced problems with blood clot formation. Another patient, Robert Tools, later lived for 151 days with an artificial heart.

How did Denise Ann Darvall actually pass away?

Barnard's brother Marius wrote a memoir and in his memoir he revealed that Barnard injected potassium into Denise Darvall's heart (he legally killed her)

How long was the wait for a donor for Washy?

3 weeks

What did washy develop during the waiting time for a donor?

Washy developed fulminant pulmonary edema (a sign of imminent death)

Richard Lower of Virgina

Richard Lower and Norman Shumway tried for years to overcome the immune system's rejection of another person's heart. Richard Lower narrowly missed criminal conviction for taking the heart of an African American man for transplant.

Norman Shumway

Stanford University:

Richard Lower and Norman Shumway tried for years to overcome the immune system's rejection of another person's heart. After spending a decade transplanting hearts in dogs, Shumway announced on November 20, 1967, that he actively sought a suitable candidate and donor for a human heart transplant.

Jean - Michel Dubernard

In 1998, performed the first hand transplant in France. The hand came from a 41-year-old man who had died in a motorcycle accident and went to a 48-year-old New Zealander Clint Hallam. In 2001 Clint Hallam demanded that Dubernard amputate his transplanted hand. He felt pain and had no normal feeling in it. Because the anti-rejection drugs gave him diarrhea and influenza, Hallam had not taken them. He also did not do his required physical therapy.

Matthew Scott

38 year old male. First hand transplant in America, lost his hand to a firecracker. Within a few months Matthew Scott began to feel cold and heat in his palm as nerve growth reached his wrist. With his new hand he could write his name, tie his shoelaces, and wear a new wedding ring.

Karl Merk

2008 German Dairy Farmer who lost both his arms in a corn threshing machine received the world's first double arm transplant

Jeff Kepner

2009 hands and feet were amputated after a streptococcal infection, first American to receive a double hand transplant at the University of Pittsburgh by a team led by W.P. Andrew Lee.

Katy Hayes

Developed a group A streptococcal infection after giving birth which resulted in the amputations of her arms above her elbows. Received the first double arm transplantation in the United States, led by Dr Simon Talbot of Brigham and Women's Hospital.

Maria Siemionow

Cleveland Clinic had been preparing for 20 years to do a face transplant In an April 2005 had been given permission by her institutional review board to go ahead. Jean-Michel Dubernard beat her to it. In 2008 performed the first American face transplant at the time the largest and most extensive transplant ever performed, on Connie Culp, who had been shot in the face in 2004 by her husband. Over the next 4 years, Culp underwent 23 surgeries to reconstruct her face without good results. Finally the 46 year old mother of two consented to a transplant of 80% of a face from Anna Kasper a brain dead nurse.

What is one important thing regarding donor and recipient of organs in South Africa

That both the donor and recipient is white

Nadya Suleman

32 years old in California in 2008 had six embryos left over from previous in vitro fertilization (IVF) treatments with fertility physician Michael Kamrava. She did not want the remaining embryos destroyed and underwent another cycle of IVF to have them all implanted. Two of the six embryos split into twins resulting in a total of eight embryos. When a sonogram in the first trimester revealed at least five fetuses Solomon refused reduction and on January 26th Physicians delivered eight babies. He already had children from previous cycles of IVF.

Kate and Jon Gosselin

already had a set of twin girls born in 2001 from artificial insemination by husband when sextuplets three girls and three boys were born to them in 2004. fertility doctors started the sixth topless by adjacent Kate with drugs to stimulate her ovaries and afterward introduced John sperm. The Gosselin's chose not to reduce in all six babies were delivered by cesarean on May 10th 2004. Jon and Kate Plus 8 they later divorced to do affairs and the show changed to Kate Plus 8.

Elizabeth Carr

The first IVF baby in America Elizabeth Carr was born in 1981

Cecil Jacobson

Fairfax Virginia wrongly used his own sperm instead of the intended fathers to create as many as 75 embryos throughout the 1980s. In 1992 he went to jail for this.

Ricardo Asch

at the University of California Irvine switched donor eggs around without women's consent and fled the country to avoid prosecution.

Jan Karbatt

Use his own sperm rather than that of the donors to father at least 168 children and maybe a dozen more. He died at age 89 before he came to be questioned.

Donald Kline

ran a major infertility clinic near Indianapolis from 1978 to 1990 remorse fully admitted that he had used his own sperm 50 times, which resulted in the creation of at least 39 children. In 2017 the 79-year-old Kline pleaded guilty to obstruction of justice for lying to investigators but neither received jail time nor probation. He surrendered his medical license in 2018.

Baby Jaycee case

the child with five parents. Born in 1995 from a paid surrogate but became embroiled in a divorce between the would-be parents. Jaycee was also conceived from sperm and egg other than from the parents who hired the surrogate. A California Appeals Court ruled in 1998 that the parents who hired the surrogate had to be responsible for Jaycee.

Crystal Kelly

In 2013, surrogate Crystal Kelly refused to abort a fetus with severe heart defects, a cleft palate, and a brain cyst, despite a contract requiring abortion in cases of major fetal abnormalities. The intended parents had agreed to pay her $22,000 but offered her $10,000 to terminate the pregnancy, which she declined. They later sued to recover the $8,000 they had already paid and refused to accept legal parenthood of the child. Kelly continued the pregnancy and gave birth in Michigan, where surrogacy contracts are unenforceable. The baby was born with holoprosencephaly and heterotaxy, underwent multiple surgeries, and was eventually adopted by a Michigan couple, with medical care paid for through Medicaid.

Joseph Fletcher

defended IVF against the claim that it was unnatural. Because he disagreed with so many of the views of conservative Christianity, Fletcher gave up the priesthood around 1980 and became a secular thinker becoming one of the first secular bioethicists.

What percent of IVF couples actually take home the baby

33-40

Ernie Crowfeather

Ernie, a 26-year-old half-Sioux, half-white man, arrived at the emergency room coughing up blood and experiencing left kidney pain. He required experimental hemodialysis, which was new at the time and not covered by insurance, and physicians repeatedly saved his life during 30 months of treatment. In his final month, he used narcotics and barbiturates and refused to learn home dialysis. After robbing a hotel and later cashing a check intended to cover his medical bills, Ernie checked into a remote motel and missed his scheduled dialysis appointments. His sister eventually found him and took him to a hospital, but he died that night.

How does Kant want us to treat ourselves?

In ends- of -themselves and not just mere means.

What is Kant's viewpoint when it comes to weight and being overweight?

Don't be overweight in the first place

Cindy Ehlers

Cindy Ehlers is a researcher at the Scripps Research Institute who spent decades studying the genetic factors associated with alcoholism, particularly among Native American populations. Her research challenged the stereotype that Native Americans have an inherent weakness for alcohol and are unable to control their drinking. Ehlers found that Native Americans have a resistance to the effects of alcohol so that they can actually drink quite astronomical amounts of alcohol and not feel as intoxicated. Ehlers believes that at least 50% of alcoholism, even among Native Americans, is psychosocial.

Kant

believes humans can be "law givers unto themselves" or give up on themselves. Prefers to base his theory on what humans can achieve and how they can act, not on how they actually act. For Kant, the most important flaw of the disease model is in treating persons as mere things. The second problem for Kant is that people do have free will, and to treat them as if they do not is to treat them badly, like animals or things, and demean their humanity. Emphasizes that the right thing to do is universalizable. If we treat alcoholics or addicts as people who are not responsible for their actions because they have a disease, then we should absolve most of humanity because their actions also have prior consequences.

Sociologists

In their classic of medical sociology the courage to fail professors Renee Fox and Judith Swayze devoted a chapter to Ernie's case. They believe Ernie's response to his situation was conditioned by his social background and personality traits.They believe social factors explain a person's Behavior more than anything else

Carl Elliot

Writes in Better Than Well that Big Pharma wants people to need a pill to sleep, have sex, lose weight, erase wrinkles, and feel happy. Claims that in 2007 the top 10 drug companies made more profits than the other Fortune 500 companies combined.

Gregg and Shaw

in 2017 in the New England Journal of Medicine they answer obesity and diabetes have become a shared biological burden requiring a strong response from governments

Lew Louderback

1967 book Fat Power. Argued in a famous essay that fat people should cease trying to please thin people, that most diets wouldn't work for them, and that they should simply embrace who they are and get on with living. His essay led to a book; to 500 people doing a "fat -in" inside Central Park; to "Fat Lib" and "Fat Power."

Roxane Gay:

a famous feminist and African American professor from Haiti wrote Hunger: A Memoir of (My) Body in which she describes the daily mortification of being a 6 '3 woman of size. She attributes her eating to the aftermath of a sexual assault she suffered as a child.

Dr. Scott Kahan of the National Center for Weight and Wellness

Dr. Scott Kahan of the National Center for Weight and Wellness: says obesity has been called the last socially acceptable form of prejudice and persons with obesity are considered acceptable targets for stigma.

What age does bias against fat people start according to researchers at Duke University?

3 years and is as common as racial prejudice.

What states have passed laws barring discrimination against people based on their weight?

New York, Maine, and New Hampshire.

What did New York's mayor sign in 2023.

Eric Adams signed a bill, making it illegal to discriminate by weight or height against people for employment, housing, and access to public accommodations.

In 2014 what was the estimated percentage of veterans that were overweight or obese?

78%

Frank Sacks:

Professor of nutrition at Harvard. believes obesity is like cancer, meaning both are not one disease but many. Believes he has discovered about 60 different kinds of obesity.

Stephen O'Reilly:

researcher at Cambridge University who believes that 25 key genes exist that powerfully affect weight gain, such that if one mutates, a person is almost guaranteed to be overweight.

What is the percentage of patients who can use non-surgical therapies to get to an acceptable weight?

15 to 20%

Drugs that affect weight

Phentermine (suprenza): Decreases appetite and increases feelings of fullness after eating This drug can be addictive

Orlistat (xenical): Blocks the absorption of fat

Phentermine and topiramate (Qsymia):Decrease appetite and increase feelings of fullness

Liraglutide (saxenda): Slows gastric emptying and increases feeling of fullness

What are two activities that are indicators that women may become anorexic later on

Ballet and Cross Country

What can new weight loss drugs also help combat

may also help overweight people drink less because the genes that make some drink make others eat too much

Presentations

When Celebrities Prescribe: Regulating drug promotion on the internet

Main idea: How does celebrity endorsement affect informed consent and patient autonomy?

Ethics of prenatal genetic testing: Can genetic testing lead to eugenics;Risks of miscarriages from these genetic testing are very high; Should parents have predictions of these genetic diseases

AI Generated Dead Relatives: Should we give these chatbots access to our information? The dead relatives have not consented to this. Establishes the question: can the dead be harmed?

Was the Rosenhan Study a Fake: Explain the purpose of the Rosenhan study, how it was conducted,and what it proved

Should ER Doctors work with ICE: Apply confidentiality, nonmaleficence, justice, and dual loyalty to a documented case;Distinguish legal permission to disclose information from a legal duty to disclose

Bruce Tucker

1968 Richard Lower transplanted the heart of Bruce Tucker using the new Harvard criteria of brain death. When Tucker's hear was removed he was not legally dead, by the old whole body criteria.