Bioethics II: Applications — Study Notes

Learning Objectives

• Apply the four principles of bioethics to complex and emerging dilemmas in medicine and healthcare.
• Identify and analyze situations where principles conflict, and articulate the ethical trade-offs involved.
• Evaluate contemporary cases using multiple ethical perspectives.
• Develop and justify an ethically defensible decision in scenarios where no single principle clearly dominates.

Structure

• 12:00 – 12:50 → Applying principles to contemporary dilemmas (cases 1 & 2 & 3)
• 12:50 – 1:00 → Break
• 1:00 – 1:50 → Applying principles to contemporary dilemmas (cases 4 & 5 & 6)
• 1:50 – 2:00 → Break
• 2:00 – 2:50 → Sample Questions
• 2:50 – 3:00 → Wrap-up

Quick Recap

• Beneficence → promote patient’s good
• Non-Maleficence → avoid causing harm
• Autonomy → respect patient’s informed choices
• Justice → fairness in access and distribution

The Four Principles in Context

• The four principles remain foundational in medical ethics.
• Real-world dilemmas require applying them together, not in isolation.
• Conflicts and trade-offs are unavoidable; good ethics = making them explicit.
• The goal is not a single “right answer,” but a well-reasoned, defensible decision.

CASE 1

• Scenario: Dr. Lin’s hospital uses a new AI diagnostic tool to detect sepsis in ICU patients. Early data show the system predicts sepsis roughly 12\,\text{hours} earlier than physicians in many cases, reducing mortality by up to 20\%. The tool is a “black box” that provides a risk score without explanation. Clinicians feel uneasy about treating without understanding the AI’s reasoning. An evening alert signals a patient, Mrs. Alvarez, has very high sepsis risk, though vitals appear stable. Family objects to aggressive antibiotics and ICU monitoring without understanding the AI’s basis.

• Key ethical tensions

  • Beneficence: potential to reduce mortality by acting on early AI signal.
  • Non-Maleficence: risk of harms from unnecessary or premature interventions when the AI’s reasoning is opaque.
  • Autonomy: patient/family desire for transparency and consent; respect for patient values.
  • Justice: resource implications and equitable use of AI-supported decisions; transparency concerns may affect trust.
  • Transparency/Explainability: tension between clinical benefit and need to understand rationale for treatment.

• Questions to address

  • If you were Mrs. Alvarez’s physician, would you act on the AI’s recommendation? Why or why not?
  • How should clinicians explain AI-driven decisions to patients and families when the reasoning isn’t transparent?
  • Which principles support using the AI, and which raise concerns?
  • If the hospital refuses to use the AI due to transparency issues, is that ethically justifiable even if outcomes worsen?

CASE 2

• Scenario: At a fertility clinic, Mark and Leila both carry the cystic fibrosis gene. After multiple miscarriages and the loss of a CF-affected child, they seek to avoid passing the condition via a gene-editing procedure during IVF to correct the mutation in embryos before implantation. The procedure is experimental; long-term effects are unknown; critics warn it could open doors to “designer babies.” Mark says the couple has suffered enough and wants to avoid CF; Leila says they want a healthy child, not a perfect one. The ethics board is divided: some view it as compassionate and justifiable; others warn of dangerous lines in medicine.

• Key ethical tensions

  • Autonomy: couple’s right to decide about conception and to seek potentially beneficial technology.
  • Beneficence: aim to prevent CF and associated suffering.
  • Non-Maleficence: unknown long-term risks to the embryo, future offspring, and social consequences.
  • Justice: access to experimental technologies and potential societal impact (e.g., eugenics concerns).

• Questions to address

  • Should the couple be allowed to use the gene-editing procedure? Why or why not?
  • What risks (scientific, social, ethical) should weigh most heavily in this decision?
  • Which principles (autonomy, beneficence, non-maleficence, justice) are most persuasive for and against the procedure?
  • If you were on the ethics board, what would your recommendation be, and how would you defend it publicly?

CASE 3

• Scenario: Mr. Patel, a 72-year-old retired engineer with advanced ALS, is fully competent and requests physician-assisted dying. He wants to die before losing the ability to communicate. Assisted dying is legal in his state under strict conditions. The physician is conflicted. Family members (his wife and two adult children) urge against the option, arguing for continued care; the care team faces pressure from both sides with a competent patient asserting his right and a grieving family asserting value in his life.

• Questions to address

  • If you were Mr. Patel’s physician, how would you respond to his request?
  • How much weight should the family’s objections carry in this decision?
  • Which principles are in conflict here, and how might you rank their importance?
  • Could a different ethical perspective change how you’d approach this case?

CASE 4

• Scenario: Angela, a 28-year-old woman, is admitted after a car accident with severe internal bleeding. She is a Jehovah’s Witness and has an advance directive refusing all blood products. Without a transfusion, she will likely die within hours. Her parents arrive distraught, urging override of her autonomy: she is too young to die. The physician faces a clear patient choice but a rapid, devastating harm if autonomy is not honored.

• Questions to address

  • Should the care team honor Angela’s refusal, even though it will likely result in death?
  • How should the physician weigh autonomy against beneficence and non-maleficence?
  • If Angela were unconscious without an advance directive, would the decision change?
  • How does justice factor in here, if at all?

CASE 5

• Scenario: During a severe pandemic surge, the hospital has 5 ICU beds left but 6 critically ill patients needing them immediately: Maria (25, pregnant, otherwise healthy); James (40, single father of three, moderate survival odds); Dr. Chen (70, retired surgeon, trained many current physicians, poor prognosis); Mr. Johnson (55, homeless with diabetes and lung disease, poor prognosis); Nurse Elena (30, ICU nurse who contracted the infection while treating patients, good prognosis); Sophia (10, CF, uncertain prognosis). The ethics committee must decide who receives ICU admission amid public pressure and media attention.

• Questions to address

  • Which patients would you prioritize, and why?
  • Which principles guide your reasoning most strongly in allocation?
  • Which principle do you find the hardest to uphold here?
  • If you were to justify this allocation publicly, what would you emphasize?
  • Would your decision change if the community knew exactly how you made it?

CASE 6

• Scenario: Mr. Lewis, 62, has advanced lung cancer. A new drug has been approved that could extend life by up to 1\,\text{year}, but costs 150{,}000 per course and is not covered by insurance. The hospital has a limited charity fund that can cover this drug for only 5 patients a year. Younger patients with better prognoses could also benefit. Mr. Lewis pleads that he has paid taxes all his life and deserves a chance too. The oncology team must decide how to allocate the fund fairly.

• Questions to address

  • Should Mr. Lewis receive the drug, knowing it might take resources from others with better prognoses?
  • Which principles support giving him treatment, and which argue against it?
  • How should fairness (justice) be defined here: equal access, greatest benefit, or something else?
  • If you were presenting your decision to the hospital board, how would you defend it?

Wrap-Up

1) The Four Principles remain foundational in medical ethics.
2) Real-world dilemmas require applying them together, not in isolation.
3) Conflicts and trade-offs are unavoidable; good ethics = making them explicit.
4) The goal is not a single “right answer,” but a well-reasoned, defensible decision.