Case Studies: Rough Draft

1. Research and Medicine Haiti - (Research and Medicine Collide in Haiti) A. A brief summary of the case under consideration (Gabby) i. The case “Research and Medicine Collide in Haiti” seeks to determine the ethics of using an impoverished population to further AIDS research. Cornell Medical College runs an AIDS research clinic in Port-au-Prince, Haiti to study AIDS in cases where only one sex partner has the disease in hopes to find a cure. Haitians are ideal research subjects due to not receiving care that is standard in the rest of the world. In Haiti, condom use is low and antiviral drugs are unavailable except for the very wealthy. Throughout the study, participants continue to be exposed to the virus while the clinic only promises to provide medical help in the case the participant is unable to afford it on their own without the promise of antiretroviral drugs. Experts agree that if this research were done in the United States, physicians would be obligated to prescribe antiretroviral and counseling for participants. There are concerns that participants at the Haitian clinic do not receive the same level of counseling and care as those in the United States. This study has received scrutiny from officials in Washington due to the lack of treatment and lack of information provided by the clinic in Haiti to its participants. B. Ceniya: i. In reviewing of this case, Aristotle’s framework emphasized the virtues of justice, compassion, honesty, and practical wisdom. It’s not clear whether he would agree with the clinical trials proceeding through Haiti, for the motivations of the researchers and physicians involved in the trials that could be for personal benefit, versus the community. Any medical trial should contribute to the overall flourishing of both the researchers and the patients. If the trials exploit the impoverished patients without consideration of their well-being or dignity, Aristotle would likely see a failure in virtue ethics. It is not an act of practical wisdom if they ignore the specific needs and vulnerability of the Haitian people. Key virtues like justice and compassion are deficient. The patients in Haiti receive a lower standard of care than in developed nations, which fails the virtue of equity. While the research is driven in a positive light (a vaccine), it should not come at the cost of exploiting the weaker status of the population. The Role of Virtue, the moral character of the researchers, is crucial. It would emphasize that good intentions alone are not enough. The care given to the Haitian patients must reflect practical wisdom in balancing research goals with the moral obligation to provide proper care regardless of external circumstances. i. Kant’s Deontological Ethics demanded the adherence to real principles, especially the categorical imperative, which requires treating every person as an end. Providing a lower standard of care to Haitian patients while using them as subjects violates their duty to treat all individuals with equal dignity and respect; along with the failure to provide antiretroviral drugs or proper protection, such as contraceptives. This is seen as neglecting the patients’ worth and violating their autonomy. There is a potential breach of the duty to ensure fully informed consent. If patients are not made aware of all the risks, or the fact that they are receiving inferior care compared to developed nations, their autonomy, is undermined. The ethics would condemn them to fail to respect their rational capacity to make decisions. i. Utilitarianism Perspective, the ethical evaluation of AIDS and HIV trials on impoverished patients in Haiti would depend on whether the research produces the greater outcome for the majority of people. With weighed potential benefit of the trials, such as finding effective treatment or vaccination, could save lives globally. This would make a significant advancement in medicine, reducing the suffering of current and future HIV/AIDS patients. However, for the trials to be ethical, the risks must be secured without manipulation due to their economic situation. There needs to be a careful balance to the potential long-term benefits of the research with the short-term harms experienced by the patients. The fact that patients are exposed to preventable risks, and do not receive the best possible care suggests a significant immediate harm that may not be justified by the future benefits. It’s a question whether the long-term goals truly justify the short-term harm and exploitation of a vulnerable population. C. Stefano - Cornell University knowingly has a conflict of interest with in what data they want to collect, and what to exploit in terms to receive that information. Why is this not being investigated? The university has no interest in pursuing the problem because “they have other studies that MUST be tended to”. We see the comparison of the Tuskegee study to this of patients that have HIV and AIDS. Why do they not treat the people of Haiti the same way as health care providers do in The America’s? Because it is mentioned that there is a lack of informed consent. Rather partial informed consent, but that it is equal to as not having any at all. We also observe a lack of confidentiality with said patient(s). One statement brought up by one of the present physicians was,“ Offering the drug is an unethical lure for participation”. Well, if that's the case, why is it being perceived as a “Faustian Bargan?” If the solution is unethical, why is it being offered in the first place? Which brings back the notion of exploitation of research for the sole purpose of collecting data, and test subject that are far more than willing to participate if lied to. D. Lanie E. Jacob: The case study of research and medicine in Haiti is critiqued as unfair and unjust for those that are living in the impoverished country of Haiti. We have declared a decision not on opinions but by analyzing how the theories of Aristotle and Kant would have played a role in the judgment of the clinic and how they acted upon patients in search for better medicine. Not only Aristotle and Kant but also looked into the utilitarian perspective. The Utilitarian perspective disagreed with the practice even though it weighs the overall good versus the overall bad and the overall good is favored the majority of time. F. Claire: Is the education of the impoverished area involved in the studies a contributing reason to why these types of medical research groups target these areas? What are other powers possibly involved that allow for this type of research to keep happening? The group's conclusions are Aristotle would not approve of the process, and it goes against some of his key beliefs. He would see it as failure of virtue, justice, and compassion towards those who are being research on. Plato would also see it as a violation of justice due to lack of respect of the individual rights. Utilitarianism beliefs align with the researchers in providing information for future studies. The cost of a few could outweigh the benefits that the researchers could find in their studies. G. Caroline, A minority report about the case, if necessary: In a country plagued by poverty and limited resources, ethical issues such as informed consent and the risk of exploiting vulnerable populations are significant. Many research initiatives prioritize diseases relevant to wealthy nations, sidelining endemic health issues in places like Haiti. Research can divert essential resources from local healthcare services, leading to the dependency on external support. To address these challenges, it is crucial to strengthen ethical frameworks by ensuring truly informed consent and involving local frameworks for oversight. Research should focus on local health needs, such as AIDS, cholera, and tuberculosis, and integrate finding into health policies. Investing in the rejuvenation of healthcare facilities and workers and fostering community engagement can enhance trust and alignment with the priorities of local priorities. By prioritizing the rights and needs of impoverished patients, the intersection of research and medicine in Haiti can lead to more equitable health outcomes and sustainable local capacity. 2. Informed Consent for Organ Transplants A. Claire B. Ceniya: i. In Aristotle’s perspective, the hospital, and procurement center failed to act with honesty by withholding critical information. A virtuous healthcare professional would prioritize transparency and truthfulness. As for practical wisdom, failing to disclose the donor’s high risk status shows poor judgement and lack of practical wisdom, endangering the patient. Finally, justice alignment, requires that individuals are treated fairly and are given what they are owed. By withholding information, the hospital deprived the patient of her right to make an informed decision about her own body and health, violating the virtue of justice. Aristotle would view the actions as unethical because they contradict key virtues such as honesty, justice, and practical wisdom, ultimately harming the patient’s ability to flourish. i. Kant’s ethics are based on the categorical imperative, which demands that people act according to universal moral laws and treat others as ends in themselves, not as means to an end. There was a duty of truth, the hospital, and organ procurement center had to inform the patient about the donor’s high-risk status. Also emphasized was treating individuals as ends in themselves. In this case, failing to inform Jane Doe, about the donor’s risk status treated her as a means to an end-her consent was based on incomplete information, which undermines her autonomy. The actions of the hospital and procurement center would not be universalized under Kant’s framework. From his perspective, the actions of the hospital and organ procurement center are unethical because they violate the duties of honesty, respect for autonomy, and the categorical imperative. i. Using Deontology, it focuses on following rules and duties rather than the consequences of actions. The medical professionals involved had a clear duty to inform Jane Doe of the high-risk donor status. This duty is grounded in the ethical obligation to provide patients with all relevant information to make informed decisions. The U.S. Centers for Disease Control and Prevention guidelines were designed to protect patients and should have been followed. By violating these guidelines, the hospital failed to meet its professional and ethical duties. It emphasizes the importance of respecting patients’ autonomy by ensuring they can make informed decisions. The actions of the hospital and organ procurement center are clearly unethical, as they violated their duties to the patient, the CDC guidelines, and the principle of informed consent, ultimately endangering the woman. C. Stefano D. Lanie E. Jacob F. Gabby? G. Caroline 3. Stopping a Clinical Trial A. Gabby B. Ceniya: i. With Artistole’s ethics, the decisions that promote the best decision to halt the trial early, may reflect poor judgement if the long-term benefits or risks of the drug are not fully understood. Stopping the trial may cause errors in the important data sets regarding the drug’s effectiveness in saving lives, which undermines patient flourishing in the long term. The virtue of justice demands that all trial participants and future patients are treated fairly. The researcher’s decision to halt the trial reflects a lack of practical wisdom. They must balance immediate patient welfare with long-term implications for breast cancer treatment. Stopping, would be neglecting their duty of justice to provide equitable access to effective treatments and the compassion required to alleviate suffering. The researchers should be courageous in seeking to improve breast cancer treatments, but cautious about causing potential harm by halting the research too early. Overall, his approach would push the need for practical wisdom in balancing immediate benefits with long-term outcomes, and justice for both current and future patients. i. Kantian ethics is grounded in the idea of duty and the categorical imperative, which emphasizes acting according to maxims that can be universalized. Kant would argue that researchers have a duty to respect the autonomy and dignify of all participants. By halting the trial prematurely, they potentially disregard the patients’ right to fully informed consent and the opportunity for further benefits. The failure to continue the trial reflects a lack of moral duty to seek the best possible treatment options in the future, violating their rights. That decision may be ethically deficient under Kantian ethics, as it undermines the respect owed to patients and fails to adhere to the moral duty to seek their well-being. i. With Utilitarianism, evaluating stopping the trial prevents recurrence and improves the quality of life for current patients and utilitarians, supporting the decision. However, if continuing could generate more data that would lead to better treatment for many more people in the future, utilitarians would argue that the trial should have continued to maximize long-term benefits. Stopping the trial could limit the risks to current participants, reducing potential harm, but it could also prevent the discovery of life-saving information that would benefit future breast cancer patients, meaning the overall utility is not maximized. By choosing not to continue the trial, the researchers risk causing more harm than good, as future patients may suffer from the lack of effective treatment options. C. Stefano D. Lanie E. Jacob F. Claire G. Caroline 4. Faith healing A. Gabby B. Ceniya: i. Aristotle’s concept of justice involved giving people what they are due. In this case, the children had a right to receive medical care, helping aid in any issues, along with being their best chance of survival. By denying them that care, the parents failed in their roles to provide and care for their children’s wellbeing; a failure in justice. As for balanced judgement, considering both spiritual and physical needs, the parents' reliance solely on prayer, to the exclusion of medical care, represents neglect in weighing between faith and responsibility. By not getting medical care, the parents undermined the survival of their children. Aristotle would see this as a failure to support the children’s ability to lead a healthy life, which is a key aspect of eudaimonia. i. Using Plato’s Ethics, justice is about acting in accordance with the good and the wellbeing of the community. Denying children essential medical care contradicts the ideal form of justice. The parents’ actions, while aligned with their religious beliefs, resulted in harm and death, which does not contribute to the greater good or the children’s well-being. Plato would argue that the parents have misunderstood the Good. While their faith may be well-intentioned, it led to an outcome that is not consistent with the ultimate good, which includes preserving life and promoting health/proper development. i. Utilitarianism; It evaluates actions based on their outcomes, focusing on maximizing happiness and minimizing suffering. The parents’ reliance on faith healing resulted in the death of their child, leading to significant suffering and loss. This action is antithetical to the principles of utilitarian ethics. Their actions could set a dangerous precedent, potentially leading to more cases of neglect among other who might follow their example, resulting in a greater societal harm. The parent’s choices result in severe harm to their child and a negative impact on society, making their actions ethically indefensible. C. Stefano D. Lanie E. Jacob F. Claire G.Caroline