Medical Ethics Case Studies

  1. How do we allocate finite resources in medical emergencies? Italian doctors face tough choices during corona virus outbreak: Link
  2. Fair Allocation of Scarce Medical Resources in the Time of Covid-19 (NEJM): The rapidly growing imbalance between supply and demand for medical resources in many countries presents an inherently normative question: How can medical resources be allocated fairly during a Covid-19 pandemic? Link
  3. QALY and Healthcare Economics: Economic and human cost of general quarantine vs economic and human cost of no quarantine: Link
  4. Can we give untested drugs without consent? While the “overwhelming majority of them are awake and alert and can actually have a conversation,” Armstrong said some suffer from middle stages of dementia. In some cases, he did not discuss prescribing the tablets with anyone at all before doing so. He said it is common for physicians to prescribe new medications to patients without explicit consent from the patient or family members. “It’s not required,” he said. Link
  5. In emergencies should we allow untested drugs to be used? Dr. Kalil, who has decades of experience grappling with questions about the use — and misuse — of experimental drugs, has rarely been more frustrated. He has seen what happens when desperation drives treatment decisions. “Many drugs we believed were fantastic ended up killing people,” he said in an interview. “It is so hard to keep explaining that.” Link
  6. Articles from Harvard on Covid, resource allocation, and disability: Link
  7. Kennedy Institute of Ethics: Special Edition on Pandemic Ethics (Open Access): Link
  8. Healthcare Justice: Rationing ventilators might be a necessary response in the new Covid-19 world. Many hospitals decide who gets them by selecting patients most likely to benefit. Experts agree this is the best way of saving most lives. The approach, the model guidance, may sound fair. But baked into it are biases that disadvantage groups who, even without a Covid-19 infection, experience worse health because of historical and structural reasons, especially black people.
    Consider this case. Three patients are waiting to be admitted to an intensive care unit that has one remaining bed. All have equally severe Covid-19 symptoms. John is an otherwise healthy, white 40-year-old man. Rosa is a 45-year-old African-American woman with underlying health issues. Linda is a white 56-year-old woman with Down syndrome. Who should be admitted? NYT
  9. Overview of the Process of Vaccine Development with some discussion of ethics of vaccine challenge trials:
    Barouch: For certain pathogens, it has been considered ethical to perform human-challenge studies but typically only for pathogens for which there is a highly effective treatment. For example, for malaria there is a very widely and effectively used human-challenge model in which vaccines or other interventions can be tested. Human volunteers can be inoculated with malaria and then, if they develop the disease, can be treated rapidly so that they don’t actually get sick.
    Mukherjee: Why can’t we do this for Covid-19?
    Barouch: The dilemma for Covid-19 is that there currently is no curative therapy. So, if a volunteer in a potential human-challenge study gets severely ill, there may not be a way to cure that person. In fact, far from it: The drugs in our armamentarium are not perfect, and so we would have no guarantee that we could “rescue” a person who got severely ill.
    Weiss: I’m not an ethicist, but my gut feeling is that challenge trials are too dangerous. Young people can get quite sick and die from Covid-19. NYT
  10. Accelerated vaccine trials for coronavirus: Vaccine challenge trial. What would you do if you were on the IRB? Why? Would you join the trial? Link
  11. Article that argues for coronavirus vaccine challenge trials: Link
  12. Peter Singer and Richard Chappell on the ethics of accelerated vaccine trials (Washington Post): Link
  13. Argument against human vaccine challenge trials for Covid-19: Link
  14. Argument against human vaccine challenge trials for Covid-19: Hastings Center
  15. Who Is Responsible If A University Reopens And A Student Dies From Covid-19? The divergence of opinions expressed by universities indicates the complexity of assessing the risk Covid-19 presents on campuses. Because the situation is unprecedented, it’s hard to predict the liability a university may face should it allow students to return and there be an outbreak or, worse, deaths. Link
  16. Is it ethical to reopen universities for face to face learning? Collection of Editorials in Chronicle of Higher Ed.
  17. The ethics of pricing an eventual coronavirus vaccine: [Drug manufacturers] have justified high prices by comparing them to the costs they would prevent. Expensive hepatitis C drugs, they say, avoid the need for a $1 million liver transplant. No matter that the comparison being made is to the highly inflated costs of treating disease in American hospitals. Such logic would be disastrous if it were applied to a successful Covid vaccine. Covid-19 has shut down countless businesses, creating record-high unemployment. And the medical consequences of severe Covid-19 mean weeks of highly expensive intensive care. NYT
  18. Ethics of Financial Incentives in Human Challenge Trials: “I argue that advertised incentives as a recruitment strategy undermine the the benefit of recruiting individuals to participate out of altruism. Given the high poverty index rate, the government and medical scientists could, in effect, be taking advantage of the vulnerability of those who are socially and economically impoverished, treating them as mere means to some scientific end.” Voices in Bioethics
  19. Who should get priority in the Covid-19 vaccine? For example, should we prioritize the elderly, or other vulnerable groups, or the younger, or essential workers, or some other group? In the second phase, as production increases, there may be more vaccine than people willing to take it. The question then is: how should vaccine uptake be ethically be increased? For example, should vaccines be made mandatory, or nudged, or incentivised? We won’t consider this phase here but one of us has recently written about it. Practical Ethics Alberto Giubilini, Julian Savulescu, Dominic Wilkinson

Non-COVID-19 Medical Ethics Cases

  1. Healthy volunteer dies in asthma study: 24 year old Ellen Roche was a healthy volunteer who had nothing to gain by taking part in the study. Her death has revived debate about the adequacy of oversight of medical research that followed the death of 18 year old Jesse Gelsinger who volunteered for a gene therapy experiment. Issues: Inducement, moral and institutional responsibility, informed consent, negligence. Case study in detail